Title Page
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Conducted on
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Prepared by
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Location
PERSONNEL ON SITE
General Information
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Start Time
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End Time
Work Space Area Temperature
Outside Temperature
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Please enter extreme temperature conditions and precautions you are taking to prevent an incident.
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Weather Type
- Sunny
- Cloudy
- Rainy
- Stormy (Lightning)
- Snowy
- Hot
- Pleasant
- Cold
- Dry
- Wet
- Windy
- Tornado / Hurricane
- Humid
- Foggy
- Hail
- Sleet
- Mist
- Shitty
PERSONNEL ON SITE
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TRADES
- Project Superintendent
- Mechanical Superintendent
- Electrical Apprentice
- Plumber
- Welder
- Safety
- Controls
- Sheet Metal
- Foreman
- Pipe Fitter
- Laborer
- Other
- N/A
- Visitor
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List any one not mentioned. If needed use the notes below
Subcontractors on site
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Subcontractors on site?
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Enter the name of the subcontractor company.
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Enter trade of sub
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ADD SUBCONTRACTOR
Subcontractor
WORK COMPLETED
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Select the type work you are performing today.
- Mechanical
- Electrical
- Plumbing
- Controls
- T & B
- Other
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Select work activities performed today
- Insulate
- Welding pipe
- Welding supports
- Welding structural
- Welding prefabrication
- Brazing
- Mechnical Demolition
- Mobilize
- Demobilize
- Chain hoist
- Working from heights
- Other
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Select work activities performed today
- Insulate
- Welding pipe
- Welding supports
- Welding structural
- Welding prefabrication
- Brazing
- Mechnical Demolition
- Mobilize
- Demobilize
- Chain hoist
- Working from heights
- Other
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Select work activities performed today
- Insulate
- Welding pipe
- Welding supports
- Welding structural
- Welding prefabrication
- Brazing
- Mechnical Demolition
- Mobilize
- Demobilize
- Chain hoist
- Working from heights
- Other
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Select work activities performed today
- Install conduit raceway
- Pulling wire
- Terminating panels / device
- Building structural panel supports
- Building pipe racks
- Surveying
- Trouble shooting
- Tracing
- Low voltage panel wiring
- Low Voltage panel install
- Field device install
- Control panel install
- Hardware
- Fasteners
- Below 50v
- Above 50v
- Other
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List additional work activies performed today.
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Select work activities performed today
- Survey system
- Discovery point
- Classic design
- Point to point
- Functional performance testing
- Other
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List additional work activies performed today.
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Select work activities performed today
- Preliminary testing air
- Preliminary testing water
- Grill balance (air)
- Pressure profile (air)
- Temperature profile (air)
- Total speed adjustment (air)
- Pump speed adjustment (water)
- Balance valve adjustment (water)
- Chiller profile (water)
- Other
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List additional work activies performed today.
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List additional work activies performed today.
Deliveries
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Did you receive any deliveries today?
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Select any material received / delivered
- Pipe
- Pipe fittings
- Duct work
- Insulation
- Equipment / tools / parts
- Mobile equipment
- Wire
- Conduit
- Other
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List additional materials received today.
Rental equipment
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Rental equipment used today
- ProPress
- Telehandler
- Boom lift
- Crane
- Scissor lift
- Skid Steer
- Backhoe
- Forklift
- Trencher
- Other
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Injuries or near misses
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Was anyone injured on the job today?
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Did you fill out a Incident Report?
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My name and signature below attest that I was not physically injured on the job today nor did I witnessed an injury at work today.
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My name and signature below I attest that I was not physically injured on the job today nor did I witnessed an injury at work today.
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Add Signature
Signature
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My name and signature below I attest that I was not physically injured on the job today nor did I witnessed an injury at work today.
