Information
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Document No.
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Project Name
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Project Number
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Conducted on
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Superintendent Name
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Location
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Personnel
CONDITIONS:
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TEMPERATURE:
- 0-32F
- 33-40F
- 41-50F
- 51-60F
- 61-70F
- 71-80F
- 81-90F
- 91-100F
- 101F +
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WEATHER CONDITION:
- Sunny
- Windy
- Partially Cloudy
- Mostly Cloudy
- Raining
- Snowing
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JOBSITE GROUND CONDITION:
INCIDENT
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FIRST AID:
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Notes:
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"NEAR MISS"
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Notes:
SAFETY COMPLIANCE
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HOUSKEEPING/TRIP HAZARDS
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Notes:
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PPE:
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Notes:
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FALL PROTECTION
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Notes:
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VEHICLE SAFETY
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Notes:
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FIRE SAFETY
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Notes:
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EQUIPMENT/TOOLS
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Notes:
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ELECTRICAL:
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Notes:
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OTHER:
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Notes
APPROVAL SIGNATURE:
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Superintendent Signature
