District Travel Tracker

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Visit Information

• What is the purpose for today's visit?

  inspection

  random

  routine check in

  training

  safety meeting

• Do you have any concerns regarding the visit?

  Yes

  No

  N/A

• If yes, please elaborate.

• Did the employees express any concerns or pose any questions regarding safety during the visit?

  Yes

  No

  N/A

• If yes, please elaborate.

• Was this visit pertaining to a project?

  Yes

  No

  N/A

• If yes, what project?

• Were the employees wearing appropriate PPE?

  Yes

  No

  N/A

• If no, please elaborate.

• Date of last visit.

  Yes

  No

  N/A

• Select date

  Date

• Date of next visit. (6 week goal)

  Yes

  No

  N/A

• Select date

  Date

• Any media pertaining to visit.

  Media

• Signature of Section Supervisor

  Sign

• Signature of District Safety Consultant

  Sign