Title Page
-
Date
-
Business Area
-
DOT Staff Member
-
Project Name
-
Project Address
-
Discription of Works Obesrved
-
Contractor
-
Did DOT staff get out of the car
- Yes
- No
- N/A
-
COVID-19 Safe Plan Review
- Yes
- No
- N/A
-
SWMS Reviewed
- Yes
- No
- N/A
-
Number of People on Site
-
Masks
- Yes
- No
- N/A
-
Social Distancing
- Yes
- No
- N/A
-
Sharing of Plant and Equipment
- Yes
- No
- N/A
-
General Hygiene
- Good
- Fair
- Poor
- N/A
-
Was Site Compliant
- Compliant
- Non-Compliant
- N/A
-
Action Taken
-
Action Required
-
Other Observations
