EFS Daily Report Ver 3

• Document No.

• Job Number and Name

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

DAILY REPORT

• Select date

  Date

• Job Number and Name..

• Todays weather

  Select Sunny Clouds some sun Clouds no sun Windy Rain/Raining Flooding Snowing Snow/ice on surfaces

  • Sunny
  • Clouds some sun
  • Clouds no sun
  • Windy
  • Rain/Raining
  • Flooding
  • Snowing
  • Snow/ice on surfaces

• Temperature

WORK PERFORMED BY FLUIDICS TODAY

TRADEMAN ON SITE TODAY

• Steamfitters

• Plumbers

• Electricians

• Sheet Metal

• Service Techician

• Other Trades (Name and Count)

NON CONTRACTED COST EVENTS

• Were there any events, not included in our contract?

  Yes

• Any deals, decisions, agreements,compromises, with owners, GC's, Subs, or PM?

  Yes

  No

• Did we do extra work, even as a favor, that you feel should not be required under the contract or scope?

  Yes

  No

• Is anyone or anything delaying us?

  Yes

  No

• Did we perform extra work for Fluidics subcontractors, or material supplier that you feel should be back charged?

  Yes

  No

• Was your operations halted due to the presence of asbestos, or any other hazardous material/condition?

  Yes

  No

• Did Fluidics, and its Subcontractors clean up and or properly store all equipment or debris generated by our work operation, take photos to document at end of Daily Report Form.

  Yes

  No

• Were there any injuries, incidents, near misses, damage to property?

  Yes

  No

• Other - Explain here.

WORK DISRUPTIONS

• Document any work disruptions

SUBCONTRACTORS

• Name of subs and where were they working and what did they accomplish?

Subcontractors On site Today

CHANGE ORDERS

• Were there any change orders today?

Change Order Request

• Add signature

  Sign

CRANE OPERATIONS

• Where there any crane operations today?

  Yes

• Outriggers not placed on manhole covers, grate, weak areas, etc.?

  Yes

  No

  N/A

• Danger tape place between all outriggers?

  Yes

  No

  N/A

• Overhead lines protected

  Yes

  No

  N/A

• Rigging load labels present?

  Yes

  No

  N/A

• Wire rope Slings free of bird caging, pinched cable, broken strands?

  Yes

  No

  N/A

• Synthetic slings not showing signs of wear, worn spots, or indicators threads?

  Yes

  No

  N/A

• Right rigging for the job?

  Yes

  No

  N/A

• Sling or wire rope angle less than 60 degrees?

  Yes

  No

  N/A

• Spreader bar has correct spread for lift?

  Yes

  No

  N/A

• Are equipment lifting points adequate?

  Yes

  No

  N/A

• All loose material is secured to prevent falling?

  Yes

  No

  N/A

• Taglines on all loads, long enough, and free of knots?

  Yes

  No

  N/A

• Loads - Lifting points center the load?

  Yes

  No

  N/A

• Is load going over high risk area?

  Yes

  No

  N/A

• Occupied areas in the path of boom travel secured?

  Yes

  No

  N/A

• All personnel have on their Hard Hat, Safety Glasses and Hand Protection?

  Yes

  No

  N/A

• Foreman

  Sign

• Safety Department, (if present)

  Sign

• Images of Crane, Load(s), Operators Certification Card, Crane's Annual Proof of Load Test.

  Media

PRE TASK PLAN(S)

• Were there any operations necessitating: Lock Out Tag Out, Man lift Operations, Fall Hazard Areas, Confined Spaces, Scaffolds, Use of Powder Actuated Tools, NFPA 70E use, Excavations, Pressure Tresting. If so you must complete a Pre Task Plan by tapping on button to the right.

  Yes

• Tap the the button to the right for each Pre ask Plan. Then press the + sign as needed for each additional pre task plan.

Pre Task Plan

• Describe Task

• Hazards associated with task (check all that apply).

  Select Crane Operator Forklift Operator Man lift Operator Powder Actuated tool Operator NFPA 70E Confined Space Entrant, Attendant, Supervisor Scaffold Signal Person Certification Rigging Person Certification

  • Crane Operator
  • Forklift Operator
  • Man lift Operator
  • Powder Actuated tool Operator
  • NFPA 70E
  • Confined Space Entrant, Attendant, Supervisor
  • Scaffold
  • Signal Person Certification
  • Rigging Person Certification

• Describe what will be done to eliminate/control the above hazards?

• Has this been reviewed with effected employees?

  Yes

  No

  N/A

• Acceptable access/egress to and from the worksite. Area looked at for tripping hazards and they have been removed.

  Safe

  At Risk

  N/A

• Material handling: Carts or other means used to move bulk and/or heavy materials around the work area?

  Safe

  At Risk

  N/A

• Adequate illumination for all work?

  Safe

  At Risk

  N/A

• Barricades provided and maintained where appropriate

  Safe

  At Risk

  N/A

• Weather (Snow, Ice, wind, rain, etc) addressed?

  Safe

  At Risk

  N/A

• Trash receptacles available and emptied regularly

  Safe

  At Risk

  N/A

• Hot Work: Fire extinguisher available and inspected.

  Safe

  At Risk

  N/A

• Hot Work: flammable and combustible materials moved or protected?

  Safe

  At Risk

  N/A

• All hand and power tools inspected and removed from service if damaged?

  Safe

  At Risk

  N/A

• Ground Fault circuit Interrupter, GFCI tested and in use for all electrical cord attached equipment?

  Safe

  At Risk

  N/A

• Fall Restraint/Protection - Does the task require fall protection. if so STOP until all equipment has been acquired, inspected and installed correctly. Contact Safety Department if with any questions

  Safe

  At Risk

  N/A

• Personal Protective Equipment needed for this task, select all that apply

  Select Eye protection Face protection Head Protection Hand protection Fall protection NFPA 70E protection Welding Protection Respiratory Protection High Visibility Protection

  • Eye protection
  • Face protection
  • Head Protection
  • Hand protection
  • Fall protection
  • NFPA 70E protection
  • Welding Protection
  • Respiratory Protection
  • High Visibility Protection

• Employee certifications required, check all that apply:

  Select Confined Spaces Manlift NFPA 70E signal Person Certification Rigging Person Certification Powder Actuated Tool Certification Other: see below

  • Confined Spaces
  • Manlift
  • NFPA 70E
  • signal Person Certification
  • Rigging Person Certification
  • Powder Actuated Tool Certification
  • Other: see below

• Procedures/Permits?

  Select Energized Work Permit Hot Work Fire Watch Excavation Confined space Other: see below

  • Energized Work Permit
  • Hot Work
  • Fire Watch
  • Excavation
  • Confined space
  • Other: see below

• Post Task Information

• Was anyone injured or did an incident occur today, provide details in pop up area.

  Yes

  No

  N/A

• Who was injured

• Describe incident

• Did they call the EMCOR Incident Hotline at 1-800-809-9895?

  Yes

  No

  N/A

• Witness #1

• Witness #2

• Was it reported to the Foreman and Projects Manager, enter names in space below.

  Yes

  No

PRE TASK PLAN SIGNATURES

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

JOB SITE SAFETY INSPECTION

• Safety Inspection Conducted?

  Yes

Fire Protection

• Fire Extinguishers inspected, charged, and accesible

  Safe

  At Risk

  N/A

• Combustible Materials removed, stored properly and/or protected

  Safe

  At Risk

  N/A

• Exit routes labeled and clear

  Safe

  At Risk

  N/A

ELECTRICAL SAFETY

• Power Panels, controls, receptacles and wiring covered and protected

  Safe

  At Risk

  N/A

• Power cords not damaged or broken, all prongs are present on plugs. No tape repair anywhere along cord length

  Safe

  At Risk

  N/A

• GFCI In use

  Safe

  At Risk

  N/A

• Power tools inspected and proper

  Safe

  At Risk

  N/A

TRIPS,SLIPS, and FALL HAZARDS

• Walkways clear of materials/hazards

  Safe

  At Risk

  N/A

• Ladders inspected and removed from service and tagged if defective

  Safe

  At Risk

  N/A

• Adequate lighting

  Safe

  At Risk

  N/A

• Floor holes and openings protected

  Safe

  At Risk

  N/A

• Wall openings and holes protected

  Safe

  At Risk

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Eye, Face, Head and Hand Protection available and in use

  Safe

  At Risk

  N/A

PHOTOS

• Take photos, as needed, here to document any of the above responses

  Media

SIGNATURES

• Foreman

  Sign

• WHEN COMPLETED, SEND REPORT TO PROJECTS@FLUIDICS.COM, AND THE PROJECT MANAGER FOR THIS PROJECT