Foreman's Complete Days Work

• Date

  Date

• Prepared by

• Job Number

  Select
• Location
  Address

• Weather

• Task and Safe Work Procedure as detailed on JHRA located in the SSSP

• If there is an Extraordinary Condition?

  Yes

  No

  N/A

• Identify and Explain

• Task and Safe Work Procedure as detailed on JHRA located in the SSSP

• If there is an Extraordinary Condition?

  Yes

  No

  N/A

• Identify and Explain

• Task and Safe Work Procedure as detailed on JHRA located in the SSSP

• If there is an Extraordinary Condition?

  Yes

  No

  N/A

• Identify and Explain

• Task and Safe Work Procedure as detailed on JHRA located in the SSSP

• If there is an Extraordinary Condition?

  Yes

  No

  N/A

• Identify and Explain

• Task and Safe Work Procedure as detailed on JHRA located in the SSSP

• If there is an Extraordinary Condition?

  Yes

  No

  N/A

• Identify and Explain

• Task and Safe Work Procedure as detailed on JHRA located in the SSSP

• If there is an Extraordinary Condition?

  Yes

  No

  N/A

• Identify and Explain

• Was toolbox talk completed today?

  Yes

  No

  N/A

• What was the talk about?

• Name:

• Signature

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• Signature

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• Signature

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• Name:

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• Name:

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• Name:

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• Name:

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• Name:

• Signature

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• Name

• Signature

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• Name:

• Signature

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• Name:

• Signature

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• Name:

• Signature

  Sign

• Is Elevated Work for Perimeter Walls being conducted?

  Yes

  No

• Describe work to be done:

• Estimate date range required of work to be done:

• Are Mirror Drain/Waterproofing completed?

  Yes

  No

  N/A

• Is dowel protection in place?

  Yes

  No

  N/A

• Holes covered, secured and covered?

  Yes

  No

  N/A

• Type of ladder, scaffolding or man lift are they in compliance with known regulations?

  Yes

  No

  N/A

• Have you spoken with the formwork foreman or GC to ensure the deck is ready for access by our manpower and preloading of our reinforcing materials?

  Yes

  No

  N/A

• Name of the Foreman that you spoke with?

• Have you walked the perimeter area before accessing with the manpower or preloading materials in the area?

  Yes

  No

  N/A

• Were all questions or concerns addressed by GC & forming contractor?

  Yes

  No

  N/A

• Rescue plan reviewed with the GC? (man basket & crane, man lift, ramps or other)

  Yes

  No

  N/A

• Is climbing rebar curtains with fall protection required?

  Yes

  No

  N/A

• Are vertical work bracing plans required? review plan if required.

  Yes

  No

  N/A

• If form work is provided, have you reviewed with GC or form work if it has been braced to handle rebar and manpower loads?

  Yes

  No

  N/A

• Do you have your vertical work plans completed, approved and signed off?

  Yes

  No

  N/A

• If engineered tie-off points are requested and supplied, are they inspected and signed off?

  Yes

  No

  N/A

• Project Name

• Begin Date

  Date

• End Date

  Date

• Location (Building, Floor, Grid)

• Description

• List Authorized Workers

• How high is the work surface and how will access be achieved?

• How will equipment and tools be conveyed to the work location?

• Describe any environmental factors to consider, such as heat, cold, slippery, wet, wind, glare?

• Will work activities create a hazard for persons below?

  Yes

  No

• Is barricading required to keep non-essential personnel away?

  Yes

  No

• List equipment to be used, such as full body harness, minimum length lanyard, shock absorber, connecting hardware, I-beam strap, self-retracting lifeline, etc.)

• Describe protection method

  Guard Rail System

  Fall Restraint

  Fall Arrest

  Control Line (designated area)

• Are there any approved anchorage points I can use? Where?

  Yes

  No

• Are these points labeled as approved anchorage points(s) or obviously capable of holding 5,000 lbs or 2 times the anticipated load as determined by a designated qualified person?

  Yes

  No

• If not, can approved pre-manufactured or engineered anchorages be installed?

  Yes

  No

• Have the anchor point(s) been inspected?

  Yes

  No

• What is the clearance or how far is the distance that I may fall?

• For the next question, calculate fall distance to include lanyard length, deceleration distance of 3.5 feet, your height, and the safety factor - generally 3 feet

• Is there at least 15-18 feet of clear space from the anchorage point before the next level down?

  Yes

  No

• For the next question, consider plumbing lines, electrical exposures, protruding or impalement hazards, etc?

• Are there any hazards nearby or underneath that are exposed or could become exposed in an impact?

  Yes

  No

• What kind of hazard?

• How will rescue be ensured within 15 minutes should a fall occur? (If no rescue equipment is available locally, contact the fall protection competent person)

• List rescue equipment immediately available for this location and describe how it can be staged quickly should it be needed. Include whatever might be needed such as a ladder, aerial device elevating work platform, tripod, additional harness, controlled descent device, winch, pulley, etc.

• What obstructions are in the way of reaching the suspended worker?

• How will the safety of rescuers be ensured?

• List the communication system(s) will be used between the suspended worker and rescue team

• Foreman

• Foreman Cell Number

• Foreman Signature

  Sign

• Signature Date

  Date

• Superintendent

• Superintendent Cell Number

• Superintendent Signature

  Sign

• Signature Date

  Date

• Does work described above require a Fall Protection Plan?

  Yes

  No

  N/A

• Please review.

• Harness and Lanyard selection and inspection?

  Yes

  No

  N/A

• Lifeline or horizontal retractable line plan complete, retractables selected and inspected?

  Yes

  No

  N/A

• Rated for one person 5,000 lbs and two person 10,000 lbs

  Yes

  No

  N/A

• Is Elevated work being conducted on the Deck?

  Yes

  No

• Describe work to be done:

• How much of the pour is ready for placement?

• Estimated date range of work to be done:

• Formed deck completed?

  Yes

  No

  N/A

• Handrails completed?

  Yes

  No

  N/A

• Holes covered, secured and covered?

  Yes

  No

  N/A

• Type of ladders, scaffold stairs access, man lift or ramp are in compliance with known regulations?

  Yes

  No

  N/A

• Have you spoken with formwork foreman or GC to ensure the deck is ready for access by our manpower and preloading our reinforcing materials?

  Yes

  No

  N/A

• Name of foreman's that you spoke with?

• Have you walked the deck above and below accessing with manpower or preloading materials in the area?

  Yes

  No

  N/A

• Were all questions or concerns addressed by the GC & forming contractor?

  Yes

  No

  N/A

• Rescue plan reviewed with GC? (man basket & crane, man lift, ramps or other)

  Yes

  No

  N/A

• Is climbing rebar elements with fall protection required?

  Yes

  No

  N/A

• Is vertical work near perimeter i.e. within 10' of deck edge- 100% tie-off required

  Yes

  No

  N/A

• Are vertical work bracing plans required?

  Yes

  No

  N/A

• Review plan with team

• If formwork is provided, have you reviewed with GC or formwork that it's been braced to handle rebar and manpower loads?

  Yes

  No

  N/A

• Bracing and anchor points been inspected?

  Yes

  No

  N/A

• Do you have vertical work plans completed, approved and signed off?

  Yes

  No

  N/A

• If engineered tie-off points are requested and supplied have they been inspected and signed off?

  Yes

  No

  N/A

• Does work described above require a Fall Protection Plan?

  Yes

  No

  N/A

• Please review with team

• Harness and lanyard selection and inspections completed?

  Yes

  No

  N/A

• Lifeline or horizontal retractable line plan complete, retractable selected and inspected?

  Yes

  No

  N/A

• Anchor points planned, selected and inspected?

  Yes

  No

  N/A

• Rated for one person 5,000 lbs and two person 10,000 lbs?

  Yes

  No

  N/A

• Is Elevated Work being conducted in Core and Shear Wall Area?

  Yes

  No

• Describe work to be done:

• How much of the pour is ready for placement?

• Estimated date range of work to be done:

• Are vertical forms complete and Halo in place?

  Yes

  No

  N/A

• Handrails completed?

  Yes

  No

  N/A

• Holes covered, secured and covered?

  Yes

  No

  N/A

• Type of ladders, scaffold stairs access, man lift or ramp are in compliance with known regulations?

  Yes

  No

  N/A

• Have you spoken with formwork foreman or GC to ensure the deck is ready for access by our manpower and preloading our reinforcing materials?

  Yes

  No

  N/A

• Name of foreman's that you spoke with?

• Have you walked the core area before accessing with manpower or preloading materials in the area?

  Yes

  No

  N/A

• Were all questions or concerns addressed by the GC & forming contractor?

  Yes

  No

  N/A

• Rescue plan reviewed with GC? (man basket & crane, man lift, ramps or other)

  Yes

  No

  N/A

• Is climbing rebar elements with fall protection required?

  Yes

  No

  N/A

• Is vertical work near perimeter i.e. within 10' of deck edge- 100% tie-off required

  Yes

  No

  N/A

• Are vertical work bracing plans required?

  Yes

  No

  N/A

• Review plan with team

• If formwork is provided, have you reviewed with GC or formwork that it's been braced to handle rebar and manpower loads?

  Yes

  No

  N/A

• Bracing and anchor points been inspected?

  Yes

  No

  N/A

• Do you have vertical work plans completed, approved and signed off?

  Yes

  No

  N/A

• If engineered tie-off points are requested and supplied have they been inspected and signed off?

  Yes

  No

  N/A

• Does work described above require a Fall Protection Plan?

  Yes

  No

  N/A

• Please review with team

• Harness and lanyard selection and inspections completed?

  Yes

  No

  N/A

• Lifeline or horizontal retractable line plan complete, retractable selected and inspected?

  Yes

  No

  N/A

• Anchor points planned, selected and inspected?

  Yes

  No

  N/A

• Rated for one person 5,000 lbs and two person 10,000 lbs?

  Yes

  No

  N/A

• Has an Accident occured?

  Yes

  No

• Job Name and Number

• Conducted on

  Date

• Prepared by

• Location
  Address

• Name of Injured Teammate:

• Date of Birth:

• Date and Time of Incident

  Date

• Type of Injury:

  Cut

  Bruise

  Fracture

  Sprain/Strain

  Other

• Body Part: (Arm, Hand, etc)

• Side of body?

  Left

  Right

  Middle

• What was the Teammate doing when injured?

  Select Trying Carrying Climbing Walking Prying Other

  • Trying
  • Carrying
  • Climbing
  • Walking
  • Prying
  • Other

• Describe:

• Travel Distance?

• Weight?

• Describe Terrain Conditions? (Muddy, level, un-level, etc.)

• Was teammate using PPE?

  Yes

  No

  N/A

• Type of equipment used (Hickey bar, Chokers, etc.)

• Was any hazardous material involved?

  Yes

  No

  N/A

• What was the material involved?

• How did the injury happen?

• Was the hazard covered during Pre-task review?

  Yes

  No

  N/A

• What specific unsafe act or condition was responsible for this accident?

• Why was this specific act or condition responsible for this accident?

• How long has employee been performing this task?

• How often is this tasked performed? (daily, monthly)

• How could this injury been prevented?

• Number of teammates involed?

• Was injury caused by another person

  Yes

  No

  N/A

• Name of person that caused the injury?

• Were there witnesses?

  Yes

  No

  N/A

• Has the witness completed the "witness accident report" form?

  Yes

  No

  N/A

• Is this injury an original injury or a reinjury of a preexisting condition?

  Original Injury

  Preexisting condition

Off-Site Treatment

• Did the teammate see a doctor?

  Yes

  No

  N/A

• Doctor:

• Facility:

• Address:

• Telephone:

Supervisor Signature

• Sign

  Sign

• Has an accident occured?

  Yes

  No

• Job Name and Number

• Conducted on

  Date

• Prepared by

• Location
  Address

• Name of Injured Teammate:

• Date of Birth:

• Date and Time of Incident

  Date

• What were you doing before the injury?

• Type of Injury:

  Cut

  Bruise

  Fracture

  Sprain/Strain

  Other

• Body Part: (Arm, Hand, etc)

• Side of body?

  Left

  Right

  Middle

• What were you doing?

  Select Tying Carrying Climbing Walking Prying Other

  • Tying
  • Carrying
  • Climbing
  • Walking
  • Prying
  • Other

• Describe:

• Travel Distance?

• Weight?

• Describe Terrain Conditions? (Muddy, level, un-level, etc.)

• Was teammate using PPE?

  Yes

  No

  N/A

• Type of equipment used (Hickey bar, Chokers, etc.)

• Was any hazardous material involved?

  Yes

  No

  N/A

• What was the material involved?

• How did the injury happen?

• Was the hazard covered during Pre-task review?

  Yes

  No

  N/A

• What specific unsafe act or condition was responsible for this accident?

• Why was this specific act or condition responsible for this accident?

• How long has employee been performing this task?

• How often is this tasked performed? (daily, monthly)

• How could this injury been prevented?

• Number of teammates involed?

• Was injury caused by another person

  Yes

  No

  N/A

• Name of person that caused the injury?

• Were there witnesses?

  Yes

  No

  N/A

• Has the witness completed the "witness accident report" form?

  Yes

  No

  N/A

• Is this injury an original injury or a reinjury of a preexisting condition?

  Original Injury

  Preexisting condition

• Was site first aid adiminstered?

  Yes

  No

  N/A

• Name of Foreman

• Name of Superintendent

Off-Site Treatment

• Did you see a doctor?

  Yes

  No

  N/A

• Doctor:

• Facility:

• Address:

• Telephone:

Employee Signature

• Sign

  Sign

• Has an Accident occured?

  Yes

  No

• Job Name and Number

• Conducted on

  Date

• Prepared by

• Location
  Address

• Name of Witness

• Contact Number:

• Name of Injured Teammate

• Time and Date of Statement

  Date

• Time and Date of Accident

  Date

• Type of Injury:

  Cut

  Bruise

  Sprain/Strain

  Fracture

  Other

• Part of body injured (Arm, Hand, Finger, etc.)

• What were you doing at the time of the incident?

  Tying

  Climbing

  Carrying

  Lifting

  Other

• Please explain:

• What was the injured teammate doing?

  Tying

  Climbing

  Carrying

  Lifting

  Other

• Please explain:

• Were you using PPE?

  Yes

  No

  N/A

• Type of equipment being used (Hickey Bar, Choker, etc.)

• How did this injury happen?

• Was this hazard covered during the pre-task review?

  Yes

  No

  N/A

• How could this accident have been prevented?

• Name of immediate foreman:

• Name of project Superintendent:

• Please sign

  Sign

A. Work in Progress

• 1a. Primary area worked today and brief detailed description of the work performed today.

• 2a. Multiple areas worked today?

  Yes

  No

• List all areas worked today and brief description of work completed?

• 3a. Picture(s) of work at end of day

  Media

• 4a. Number of teammates onsite for Nucor Harris Rebar

• 5a. Total number of hours worked on todays shift (Example 4,8,10 etc. OT included)

B. Project Interruptions/Challenges

• 1b. Issues/Concerns that happened today

• 2b. Photograph(s) of identified issue/concern (if applicable)

  Media

• 3b. Contractor reasons/statement for delays, interruptions, change orders, etc.

• 4b. Will additional work be needed to mitigate these issues?

  Yes

  No

• Has supporting documentation for delays or/and interruptions been completed?

  Yes

  No

• When will documentation be completed?

  Date

C. Safety

• 1c. Were there any incidents onsite today requiring first aid, OSHS or medical treatment?

  Yes

  No

• Provide description of what occurred

• 2c. Were any safety concerns identified onsite?

  Yes

  No

• Provide description of concerns

D. Extended Site Leave Report

• 1d. Will the team be offsite, or jobsite closed for an extended period?

  Yes

  No

• How many days will the Nucor Harris Rebar team be offsite?

• Describe controls in place to protect work areas, mitigate hazards, securing equipment, etc.

E. Any Additional Information

• 1e. Any additional information not addressed above?

• 2e. Any additional photographs?

  Media