Foreman's Daily Report Rev. Nov 2015

• Division Name

• Conducted on

  Date

• Prepared by:

• Location
  Address

• Company Contact

• Project #

• Project Name

• Item #

• Weather condition

• Extra Item:

• Contractor/ GC/ Sub-tier/ Other

• Was Traffic Control Set-Up by a Lakeside Industries Employee?<br> <br>

  Yes

  No

  N/A

GRADE CONDITION(S):

• 1.1 Is grading done?

  Yes

  No

  N/A

• 1.2 Grading by?

• 1.3 Edges compacted?

  Yes

  No

  N/A

• 1.4 Edges cleaned?

  Yes

  No

  N/A

• 1.5 Is project ready to pave?

  Yes

  No

  N/A

• 1.6 Did grade hold up?

  Yes

  No

  N/A

• 1.7 Grade Signed off ?

  Yes

  No

  N/A

• 1.8 Site Safety Observation:

  Safe

  At Risk

  N/A

• Comment:

PAVING CONDITION(S)

• 2.1 Overlay?

  Yes

  No

  N/A

• 2.2 Overlay / Project condition:

• 2.3 Clean by?

• 2.4 Does project need to be sealed?

  YES

  NO

• 2.5 Tonnage?

• 2.6 Site Safety Observation:

  Safe

  At Risk

  N/A

• Comment:

EQUIPMENT ON PROJECT

• 3.1 Paver

Paver

• Paver Equipment #

• 3.2 MTV

MTV

• MTV Equipment #

• 3.3 Roller

Roller

• Roller Equipment #

• 3.4 Plate Compactor

Plate compactor

• Plate Compactor Equipment #

• 3.5 Distributor Truck

Distributor

• Distributor Equipment #

EMPLOYEES ON PROJECT

• 4.1 Employees Name

Crew member

• Yes

  No

  N/A

• 4.2 Employee Name:

• Is employee wear required PPE for this project?

  YES

  NO

• 4.3 Name of Quality Control personnel:

ACCIDENT OR DAMAGED PROPERTY

• 5.0 Was there an accident or did any property damage occur while on site?

  NO

  YES

• Is project day or night

  DAY

  NIGHT

• Project Start Time:

• Project Stop Time:

PHOTOS

• Add media

  Media

• Notes:

• Foreman Signature

  Sign

• 3. All Supervisors’ First Aid/CPR cards checked at start of all new projects

  Yes

  No

  N/A

• 3.1 Certification information for employees are tracked and on file

  Yes

  No

  N/A

• 3.2 OSHA 300

  Yes

  No

  N/A

• 4. Reporting procedures are clarified at the time of hire (see Orientation Checklist)

  Yes

  No

  N/A

• 4.1 Investigation procedures for “near misses”

  Yes

  No

  N/A

• 4.2 Investigations are conducted in 24 hours

  Yes

  No

  N/A

• 4.3 Investigations are documented on a company report form

  Yes

  No

  N/A

• 4.4 Investigations of accidents & “near misses” are discussed during weekly safety meeting<br><br>

  Yes

  No

  N/A

• 5. A written Drug & Alcohol Policy, reflecting current company policies

  Yes

  No

  N/A

• 5.1 Drug Testing (optional) For example: Pre-employment, post-accident, for-cause, random, DOT

  Yes

  No

  N/A

• 6. Participation in at Least One Construction Safety Activity by One or More Employees: (For example: AGC Safety Symposiums, AGC Safety Committee meetings, ASSE meetings or seminars, Puget Sound Safety Summit meetings, Seattle Vicinity Construction Safety Council meetings, or Evergreen Safety Council)

  Yes

  No

  N/A

• 7. AGC RETRO PARTICIPANT

  Yes

  No

  N/A

• 7.1 Written Return-to-Work Program

  Yes

  No

  N/A

• 7.2 Written Light Duty job descriptions

  Yes

  No

  N/A

• 7.3 Documentation of supervisory training in Return-to-Work criteria

  Yes

  No

  N/A

• 7.4 Top management commitment to a Return-to-Work program

  Yes

  No

  N/A

• 8.0 Accident prevention program on site

  Yes

  No

  N/A

• 8.1 Job Hazard Analysis

  Yes

  No

  N/A

• 8.2 Confined Space Permit

  Yes

  No

  N/A

• 8.3 Fall Protection Work Plan

  Yes

  No

  N/A

• 8.4 Complete inspection forms: Assured Grounding/GFCI Program

  Yes

  No

  N/A

• 8.5 Weekly Jobsite Inspection Forms

  Yes

  No

  N/A

• 8.6 Weekly Toolbox Meeting Minutes

  Yes

  No

  N/A

• 8.7 Site Specific Safety Plan

  Yes

  No

  N/A

• 8.8 Cranes documentation:

  Yes

  No

  N/A

• 8.8.a Crane Operator Certification and hours

  Yes

  No

  N/A

• 8.8.b Crane Certification with proof of load testing

  Yes

  No

  N/A

• 8.8.c Certifier Certification

  Yes

  No

  N/A

• 8.8.d Rigger Qualification (by Type)

  Yes

  No

  N/A

• 8.8.e Signal Person Qualification

  Yes

  No

  N/A

• 8.9 WAC Standards for construction located on worksite

  Yes

  No

  N/A

• 8.10 Safety Bulletin Board with required posting

  Yes

  No

  N/A

• 8.11 Emergency phone numbers posted

  Yes

  No

  N/A

• 8.12 OSHA 300A (Posted February through April)

  Yes

  No

  N/A

• 8.13 First Aid/CPR training certification cards (Superintendents, Foremen)

  Yes

  No

  N/A

• 9.0 Toilet

  Yes

  No

  N/A

• 9.1 Wash area with temperate water/ Sanitizer

  Yes

  No

  N/A

• 9.2 Dry shack - lunch room

  Yes

  No

  N/A

• 9.3 Above listed facilities clean and sanitary

  Yes

  No

  N/A

• 10.0 First aid kit suitable for crew size (office, dry shack, tool van)

  Yes

  No

  N/A

• 10.1 Fire protection (extinguisher date and type correct for situation)

  Yes

  No

  N/A

• 11.0 Work Areas clean and orderly

  Yes

  No

  N/A

• 11.1 Deck free of: protruding nails, holes, loose boards

  Yes

  No

  N/A

• 11.2 Aisles and walkways clear of obstructions

  Yes

  No

  N/A

• 11.3 Guardrails in place where required

  Yes

  No

  N/A

• 11.4 Trash chute for over 20’ heights

  Yes

  No

  N/A

• 12.0 Head Protection - hard hats

  Yes

  No

  N/A

• 12.1 Hearing protection - ear plugs<br>Sound Level Meter: _____dB reading <br>

  Yes

  No

  N/A

• 12.2 Leg protection - chain saw chaps

  Yes

  No

  N/A

• 12.3 Foot protection - work boots

  Yes

  No

  N/A

• 12.4 Eye and face protection - safety glasses

  Yes

  No

  N/A

• 12.5 Respiratory protection - mask dependent on exposure

  Yes

  No

  N/A

• 12.6 Fall protection - safety harness, lanyards

  Yes

  No

  N/A

• 12.7 Reflective Clothing- vest, 360 degrees

  Yes

  No

  N/A

• 13.0 Office trailer step railings

  Yes

  No

  N/A

• 13.1 Only approved ladders in use (and secured)

  Yes

  No

  N/A

• 13.2 Machine guards in place (saws, grinding wheels, etc.)

  Yes

  No

  N/A

• 13.3 All power equipment is properly grounded

  Yes

  No

  N/A

• 13.4 Extension cords and power equipment checked for shorts

  Yes

  No

  N/A

• 13.5 Compressed gas cylinders in secured storage area

  Yes

  No

  N/A

• 13.6 Fuel gas stored at a minimum of 20 feet from compressed gas cylinders

  Yes

  No

  N/A

• 13.7 Flash back protectors for oxygen-acetylene torches in place/use

  Yes

  No

  N/A

• 13.8 Proper access/egress for trenches more than 4 feet deep

  Yes

  No

  N/A

• 13.9 Gas and diesel fuel stored in approved and properly marked safety cans

  Yes

  No

  N/A

• 13.10 Proper barricades around pinch point exposure area (revolving cranes)

  Yes

  No

  N/A

• 13.11 Proper Scaffold erection and usage

  Yes

  No

  N/A

• 13.12 Back-up alarms on appropriate motorized equipment

  Yes

  No

  N/A

• 13.13 Provisions for public safety

  Yes

  No

  N/A