Forte Citnalta JV Daily Safety Report

• Site conducted

• Conducted on

  Date

• Prepared by

• Location
  Address

Project Information

• Project #

• Project Name

• Date/Day

  Date

• Shift (Start time/Finish time)

• Weather

Project Team

• Name of Competent Person

• # of Workers

• Work performed

• Toolbox Talk given

• Applicable SWPs

• Safety Issues Noted

  Yes

  No

  N/A
Subcontractor(s)

• Company

• Name of Competent Person

• # of Workers

• Work Performed

• Toolbox Talk Given

• Applicable SWPs

• Safety Issues Noted

  Yes

  No

  N/A

SAFETY MEETINGS, *DEFICIENCIES, UNUSUAL INCIDENTS, & OUTSTANDING PROJECT ISSUES

• Safety Issues, Meetings, Incidents, Safety Issues Noted, Corrective Actions Taken

General Orders

• General Orders in effect

  Yes

  No

  N/A

• GO number

• Power off?

  Yes

  No

  N/A

• Extent of GO/Power Off

New Hires/New Subcontractor Personnel

• Any new hires

  Yes

  No

  N/A

• Number of new hires

• Was Safety Orientation completed

  Yes

  No

  N/A

• Any new subcontractor personnel?

  Yes

  No

  N/A

• Number of new sub workers

• Was Safety Orientations completed?

  Yes

  No

  N/A

Accidents/Injuries/Near Misses

• Were there any accidents/injuries/near misses?

  Yes

  No

  N/A

• Was SAIR completed? (if yes attach copy of SAIR)

  Yes

  No

  N/A

• Type of incident

  Accident

  Injury

  Near Miss

  N/A

• OSHA Recordable?

  Yes

  No

  N/A

• Did injured go to CityMD or Hospital?

  Yes

  No

  N/A

• Was CCM/PCM/MTACD notified?

  Yes

  No

  N/A

Safety Visits/Inspections (OSS, C&D SAFETY, OCIP, FDNY, EED, DOB, OSHA)

• Were there any visits today?

  Yes

  No

  N/A

• Inspector's name(s)/Agency

• Location(s) inspected

• Safety Deficiencies Noted?

  Yes

  No

  N/A

• Stop Worker Order given?

  Yes

  No

  N/A

• Safety Deficiencies/Notes/Details/Comments/Photos

Damage to Property/Lost or Stolen Items

• Any damaged property/stolen items?

  Yes

  No

  N/A

• Brief description of items/property involved

• When/Where?

• Estimated Value

• Property Owner/Contact info

• Police Notified?

  Yes

  No

  N/A

• Any complaints?

  Yes

  No

  N/A

Violations

• Any violations received?

  Yes

  No

  N/A

• Agency giving violation

• Description of ticket/Details (attach copy of ticket)

Additional Information

• Add any additional information

End of shift certification

• All work is completed, all areas clean and secure/locked at the end of the shift.

  Yes

  No

  N/A

• Time/date for end of shift

  Date

• Shielding visually inspected and in good condition.

  Yes

  No

  N/A

• Walked all platforms, all material secured and no track obstructions

  Yes

  No

  N/A

• Stair towers are locked and secured.

  Yes

  No

  N/A

• All street MPT’s removed; clear and clean pedestrian walkways.

  Yes

  No

  N/A

• All workers have left site.

  Yes

  No

  N/A

• Work is continuing on next shift; turned shift over to (name and time)

Attachments

• Access Form

• Toolbox Talk(s)

• SAIR

• Tickets/Violations

Safety Manager/Coordinator Signature

• Signature

  Sign