IME - JHA and Daily Log DIA

• Job Name

• Job Number

• Site

• Location
  Address

• Conducted on

  Date

• Prepared by

• Supervisors Name

• Weather

• Temp

Equipment

Add Equipment and Tools

• Equipment

• Quantity

Man Power

• General Foreman

• Number

• Foreman

• Number

• Journeyman

• Number

• Apprentice

• Number

Daily Tasks

Work in Progress

• Work in Progress Today (Who, What, When, Where, Why)

• Five main hazards
  1. Life safety - egress, emergency response, fire protection
  2. Fall hazards
  3. Electrical hazards
  4. Caught in hazards
  5. Struck by issues- vest, material handling, moving equipment

• Hazards

• Abatement (Corrective Action)

• Add media

  Media

Job Factors

• Impacts to the job

• Materials received

• Phone calls / Visitors

Safety Requirements

• Does everyone have the following

• Hard Hat

  Safe

  At Risk

  N/A

• Safety Glasses, Face Shield, Goggles

  Safe

  At Risk

  N/A

• Proper Foot Ware

  Safe

  At Risk

  N/A

• Proper Gloves

  Safe

  At Risk

  N/A

• Lock Out / Tag Out

  Safe

  At Risk

  N/A

• Hot Work PPE

  Safe

  At Risk

  N/A

• Meters / Testers

  Safe

  At Risk

  N/A

• Fall Protection

  Safe

  At Risk

  N/A

• Trench Safety Equipment

  Safe

  At Risk

  N/A

• Confined Space Equipment

  Safe

  At Risk

  N/A

• Hearing Protection

  Safe

  At Risk

  N/A

• Respirator

  Safe

  At Risk

  N/A

• Stretch & Flex

  Safe

  At Risk

  N/A

• Monthly AED Check

  Safe

  At Risk

  N/A

• Comments:

Personnel

Add Personnel

• Employee Title

• Employee Name

• Employee #

• Signature

  Sign

Sub contractor

• Company name

• Employee name

• Add signature

  Sign

Comments

Add comments

• Employee Name

• Comments

• If this is an ACCIDENT please fill out an Accident report (This is a different form!)
  
  Accident - undesired event that CAUSES HARM or damage to people, property, or process. (Not always an OSHA recordable)
  Examples:
  Cut that could require first aid (including bandaid).
  Used eye wash station to remove foreign body.
  Vehicle accident resulting in damage with or without personal injury.
  
  Incident - undesired event that under slightly different circumstances COULD have caused harm to people, property, or process. (Near Miss)
  Examples:
  Almost get struck by a loader on job site.
  Carrying iPad up a ladder without a hands free strap. (could not maintain 3 points of contact)

Add New Incident

• Type

  Select Personal Injury Auto / Equipment Tools General Liability Other

  • Personal Injury
  • Auto / Equipment
  • Tools
  • General Liability
  • Other

• Severity

  Mild

  Moderate

  Severe

• Review if this should be an Accident!

• Description