KGP Co JHA UG Form

• Date/ Time

  Date

• Jobsite Safety Inspection Report

  Select Doug Davis Hugo Tejera Willie Bowen Miguel Salmeron Jason Salmeron Chelsy Tool Jose Luna

  • Doug Davis
  • Hugo Tejera
  • Willie Bowen
  • Miguel Salmeron
  • Jason Salmeron
  • Chelsy Tool
  • Jose Luna

• Map area working in?

  FDH-184

  FDH-197

  FDH-196

  FDH-193

  FDH-195
• Location of work
  Address

• Closest medical facility is

  Vaughan Medical Center

• Company Performing Work

  Select HD Contracting South Drilling

  • HD Contracting
  • South Drilling

• Who are the crew leads on site?

  Select Willie Bowen Miguel Salmeron Jason Salmeron Jason Salmeron Chelsy Tool Jose Luna

  • Willie Bowen
  • Miguel Salmeron
  • Jason Salmeron
  • Jason Salmeron
  • Chelsy Tool
  • Jose Luna

• Crew members on site.

• Did you preform your daily Tailgate Safety Meeting?

  Yes

  No

  N/A

• Are utilities properly located?

  Yes

  No

  N/A

• Is equipment properly functioning/grounded?

  Yes

  No

  N/A

• Are signs and logos in place.

  Yes

  No

  N/A

• What type of work is being preformed?

  Select Drilling Potholing Missiling Vault Placement

  • Drilling
  • Potholing
  • Missiling
  • Vault Placement

• What hazards are associated with your days task?

  Select Utility Strikes Traffic Fire Hazard Fall Hazard Noise

  • Utility Strikes
  • Traffic
  • Fire Hazard
  • Fall Hazard
  • Noise

Safety precautions taken:

• What cautionary measures are being taken to prevent injuries.

  Select High Viz Hardhats Cones Traffic control Fall Precautions Safety glasses when missiling.(if needed) Fire extinguisher Safety Boots Gloves Hearing Protection(if needed) First Aid kit

  • High Viz
  • Hardhats
  • Cones
  • Traffic control
  • Fall Precautions
  • Safety glasses when missiling.(if needed)
  • Fire extinguisher
  • Safety Boots
  • Gloves
  • Hearing Protection(if needed)
  • First Aid kit

Emergency services contact info.

• Local Fire Dept Number?

  334-874-2150

• Local Police Dept?

  334-874-2137

• Local Hospital?

  334-418-4100

Emergency Contact for marked utility.

• Water

  Robert Bridges 334-874-8857

• Sewer

  Henry Hicks 334-375-1551

• Gas

  1-800-292-4008

Notes

• Is your crew adequately prepared for the weather?

  Yes

  No

  N/A