Monthly Safety Report - DCC

• Project Number

• Project Name

• Date

  Date

• DCC Representative

Site Work

• 1. The contractor has provided DCC with copies of the reports or directions issued by the authorities?

  Yes

  No

  N/A

• 2. The contractor submitted a documented report of accidents and incidents within 24 hours of the occurrence?

  Yes

  No

  N/A

• 3. The work site is maintained in a safe/orderly/clean manner?

  Yes

  No

  N/A

• 4. The contractor is completing documented safety inspections of the work site?

  Yes

  No

  N/A

• 5. The contractor is completing Documented safety meetings at the work site?

  Yes

  No

  N/A

• 6. The contractor is ensuring that their workers wear/use required PPE?

  Yes

  No

  N/A

• 7. The contractor has implemented site delineation measures to control work site access and activities?

  Yes

  No

  N/A

• 8. Required signage has been provided by the contractor and is posted in a conspicuous location on site?

  Yes

  No

  N/A

• 9. Permits, licenses and compliance certificates from the authorities having jurisdiction have been obtained?

  Yes

  No

  N/A

• 10. The contractor is maintaining a copy of their H&S program and required safety documentation on site?

  Yes

  No

  N/A

• 11. The contractor is complying with the minimum site safety rules as established in the safety requirements?

  Yes

  No

  N/A

• 12. The contract has made available First Aid services and supplies (kit) on site

  Yes

  No

  N/A

• 13. The contractor has made readily accessible current MSDS's on site for all controlled products

  Yes

  No

  N/A

Safety Observations and Description of Activities

Safety Observation

• Description of Observation

• Is there evidence of this observation on site?

• Photos of Observation

  Media

Record of Safety

Safety Situation

• Description of Situation

• Contractor's Corrective Action

• Date Corrective Action Confirmed

  Date

• Signed by DCC Representative

  Sign