Title Page
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Conducted on
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Prepared by
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Location
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This form is to be filled out at the start and end of every shift. We just want to know that you are okay today.
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Name
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Supervisor's Name
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Is this start of shift or end of shift ?
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My start time
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Today I feel ......
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I have all of my PPE that I need to do my tasks safely ?
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I have my LOTO locks with my name on them ?
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I am not under the influence of any substance that could impact my safety or the safety of others.
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My work area has been left clean and tidy by the last team ?
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I will report any Hazards I see during my shift ?
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Snap a selfie if you want to.................
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My finish time
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I feel .......
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I have reported a hazard today ?
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I have put all my PPE away ?
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I have left my work area clean and tidy ?
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Take a photo of your work area
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I had all the equipment i needed to complete my tasks today .
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I could do my job easier if................
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Feel free to take a selfie...
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Additional comments
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Sign here & have a good day.....
