SAFER TOGETHER MEMBER COMPANY’S & CONTRACTORS WEEKLY PERFORMANCE REPORT - duplicate

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Week Ending

• Reporting Period

  Select Monday Tuesday Wednesday Thursday Friday Saturday Sunday

  • Monday
  • Tuesday
  • Wednesday
  • Thursday
  • Friday
  • Saturday
  • Sunday

• Date

  Date

• Tag Number

• Total KM Driven

• Date of Journey

  Date

• Number of Drivers

• Speed of Category 1

• Speed of Category 2

• Speed of Category 3

• Reportable Speed Event

• Fatigue Management > 2.15 hours

• Seatbelt not Engaged

  Yes

  No

  N/A

• Harsh Acceleration

  Yes

  No

  N/A

• Harsh Braking

  Yes

  No

  N/A

• Excessive Harsh Braking

  Yes

  No

  N/A

Comments

• undefined

• Date

  Date

• Name & ID Number

• Prepared a Pre-Start on the Vehicle

  Yes

  No

  N/A

• Date of Journey

  Yes

  No

  N/A

• Prepared and Followed JMP inclusive of Step 7 and Fatigue Management

  Yes

  No

  N/A

• Made the necessary stops on the journey when required

  Yes

  No

  N/A

• Recorded no breeches to speed limit, seatbelt, harsh acceleration, harsh and excessive harsh braking at all times

  Yes

  No

  N/A

• Engaged in 4WD on unsealed roads

  Yes

  No

  N/A

Sign-off

• Completed by

  Sign