Safety Compliance Solutions Daily Report Checklist

• Job Site

• Date and Time

  Date
• Location
  Address

Job Description

• Company Name

• Job No.

• Client Project #

Weather Information

• Weather Report

  Clear / Sunny

  Party Cloudy

  Overcast
Temperature

• Winds (MPH)

• Precipitation AM

  Rain

  Snow

  Sleet

  None

• Enter Inches

• Precipitation PM

  Rain

  Snow

  Sleet

  None

• Enter Inches

Enter Crew Information Crew

• TCT Foreman

• Crew Member Name

Subcontractor

• Enter Non SCS Employee Name

• Non SCS Employees

• No. of Crew

• Total No. of Hrs

Daily Operations

• Add 1 of the following:
  Shoulder. Mobile, Flagging, Single LC, Double LC, Triple LC, Detour, Primary, Urban/Secondary, Interstate, Over 60, Under 60, Canceled (Job Set), Canceled En Route

• Operation Type

• Describe the Daily Activities and Phase of the Project

• Photo/s

  Media

Equipment & Materials

• Was any Subcontractor scheduled to start or material to arrive but didn't appear?

  Yes

  No

  N/A

• Describe or List

• Signs

  Needed

  On-Hand

  Used On-Site

• How Many?

• How Many?

• Stands

  Needed

  On-Hand

  Used On-Site

• How Many?

• How Many?

• Stop/Slow Signs

  Needed

  On-Hand

  Used On-Site

• How Many?

• How Many?

• Cones

  Needed

  On-Hand

  Used On-Site

• How Many?

• How Many?

• Radios

  Needed

  On-Hand

  Used On-Site

• How Many?

• How Many?

• How Many?

• Needed

  On-Hand

  Used On-Site

Mobilization During Shift

• Start Time (Reporting to Project from yard/hotel)

  Date

• Start Miles (Departing to Job site)

• End Miles (Arriving to Job site):

• On-Site Meetup Time:

  Date

• Start Setup Time:

  Date

• Finish Breakdown Time:

  Date

Mobilization End of Shift

• Mobilization: End Time (Report from Project back to yard/hotel)

  Date

• Start Miles (Departing from Job site):

• End Miles (Arriving to shop/hotel):

• Demobilization: End Time Back at Shop/ Hotel

  Date

Safety

• Was a job site inspection performed today?

  Yes

  No

  N/A

• Were there any job site hazards observed or incidents that occured today?

  Yes

  No

  N/A

• Give detailed account

• Photo/s

  Media

• Are all Subcontractors compliant to THG Safety Management Program?

  Yes

  No

  N/A

• Describe

More Information

• Was worked delayed for any reason?

  Yes

  No

  N/A

• Describe reason why

• Was stoppage order in writing?

  Yes

  No

  N/A

• Describe reason why

• Were verbal instructions recieved?

  Yes

  No

  N/A

• Describe

• Has the directions been put in writing?

  Yes

  No

  N/A

• Has any verbal or written direction been given to a Subcontractor?

  Yes

  No

  N/A

• Describe

• Has the directions been put in writing?

  Yes

  No

  N/A

• Were any field work orders received or implemented today?

  Yes

  No

  N/A

• Describe or List

• Were you required to do any extra work?

  Yes

  No

  N/A

• Was it authorized in writing?

  Yes

  No

  N/A

• Should it be backcharged?

  Yes

  No

  N/A

• To whom & why?

Visitor Information

• Was there any visitors today?

  Yes

  No

  N/A

• List Names

Completion

• For Customer to Review and Sign

• Print Name:

• Foreman or Site Supervisor: Name and Signature

  Sign

• Customer Comments and Acknowledgements:

• Upload Attachments (Images, Videos, etc.)

  Media