Safety Department

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Any Injuries

• Yes

  No

• If Yes, Complete A First Injury Report

Date Of Incident

• Select date

  Date

Estimated Time Of Injury

• Select date

  Date

Port

• Select Turning Basin Greens Port San Jack J.D. Fields LaPorte JSW Steel Yard Concrete Plant

  • Turning Basin
  • Greens Port
  • San Jack
  • J.D. Fields
  • LaPorte
  • JSW Steel Yard
  • Concrete Plant

Dock/Wharf

Vessel Name

Stevedore

Supervisor

Phone

Investigating Agency

Case #

Officer

Condition Of Weather

Road

Visibility

Day Or Night

Operator Name

Operator's Phone

Unit #

Unit #

Material Damaged

• Select Galvanized Coil Coil Bundled Pipe Loose Pipe Regular Cargo Crates

  • Galvanized Coil
  • Coil
  • Bundled Pipe
  • Loose Pipe
  • Regular Cargo
  • Crates

Estimated Amount

Media

• Take Pictures. Also close up pictures of the product label if there is product damage. If vessel damage, notify Chief's mate and Steve doing Superintendent. Was ship's file created when the vessel arrived, prior to start work.. yes or no. If a vessel file was created, place a copy of this report with the file. Notify Chance or Kelly of product damage so they can notify the customer.

• Add media

  Media

NOTES:

• Select date

  Date

Your Name

• Add signature

  Sign