Title Page
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Jicarilla: 021579 - 0372
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Conducted on
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Prepared by
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Location
Untitled Page
Jicarilla Power Station
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Check one:
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Date:
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Site Lead:
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Total on site
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Task:
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Safety Notes:
Weather
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Wind speed
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Wind direction
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Temp
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Weather Delay
Daily Summary:
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JSA Completed?
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Daily Summary notes:
Work Activity
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Work activity
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Number Of Workers
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Total Hours
ACOUNTABILITY REPORT
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Accountability for all on site
Other Items
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Attach additional media
Signature
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Type name
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Sign name