Supervisor Weekly Safety Report - TCCB

• Supervisor:

• Site conducted:

  Select

• Department:

  Select

• Conducted the week of:

  Date

Daily Safety Meeting Topic or Toolbox Talk (Minimum of 1 per work day)

• Sunday:

  Select Yes No N/A (Day Off, On vacation, or Sick)

  • Yes
  • No
  • N/A (Day Off, On vacation, or Sick)

• Daily Safety Meeting Topic or Toolbox Talk Topic

• Monday:

  Select Yes No N/A (Day Off, On vacation, or Sick)

  • Yes
  • No
  • N/A (Day Off, On vacation, or Sick)

• Daily Safety Meeting Topic or Toolbox Talk Topic

• Tuesday:

  Select Yes No N/A (Day Off, On vacation, or Sick)

  • Yes
  • No
  • N/A (Day Off, On vacation, or Sick)

• Daily Safety Meeting Topic or Toolbox Talk Topic

• Wednesday:

  Select Yes No N/A (Day Off, On vacation, or Sick)

  • Yes
  • No
  • N/A (Day Off, On vacation, or Sick)

• Daily Safety Meeting Topic or Toolbox Talk Topic

• Thursday:

  Select Yes No N/A (Day Off, On vacation, or Sick)

  • Yes
  • No
  • N/A (Day Off, On vacation, or Sick)

• Daily Safety Meeting Topic or Toolbox Talk Topic

• Friday:

  Select Yes No N/A (Day Off, On vacation, or Sick)

  • Yes
  • No
  • N/A (Day Off, On vacation, or Sick)

• Daily Safety Meeting Topic or Toolbox Talk Topic

• Saturday:

  Select Yes No N/A (Day Off, On vacation, or Sick)

  • Yes
  • No
  • N/A (Day Off, On vacation, or Sick)

• Daily Safety Meeting Topic or Toolbox Talk Topic

Area(s) Inspected (A minimum of 1 is required per week/shift)

• 1. Was an area inspected?

  Select Yes No N/A (Day Off, On vacation, or Sick)

  • Yes
  • No
  • N/A (Day Off, On vacation, or Sick)

• What area was inspected?

• Any concerns or Improvements?

• Inspection date?

  Date
Other Areas Inspected

• Was an area inspected?

  Yes

  No

• What area was inspected?

• Any Concerns or Improvements?

• Inspection date?

  Date

Employee Contacts (A minimum of 3 is required per week/shift)

1. Employee Contact

• Was an employee contact completed?

  Select Yes No N/A (Day Off, On vacation, or Sick)

  • Yes
  • No
  • N/A (Day Off, On vacation, or Sick)

• Name of Employee:

• Contact date/time:

  Date

• Topic/Description/Task:

2. Employee Contact

• Was an employee contact completed?

  Select Yes No N/A (Day Off, On vacation, or Sick)

  • Yes
  • No
  • N/A (Day Off, On vacation, or Sick)

• Name of Employee:

• Contact date/time:

  Date

• Topic/Description/Task:

3. Employee Contacts

• Was an employee contact completed?

  Select Yes No N/A (Day Off, On vacation, or Sick)

  • Yes
  • No
  • N/A (Day Off, On vacation, or Sick)

• Name of Employee:

• Contact date/time:

  Date

• Topic/Description/Task:

  Date
Other Employee Contacts

• Was an employee contact completed?

  Yes

  No

• Name of Employee:

• Contact date/time:

  Date

• Topic/Description/Task:

Hazard Recognition Plus (HRP) Evaluation? (A minimum of 1 required per week/shift)

1. Hazard Recognition Plus (HRP) Evaluation.

• Was a Hazard Recognition Plus (HRP) Evaluation Completed?

  Select Yes No N/A (Day Off, On vacation, or Sick)

  • Yes
  • No
  • N/A (Day Off, On vacation, or Sick)

• What was the job?

  1

  2

  3

• What energy is involved?

  1

  2

  3

• Where is the energy going?

  1

  2

  3

• How will we manage the energy for a safe job?

  1

  2

  3

• What are the specific Stop-The-Job Triggers

  1

  2

  3
Other Hazard Recognition Plus (HRP) Evaluations Completed

• 

• Was a Hazard Recognition Plus (HRP) Evaluation Completed

  Yes

  No

• What was the job?

  1

  2

  3

• What energy is involved?

  1

  2

  3

• Where is the energy going?

  1

  2

  3

• How will we manage the energy for a safe job?

  1

  2

  3

• What are the specific Stop-The-Job Triggers?

  1

  2

  3

Formal Training Presented to Employees (ex: OSHA-required monthly training, Safe Work Procedure review, JSA review, etc.)

• Topic name:

• Number of attendees:

• Training date/time:

  Date