TSCMG Site Surveillance Checklist

• Document No. TSCMG SS Rev 0

• Conducted on

  Date

• TJHD Site

• Conducted by

• Attendees:

• Location
  Address

Any Safety Concerns

• Safe

  At Risk

  N/A

Any Environmental Concerns

• Safe

  At Risk

  N/A

Any Community Concerns

• Safe

  At Risk

  N/A

Site Activities

• Safe

  At Risk

  N/A

Number of Personnel

• Safe

  At Risk

  N/A

Contractors onsite

• Site personnel

  Yes

  No

  N/A

Corrective Actions at time of inspection

• Safe

  At Risk

  N/A

List corrective actions outstanding from previous visit

• Safe

  At Risk

  N/A

Signatures

• Signed

  Sign

• Signed

  Sign