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Site Supervisors use this form to submit detailed daily reports in compliance with OSHA and government contract requirements.


[current-date] Daily Project Report and Safety Task Assignment

Site Conditions Permit Work Requirement Electrical Program Mobile and Fixed Scaffolding
Sunny Fire Impairment Electrical Tools Outriggers above 5 feet
Cloudy Excavation
White: Jan-MarGreen: Apr-JunRed: Jul-SepOrange: Oct-Dec
Lateral support when two sections are installed
Rainy Hot Work
No daisy chainingGround prongs presentSuspended or routeNo frayed cords
Railing installed above 4 feet
Snow
Working at Height Inspection tag current
Windy (wind > 15 mph) Lifting All wheels locked
Temp (deg. F) Lock out tag out Fall arrest protection
Lightning Other
Stilts installed according to manufacturer instructions
IndoorsDryWet Top/Mid-rails/Toe boards present
Other

Ladder Usage Hand Tools PPE Minimum Housekeeping
Type 1-A 300 lb rating or above All guards in place Hardhat bill forward Clean as you go
Non-conductive (fiberglass) Not damaged Steel toed footwear All areas left neat and clean at end of day
Do not work above 2nd highest rung on ladder No modification Safety Glasses Ventilation needed
Do not use broken or dented ladder Proper tool for the job Cut resistant lvl 4 gloves Flammable storage addressed
24 in. clear at base of ladder No makeshift cutting surfaces High visibility shirts or vests Combustible materials addressed

Hearing ProtectionDust MaskRespiratorChemical handling PPEFace shield
Doors closed to public
Harness (Less than 5 years old)Lanyard (Less than 5 years old)3600 lb anchorage point5000 lb anchorage point Floor and hallways clear
Room exit egress clear
28 in. continuous egress


Licenses, Certifications, Training Emergency Response HazCom Hot Work Area
Forklift Medical Emergency - Call 911 SDS located in HSE office Clear zone is established and marked
Stilts Notify Superintendent New items requiring SDS were brought to site All flammables and combustibles moved from the area or 35 ft. away
Powder actuated tools
Clinic for non-emergency needsFirst aid kits in HWC trailer and HSE officeEye wash bottles in HWC trailer and HSE office
All needed PPE is available Fire Extinguisher is present

Fall protection 6 ft or higherScaffold erection / disassemblyTrenching and excavationConfined Space
AED located in HSE office Special training or handling Fire Watch 1 hour minimum
Muster location at HWC Trailer

Thank you,

HWC Team