MB Electrical- EllisDon Form F

EllisDon SUBCONTRACTOR WEEKLY SUMMARY – FORM F
Please complete this form and submit it with your weekly documentation.
Company Name
Project Name
Date Submitted

MonthDayYear
Date
Week Ending

MonthDayYear
Date
MondayTuesdayWednesdayThursdayFridaySaturdaySunday
Check and submit the following:
Pre-Job Hazard AssessmentsWeekly Toolbox Safety TalksWeekly Safety InspectionEquipment Inspections (PME)
# Pre-Job Hazard Assessments
# Orientations Conducted
# Total Personnel on Site (including management, staff & workers)
Person hours worked this week (average # of personnel daily x 40 hours)
Name (s) of First Aiders
Names of Supervisors (Foreperson) on Site:
Hold Ctrl to select multiple names
Additional Information Reports must be submitted to EllisDon within 24 hours
Disciplinary Actions:
Warnings
Suspensions
Incidents:
Lost Time
Medical Treatment
Restricted Work
First Aid
Near Miss
Damage
List of all "Sub" Sub contractors
1.
2.
3.
Comments
Form Completed By
Email
example@example.com
Should be Empty: