• Job Safety Analysis

    Job Safety Analysis

  • Job Safety Analysis Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Job Safety Analysis Time In
  • Did you go on a errand?
  • Time In/Out
    Until
  • Foreman
    Rows

  • Equipment on Job Site

  • Georgia Buggy
  • Baby Riding Trowels
  • Are the machines properly working?
    Rows
  • Is the area clean?
  • Is everyone wearing PPE?
  • Do the crew need any tools?
  • Is there any/enough H20 for everyone?
  • Is everyone contributing to the work?
  • Are there any violations today?
  • Any injuries on the job site today?
  • Are all vehicles and equipments out of traffic way?
  • Is the truck tidy?
  • Is the trailer tidy?
  • Is equipment operator wearing seatbelt?
  • Do you want to make additional comment/information for this job site?

  • Work Area Evaluation

  • Have you walked your area?
  • Are you working around live systems?
  • Does this task require special training?
  • Do you have your SDS?
  • Do you have all PPE for this job?
  • Have all GFRI's been inspected?
  • Have harnesses and lanyards been inspected?
  • Are you familiar with evacuation routes and assembly point?
  • Do you have emergency equipment: Fire extinguisher, 1st Aid, eye wash?
  • Are all required tools/equipments checked for safety?
  • Have all tools/equipments been inspected prior to use?
  • Is your work area congested?
  • Did you perform toolbox talks with the crew?
  • Gas - Diesel Log
    Rows
  • Truck - Trailer Log
    Rows
  • Any hazards or debris?
    Rows
  • Hazard
  • How was it fixed?
  • When was hazard resolved?

  • Crew Observation

  • Observation: Mauro Crew
    Rows
  • Observation: Danny Crew
    Rows
  • Observation: Ulises Crew
    Rows
  • Observation: Eliseo Crew
    Rows
  • Observation: Sergio Crew
    Rows
  • Observation: Fernando Crew
    Rows
  • Observation: Rito Crew
    Rows
  • Observation: Isabel Crew
    Rows
  • Observation: Pedro Crew
    Rows
  • Observation: Manuel Crew
    Rows
  • Observation: Rene Crew
    Rows
  • Observation: Fabian Crew
    Rows
  • Observation: PorkChop Crew
    Rows
  • Observation: Noe Castro Crew
    Rows
  • Observation: Juan Crew
    Rows
  • Observation: Hernan Crew
    Rows
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  • Job Safety Analysis Time Out
  • Tool Box Topic

    Tool Box Topic

  • Date
     - -
    2 digit month, 2 digit day, 4 digit year

  • I have not nor have I witnessed any injury during the course of this week while working for PCM Construction, Inc. I am not aware of any injuries that have not been reported. I am not aware of any person employed on this stie that are currently injured. 

    No he presenciado ni he sido testigo de ninguna lesion durante el transcurso de esta semana mientras trabajaba para PCM Construction, Inc. No tengo conociemiento de ningun herido que no haya sido reportado. No conozco a ninguna persona empleada en este sitio que este lesionada actualmente.

  • Disciplinary Action Form

    Disciplinary Action Form

  • Report Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Is Report Date same as Violation Date?
  • Violation Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Time of Violation
  • Violation
  • Has the employee been warned (verbal or written) in the past?
  • Violation History

  • Management Statement

    Reviewer, please detail out the violation. Include names of all involved parties, include equipments, tools, or any objects that contributed to the violation, and comment if there has been verbal or written warnings prior to this write up.

  • Employee Statement

    Reviewee, please detail out your comment to the violation. Include names of all involved parties, include equipments, tools, or any objects that contributed to the violation, and any additional comment you would like to record in the write up.

  • Decision

    Reviewer, please detail out the decision being addressed to correct the violation. Example: Two weeks of observation to ensure the employee is making effort to correct the violation and if the employee displays a lack of effort to correct the violation, they will be placed on probation or immediate termination.
  • Workplace Incident Report

    Workplace Incident Report

  • Report Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Is Report Date same as Incident Date?
  • Incident Date
     - -
    2 digit month, 2 digit day, 4 digit year
  • Time of Incident
  • Was heavy equipment or tools involved?
  • Invovled Equipment-Tools List
  • Was anyone injured?
  • Injured Person(s) List
  • Any witnessess?
  • Witness List(s)
  • Should be Empty: