Start of Day Health Report
Please fill out this form before every workday.
Completed By
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
Date
Supervisor
*
First Name
Last Name
Job Name
*
Are you leaving the job site free from any injuries?
*
Yes
No
Did you complete the JHA form today?
*
Yes
No
Signature
Continue
Continue
Should be Empty: