P&S Job Site Safety Inspection

Vehicle and Equipment Damage Notification
Date*

MonthDayYear
Date
Employee Name

First NameLast Name
Phone Number

Area CodePhone Number
Equipment Unit #
Supervisor*

Chris PettisCody ZimmermanEric OdonelJoe PerezJosh DiGulioKris GardnerMichael KovalPaul SchaiderSean SesherZach McCoyOther
Other Employees/Witnesses On-site
Description of Damage:*
Description of Incident (What happened):*
Location of Incident:*
What could have been done to prevent the incident:*
Were other people involved in the incident?*
How many other people were involved in the incident:
Name person involved

First NameLast Name
Phone Number

Area CodePhone Number
Name person involved

First NameLast Name
Phone Number

Area CodePhone Number
Name person involved

First NameLast Name
Phone Number

Area CodePhone Number
Was there damage to other equipment and/or vehicles? *
What other equipment was damaged?
Was a person injured during the incident? *
Report the injury and the incident to the Safety Manager
Photos of the Damage
How many photos would you like to include:*
Description of the photo above:
Description of the photo above:
Description of the photo above:
Description of the photo above:
Description of the photo above:
Description of the photo above:
Should be Empty:

Vehicle and Equipment Damage Notification