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Get tl@r y Inc. Daily Report <br /> Work Order p�ll`� ;5�7 JSA# _ _ SAFETY FIRST <br /> PO# _ ® Q � v — - - - -. -- - - - - - Date: <br /> Site# Location: ��, 1 ❑S❑M❑T❑W❑THW-� S <br /> Temp. <br /> -- -- -- - - <br /> Supervisor P.M. Weather: Ua-�56—n ❑ Rain ❑ Fog ❑ cloudy ❑ Windy <br /> Employee Travel Time Onsite Time Tours Task Steps: Safety Meeting <br /> �i / Complete Breaks&Lunch Observed ❑Y ❑ N <br /> w <br /> w „r_^,✓ <br /> O / <br /> d � <br /> M ' r <br /> w <br /> Log# Work Performed Hours <br /> U) <br /> w <br /> O <br /> w <br /> (D <br /> z <br /> Q <br /> U <br /> Materials Used Ref. Number Complete/Return Visit&Description <br /> U) <br /> Q <br /> w <br /> Q Rental Equip./Temp, Utilities Term# Hazards Not Covered by JSA: <br /> Company Equipment Used Mileage <br /> �rviceTruck(s) Truck NumbersJ''�� <br /> Examples of Higher/Medium Risk Tasks: <br /> w ❑ Backhoe ❑ Skid Steer ❑ Test Equip.❑ Safety Equ. <br /> ®- ❑ compressor❑ Generator ❑ Laser Equip.❑ Blower Set <br /> D Work at Heights ❑ Trenching/Excavating ❑ <br /> CY OTHER EQUIPMENT Hoisting/Rigging ❑ Work in Confined Space ❑ <br /> w Hot Work ❑ LPG System Work ❑ <br /> Remarks I Accidents/Visitors ' <br /> PPE Required �ty vest loves [!rmard Hat ❑ Ear Plugs <br /> ®-Ruots �asses ❑ Respirator ❑ Other <br /> Date: <br /> Customer Signature <br />