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ettler- n Inc. Daily Report <br /> "Work Orderi�_ e J JSA# SAFETY FIRST <br /> Date_ _ ^P O# �� t� /- -- -- —----Site# Location: ❑S[�f ❑T❑WE]THE]F❑S <br /> Temp. <br /> Supervisor P.M. Weather: �n ❑ Rain ❑ Fog ❑ Cloudy ❑ Windy <br /> Employee Travel Time Onsite Time Hours Task Steps: Safety Meeting <br /> S ♦� �„� Complete [9-<❑ N Breaks&Lunch Observed ❑v ❑ N <br /> W <br /> _j 7, <br /> Log# Work Performed Hours <br /> W <br /> jov <br /> z <br /> e <br /> 3 <br /> v <br /> Materials Used Ref. Humber Complete/Return Visit&Description <br /> V/ <br /> LW <br /> r <br /> Rental Equip./Temp. Utilities Term# Hazards Not Covered by JSA: <br /> Company Equipment Used Mileage <br /> [jserviceTruck(s) Truck Numbers© <br /> Z Backhoe Examples of Higher]Medium Risk Tasks: <br /> W ❑ ❑ 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!Accidents/Visitors <br /> PPE Required aety Vest ��es [A-44rdHat ❑ Ear Plugs <br /> _W <br /> voo s �tnses ❑ Respirator ❑ Other <br /> Date: <br /> Customer Signature <br />