Contractors Weekly Ehs Report (Page 2 of 2) in pdf

Contractor’s Weekly EHS Report

Instructions:

This form is to be completed at the end of each week that work is performed by a contractor on SURF property. The form is to be

turned in, with all of the pertinent attachments, to the SURF POC by Tuesday of the following week.

Fill in the top portion of the form with the requested information. List all subcontractors that worked on the project during the week

being reported.

List all attachments that accompany this form. The following is a list of possible required attachments.

New and Revised JHAs:

Confined Space Entry Permits

Weekly Inspection Form

Toolbox Talk with Attendance Roster

Hot Work Permits

First Report of Injury/Incident

Excavation Permits

Incident Data Collection Form

Daily Trenching Log

Investigation Reports

Mobile Equipment Inspections

Personal Sampling Results

LOTO Documentation

Site Orientation Documentation for New Workers

First Aid Log if New Entries Have Been Made

Report all major activities completed to include EHS activities

Report the number of OSHA recordable injuries occurring during the week with a brief description of each and attach a copy of the

First Report of Injury/Incident Form, Incident Data Collection Form, and any Tap Root, or other investigation documents. The

originals documents must be turned in within the following timeframes as specified in the CEHS Manual and copies included with this

report.

Initial Report

As soon as the scene is stabilized (but not more than 1 hour)

First Report of Injury/Incident Form

By the end of shift

Preliminary Investigation Report

24 Hours

Detailed Investigation Report

4 Days

Report any First Aid cases or Near Misses reported to you either verbally or in writing to include those reported on the 5-point cards.

Report all Environmental releases

Contractors are required to do a documented self inspection at least once each week. Report the findings from that inspection and any

other inspections conducted and the resolution of those findings. Attach a copy of the inspection form to this report.

Contractors Weekly Ehs Report Page 2