End of Day Report

End of Day

Subcontractor

Completed By:

Date / Time

Supervisor:

Job Site:

Instructions: Any injuries or COVID-19 related symptoms must be reported to your supervisor immediately. Please Answer "Yes" or "No"

Time Clocked Out

Are you leaving the job site free from any injuries?

Yes

Did you complete the JHA form today?

Yes

Are you free from fever when reporting to work?

Yes

Are you free of COVID-19 symptoms when reporting to work? (Symptoms include fever, sore throat, headache, bodyaches, fatigue, runny nose or coughing.)

Yes

Are you free of COVID-19 symptoms when reporting to work? (Symptoms include fever, sore throat, headache, bodyaches, fatigue, runny nose or coughing.)

Yes

Are you free from direct exposure to a positive COVID-19 or suspected positive case?

Yes

Have you traveled out of the country, visited a "hotspot state" or went on a cruise in the last 14 days?

Yes

Have you traveled out of the country, visited a "hotspot state" or went on a cruise in the last 14 days?

Yes

Is everyone on site practicing physical distancing and have access to proper facial secretion suppressor and sanitary agents?

Yes

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End of Day Report

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