Sierra Safety Training
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JSAS Report
Name
*
Date
Date Format: MM slash DD slash YYYY
JSAS Phone Number
(530) 278-8080
JSAS Email
mike@sierrasafetytraining.com
Client
*
Project Name
*
Number Of Workers
Is project open to public?
COVID-19 Supervisor
Project Size
PROTOCOLS
Has client established a Social Distancing Protocol?
Yes
No
N/A
Needs Improvement
Have the protocols been distributed to all employees?
Yes
No
N/A
Needs Improvement
Have all workers been trained in the protocol?
Yes
No
N/A
Needs Improvement
SUBCONTRACTORS
Does client have subcontractors on site?
Yes
No
N/A
Needs Improvement
Have all subcontractors reviewed SIP orders & Directives?
Yes
No
N/A
Needs Improvement
Have all subcontractors trained employees on protocols?
Yes
No
N/A
Needs Improvement
Have all subcontractors submitted copy of protocols to client?
Yes
No
N/A
Needs Improvement
REPORTING
Have any positive cases of COVID-19 been reported in the past 48 hours?
Yes
No
N/A
Needs Improvement
Have those cases been reported to County Health?
Yes
No
N/A
Needs Improvement
Have areas where a worker with a confirmed case been sanitized?
Yes
No
N/A
Needs Improvement
PPE
Is PPE available for workers
Yes
No
N/A
Needs Improvement
Any workers observed not using or properly using PPE?
Yes
No
N/A
Needs Improvement
SOCIAL DISTANCING, SANITIZING, & OTHER MEASURES
Is the project compliant with density limitations?
Yes
No
N/A
Needs Improvement
Are workers maintaining and able to maintain 6' separation?
Yes
No
N/A
Needs Improvement
Has the project eliminated "choke points" and "high-risk areas"?
Yes
No
N/A
Needs Improvement
Are workers able to take breaks and eat their meals outdoors?
Yes
No
N/A
Needs Improvement
While on break, are workers able to maintain social distancing?
Yes
No
N/A
Needs Improvement
Have any workers been observed sharing food or beverage?
Yes
No
N/A
Needs Improvement
Is water available on site in single serve containers?
Yes
No
N/A
Needs Improvement
SIGNAGE
Are signs available in existing languages on site?
Yes
No
N/A
Needs Improvement
Which Signs Are Available?
Do not touch your face with unwashed hands or gloves
If equipment is shared, it must be fully sanitized before and after each use
Wash your hands often with soap and water
Clean and disinfect objects and surfaces often
Cover your mouth and nose with a tissue or cloth
Do not enter the jobsite if you have a fever, cough
Constantly make sure you are staying at least 6 feet away
Do not carpool to and from the jobsite
Do not share phones or PPE
COVID-19 Symptoms and Required Practices
Social Distancing Protocol
Face Mask Dos and Don'ts
LARGE CONSTRUCTION PROJECTS
Does this project qualify as a "Large Construction Project"?
Yes
No
N/A
Needs Improvement
Has a daily briefing been held either in person or teleconference?
Yes
No
N/A
Needs Improvement
New jobsite rules and pre-jobsite travel restrictions discussed
Yes
No
N/A
Needs Improvement
Review of sanitizing and hygiene procedures?
Yes
No
N/A
Needs Improvement
Coordination of construction site daily cleaning requirements?
Yes
No
N/A
Needs Improvement
New information regarding COVID-19 discussed?
Yes
No
N/A
Needs Improvement
Emergency protocols in the event of exposure or suspected exposure discussed?
Yes
No
N/A
Needs Improvement
OCCUPIED SITES
Is the work site an occupied residential or commercial building?
Yes
No
N/A
Needs Improvement
Is the work area sealed off from the remainder of the building?
Yes
No
N/A
Needs Improvement
Are entry/exit doors different from doors used by occupants?
Yes
No
N/A
Needs Improvement
Is ventilation available any time work is performed?
Yes
No
N/A
Needs Improvement
Do occupants have access to the work area after hours?
Yes
No
N/A
Needs Improvement
Is the work area cleaned and sanitized at the beginning and end of each work day?
Yes
No
N/A
Needs Improvement
Has every effort been utilized to minimize contact between workers and occupants?
Yes
No
N/A
Needs Improvement
Comments
Name
Signature
Date
Date Format: MM slash DD slash YYYY
