COVID Health and Safety Checklist Data Reporting

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This is how we make the safety checklist a tool with teeth! Please complete these form each time you do a building walk-through with your checklist.

First Name *

Option 1

Clear selection

Last Name *

Personal Email Address *

Phone Number

Who is filling this out? (Check one.) *

I am a TABCO Member

I am an ESPBC Member

I am a TABCO/ESPBC officer

I am a TABCO/ESPBC staffer

Required

Worksite

Check all categories that are being violated Today. (Please submit only one form per day) *

HEALTHY ENVIRONMENT

AIR QUALITY

SOCIAL DISTANCING

FACE COVERINGS AND MITIGATION

CONTACT TRACING

HYGIENE

CLEANING

SCREENING

TRANSPORTATION

COMMUNICATION

OTHER INSIDE

OUTSIDE

Required

Specific Sections Violated Today (Check all that apply) *

Required

Are any of these violations repeat violations?

Yes

Clear selection

If you answered yes above indicate the section or sections that have been repeatedly violated.

Submit

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