testpage

Name

Date

Office
—Please choose an option—BurwellSelseyNot sure

AHS Number

Contracts Manager

Site Supervisor

I’m lead installer
—Please choose an option—YesNo

I’m fit to work
—Please choose an option—YesNo

I have a price
—Please choose an option—YesNo

I’m working Away
—Please choose an option—YesNo

I have the correct and fit for purpose PPE
—Please choose an option—YesNo

DaysNightsWeekends

Last shift before holiday
[group return-date]
Holiday Return Date

[/group]
Works Complete

Time In Yard

Time On Site

Time Left Site

Time Left Yard

Hours Worked

Driving Time

Time spent on break

Description of works

ITEM	QTY	RATE	TOTAL
Total Earned This Shift:

OTHERS ON SITE:	PAY:

Pay Me

I have CVI’sI have Sent photos of my CVI’s
[group CVI-group]


[/group]

HAVS Exposure Equipment (AN Number)

HAVS Exposure Time (Minutes)

Select if your hands are showing any signs of skin disorderI have not used vibrating tools today