Safety Observations/Near Misses If this situation requires additional attention please call Landwehr Construction’s Safety AND COMPLIANCE DIRECTOR at 320-248-7164 Safety Observations/Near Misses Would you like to submit a Safety Idea or a Safety Oberservation/Near Miss?* Safety Idea Safety Observation/Near Miss Monthly/Annual Safety Award Nomination Name - Optional First Last Name - Optional First Last Date MM slash DD slash YYYY Date - When did the incident take place? MM slash DD slash YYYY Job - Where did the incident take place?What type of observation?* Positive Negative Not sure Describe the incidentWas anyone hurt? Yes No Please describe the nature of the injuryWas anything damaged? Yes No Please list the damaged equipment and damage details.Please describe your Safety Idea below:Would you like a follow up call? Yes No Would you like a follow up call? Yes No Name First Last Name First Last PhonePhone Safety Incentive Program Annual Award Nomination Employee Being NominatedName First Last Position Laborer Operator Foreman Shop Yard Driver Safety Driven Behavior Checklist Check all that applies to this employee's performance for the calendar year.* Actively participates in and contributes to Daily Take 5 talks throughout the calendar year Identifies and reports hazards, near misses, and unsafe conditions Provides practical safety suggestions that support a safer workplace Maintains an injury-free work record with no preventable incidents or safety violations during the award period Participant in ALL company provided quarterly or annual safety meetings Helps mentor others including new employees regarding safety procedures and training Promotes safe work practices through coaching and mentorship Properly uses required PPE at all times on job sites and yard Consistently demonstrates ongoing commitment to improving our culture of safety In 100 words or less, please describe leadership qualities and other reasons why this candidate is worthy of this award.*Nominated By:Name* First Last Date MM slash DD slash YYYY Title:Email PhoneCAPTCHA
