Daily Sign-Out Form - Unbc Security Field Work Emergency Assistance Programme

ADVERTISEMENT

DAILY SIGN-OUT
UNBC SECURITY FIELD WORK EMERGENCY ASSISTANCE PROGRAMME
Project Name: ___________________________________________________________________
Work Location:_________________________________________________________________
Planned Work Location(s) in order: (be as descriptive as possible with UTM co-ordinates to approx. centre of
block or destination)________________________________________________________________________
Location # 1: ________________________________________________________________
UTM co-ordinates: E ________________ N ______________ from ____a.m./p.m. to ____ a.m./p.m.
Location # 2: _____________________________________________________________________
UTM co-ordinates: E ________________ N ______________ from ____a.m./p.m. to ____ a.m./p.m.
Map Attached
Yes
No
Road Travel Routes:
Truck will be parked at _____km on the _________________________ Road from (time)_______ to ______.
and ________km on the______________________________________Road from (time) _______ to ______.
Vehicle Description:
Vehicle Description: Make____________Model_____________Year__________ Colour_________
License Plate #______________
Alternate modes of travel include (e.g., ATV, snowmobile, boat etc.) _________________________
Travel Information:
Date of Departure:
Time of Departure:
Expected Date of Return:
Time of Return:
# of Persons on Trip:
Crew Leader Phone #:
Crew Leader Name:
Name(s) of crew members:___________________________________________________________
__________________________________________________________________________________
Is Field Crew Information Form Attached
Yes
No
Other Information about trip/crew (e.g., medical conditions, communication devices – radio channels used,
cell/satellite phone #): ____________________________________________________________
In-Town Contact(s) (should be able to verify arrival after work; at least one should be familiar with today’s site):
Name
Phone#
Supervisor? (Y/N)
Familiar with site?
(Y/N)
Return Information: Security complete this section when person/group has returned
Time: ________________________
Date: _________________________
Security Signature:
COMMENCE EMERGENCY PROCEDURE 1 HOUR AFTER EXPECTED RETURN TIME UNBC Security
#960-7058
Call
Date & Time
Notes
1. Crew Leader or Crew Member:
2. Contact Person:
3. Security Supervisor:
4. Other (RCMP):
Department of Purchasing, Contracts & Risk Management
Rev. 2 – 10 Mar-09
Page 1 of 2

ADVERTISEMENT

00 votes

Related Articles

Related forms

Related Categories

Parent category: Business
Go
Page of 2