Report an Injury - Please fill out
Work Date
Work Order Name
Job Order
Job Name
Arborist
Site
5150 Falcon Chase Lane Northeast, Atlanta, GA, 30342
*********LINE ITEM ***********
Type of Work/Service Name:
*********LINE ITEM ***********
Type of Work/Service Name:
*********LINE ITEM ***********
Type of Work/Service Name:
TRPs, Closures, Tasks, Waivers, etc.
TASK: Tree(s) are not tagged Arborist will return to tag tree(s) being removed
TRPs, Closures, Tasks, Waivers, etc.
TASK: The project either has stumpgrinding, planting or some other underground work. Please ask your Arborist if you are unsure of why you have a utility locate request. Boutte Tree will call 811 to have the underground public utilities (gas, electric) located and painted before this job is done to prevent any digging to interfere with buried gas lines or electrical wires. Allow 3-5 days after calling to make sure that they come out on time to do the locating. Although Boutte Tree is calling in the 811, the Owner agrees to make the Contractor aware of any utilities, public or private, even those that have been located by 811. 811 will typically mark the entire property or area with flags and paint as policy. See Boutte terms covering Underground Utilities.
TRPs, Closures, Tasks, Waivers, etc.
TASK: Arborist to inspect jobsite at the START of work to ensure the project is on track and the work meets his and the client's expectations Boutte Tree office will make arrangements for Arborist to be present on site but they will not stay for the entire project unless otherwise stated in contract
Post Job Questions:
Work Order Line Item #
Internal Notes
Service Description
<p>Prune Red Maple at front, right of driveway</p><ul><li>Remove dead limbs 2" and larger</li><li>Remove crossing/rubbing limbs</li><li>Remove low drooping limbs</li><li>Remove 4" leader growing over Cryptomeria (provide 5' of clearance to Cryptomeria)</li></ul><p>Objective is to allow more light to the row of Cryptomeria and improve appearance.</p><p> </p><p>Haul away tree debris.</p>
Type of Work/Service Name:
Price
Work Order Line Item #
Internal Notes
Service Description
<p>Prune Red Maple at front of house</p><ul><li>Remove 2" dead limbs and larger</li></ul><p> </p><p>Objective is to reduce the risk of branch failure.</p><p> </p><p>Haul away tree debris.</p>
Type of Work/Service Name:
Price
Work Order Line Item #
Internal Notes
Service Description
<p>Remove additional 3" limb growing over house during Maple prune Front left</p>
Type of Work/Service Name:
Price
Task Status
Was Anyone Injured
Please select...
Yes
No
Name of Injured Worker
Please select...
Alex Soriano
Antulio Giron
Benjamin Johnston
Bryan Martinez Del Rello
Candidate Worker - On Interview
Carlos Garcia
Christian Malcolm
Curtis Miller
Derrick Angles
Diego Ivan Martinez
Dirk Brown
Edward Kelemencky
Eric Duncan
Erick Reyes
Falarryo Buckley
Gabriel Martinez
Gerber Lopez
Gustavo Carillo
Isaiah Coffey
Israel Martinez
Jacob Jenkins
James Hawkins
Jeremy Hardison
Jesus Ivan Rogel Mercado
John "Frank" DeFrances
Jonathan Covarrubias
Jorge Antonio Araujo
Josh Turner
Juan Jose Mendoza
Juan Laracuente
Juells Dorton
Julio Cesar
Leonardo Hernandez
Marcelo Barrera
Marcos Martinez
Martin Rangel
Michael Crowe
Miguel Hernandez
Milton Polio
Nahun Lemus
Orlando Misael Diaz Morales
Osvaldo Martinez
Ricardo Cano
Sal Aguilar
Stephen "Fletch" Locke
Stephen Sindall
Sterling Copeland
Thomas Cross
Tierson Boutte
Tyler Baxter
Yovaniel Rivera
Zach Moore
Explain injuries:
Injury Date
Injury Time
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7am
8am
9am
10am
11am
12noon
1pm
2pm
3pm
4pm
5pm
6pm
7pm
8pm
9pm
10pm
Injury Day of the Week
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Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Injury Site Conditions (grade, terrain, proximity to targets, etc.)
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Grade
Terrain
Proximity to targets
Other
If Other, please explain:
Injury Environmental Conditions
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Heat
Sun
Rain
Wind
Other
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Injury Risk Anticipated and/or documented in Job Site Safety Briefing/in Pre-Job Safety?
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Yes
No
Please Explain Injury Risks Anticipated
What object or substance caused harm?
What is the injury or illness?
What happened to cause the injury?
What was employee doing before injury?
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