| Project Address |
|
| General Contractor |
|
DOB Job No. |
|
| SSM Name |
|
SSM License No. |
|
| Building Floors Under Construction |
|
Total Strap Locations |
|
NOTICE: Any defect, missing strap, or non-conforming installation must be remediated before workers are permitted on the affected floor. All deficiencies must be reported to the SSM at once. Per BC §3315, workers are prohibited above any floor level where safety strap protection is impaired.
| # |
Date |
Floor / Location |
Straps In Place (Y/N) |
Defect Found (Y/N) |
Corrective Action Taken |
SSM Initials |
| 1 | | | | | | |
| 2 | | | | | | |
| 3 | | | | | | |
| 4 | | | | | | |
| 5 | | | | | | |
| 6 | | | | | | |
| 7 | | | | | | |
| 8 | | | | | | |
| 9 | | | | | | |
| 10 | | | | | | |
| 11 | | | | | | |
| 12 | | | | | | |
| 13 | | | | | | |
| 14 | | | | | | |
| 15 | | | | | | |
| 16 | | | | | | |
| 17 | | | | | | |
| 18 | | | | | | |
| 19 | | | | | | |
| 20 | | | | | | |
| 21 | | | | | | |
| 22 | | | | | | |
| 23 | | | | | | |
| 24 | | | | | | |
| 25 | | | | | | |
| 26 | | | | | | |
| 27 | | | | | | |
| 28 | | | | | | |
| 29 | | | | | | |
| 30 | | | | | | |
| SSM Name (print) |
|
License No. |
|
| Signature | | Date | |