Construction Site Intolerance Assessment Form
Evaluate and document intolerance factors and potential safety issues on the construction site.
Site Name
*
Site Location
*
Assessment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Assessor's Full Name
*
First Name
Last Name
Contact Email
example@example.com
General Site Conditions
*
Rows
Excellent
Good
Fair
Poor
Cleanliness
1
2
3
4
Organization
5
6
7
8
Signage/Markings
9
10
11
12
Access/Egress
13
14
15
16
Rate the following environmental intolerance factors:
*
Rows
None
Low
Moderate
High
Noise
17
18
19
20
Dust
21
22
23
24
Vibration
25
26
27
28
Chemical Exposure
29
30
31
32
Temperature Extremes
33
34
35
36
Lighting Issues
37
38
39
40
Which area(s) are most affected by intolerance factors?
Work Zones
Break Areas
Access Routes
Storage Areas
Other
How frequently are intolerance issues reported by workers?
*
Never
Rarely
Sometimes
Often
Always
Worker Comfort Level (1 = Very Uncomfortable, 5 = Very Comfortable)
*
Very Uncomfortable
1
2
3
4
Very Comfortable
5
1 is Very Uncomfortable, 5 is Very Comfortable
Have any incidents occurred due to intolerance factors?
*
Yes
No
Comments or Recommendations for Improvement
Submit Assessment
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