Wildlife Stop Work Form
Report and document any stop-work event due to wildlife presence or wildlife-related safety issues.
Date and Time of Stop-Work Event
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Hour Minutes
AM
PM
AM/PM Option
Location of Incident
*
Type of Work Stopped
*
Please Select
Construction
Maintenance
Surveying
Excavation
Landscaping
Other
Wildlife Observed
*
Bird(s)
Mammal(s)
Reptile(s)
Amphibian(s)
Insect(s)
Other
Describe the Wildlife Observed (species, number, behavior, etc.)
*
Describe the Hazard or Concern
*
Immediate Actions Taken
*
Ceased all work
Evacuated area
Notified supervisor
Contacted wildlife specialist
Other
Was a Supervisor Notified?
*
Yes
No
Is Follow-up Action Required?
*
Yes
No
Unsure
Name of Person Reporting
*
First Name
Last Name
Submit Report
Should be Empty: