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SECOND QUARTER SIP FORM - (APRIL 1 - JUNE 30, 2026)
DUE: JULY 10, 2026

MUNICIPALITY:(Required.)
1. QUARTERLY SAFETY COMMITTEE MEETING
DATE
Departments Attending:
Minutes from meeting were submitted to Don Ruprecht.
Injuries/Claims were reviewed?
2. INSPECTIONS OF FACILITIES, VEHICLES AND MAJOR EQUIPMENT

Check the box for the major Departments who complete documented inspections of their buildings, vehicles, and major pieces of equipment:
3. ANNUAL MOTOR VEHICLE RECORD VERIFICATIONS:
4. FORMAL INSTRUCTOR-LED CLASSES, EITHER IN-PERSON OR VIRTUAL

Check the box for the major Departments whose employees attended at least 1 class this quarter:
5. ASYNCHRONOUS LEARNING (MSI LIVE, OR OTHER RECORDED CLASSES AND VIDEOS

Check the box for the Major Departments whose employees attended asynchronous learning:
6. JOB SITE OBSERVATIONS

Check the box for the major Departments who hold job site briefings, workplace coaching or after-action debriefings:
REPORT SUBMITTED BY:(Required.)
PLEASE CLICK THE "DONE" BUTTON BELOW. THANK YOU