SHIELDS

SHIELDS

Sharing Hazards, Identifying, Educating, Locating & Developing Solutions

Our goal is to reduce injuries or incidents that occur by making employees aware of potential hazards, and implementing solutions through sharing SHIELDS.

A SHIELDS occurrence can be defined as an unforeseen incident, act or condition that although not resulting in property damage or injury, had the potential to do so if the factors had been slightly different. It is important to review all SHIELDS occurrences and share appropriately so that we may continue to make SAFETY/Our Way of Life.

**Please fill out thoroughly so your concerns can be addressed.**

Question Title

* 1. Region

Construction AR

Construction IL

Construction MO

Aggregates IL

Aggregates MO

Ready Mix

Heartland Asphalt Materials

Other (please specify)

Question Title

* 2. Location (job site or facility location):

Question Title

* 3. Date:

Question Title

* 4. Time:

Question Title

* 5. Occurrence had the potential to cause:

Property/Equipment Damage

Injury to Employee

Damage or Injury to Third Party

Question Title

* 6. Description of occurrence or potential hazard:

Question Title

* 7. Corrective action taken by you (if applicable):

Question Title

* 8. Employee Name (optional):

Question Title

* 9. Foreman Name:

Question Title

* 10. Do you want to upload a photo?

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.

Choose File