School Name: Address: / Time work began: am pm
Employee(s): / Time exited site: am pm
Site conditions upon arrival:
Accumulation:______”
Snow moisture: [ Dry/powder] [ Moderate] [Wet/heavy] [ Slush] [ Just Plowed]
Drifting Present: [ Y] [ N] Ice: [ Y] [ N]
Traffic: [ None] [ Occasional] [ Light] [Moderate] [ Heavy]
Obstructions to note: ______/ Weather Conditions during service:
Current Precipitation: [None] [Flurries] [ Moderate Snow] [Rain] [ Sleet] [ Heavy Snow/whiteout] [Freezing rain]
Conditions: [ Calm] [ Breezy] [Windy]
Cloud cover: [ Sunny/clear] [Cloudy]
Other extreme/atypical weather notes:
______
Work Performed:
Plowing & Clearing
Roads & Lots
r Plowing – All areas
r Plowing – Partial
r Entrance / Exit
r Handicap
r Road & Roadways
[Front] [Rear] [Side] [Other]
r Parking Areas
[Front] [Rear] [Side] [Other]
r Loading Docks/Delivery Area
r Bus Lane
r Ramps
r Dumpsters/trash receptacles
r ______
Walks
r Clear Sidewalks – All areas
r Clear Sidewalks – Partial
r Entrance door(s)
r Service doors
r Ramps
r Steps
r Walks [Front] [Rear] [Side] [Other]
r ______
Site Check Only
r No Service Performed
/ Ice Management
Roads & Lots
r De-Ice – All areas
r De-Ice – Partial
r Entrance / Exit
r Handicap
r Road & Roadways
[Front] [Rear] [Side] [Other]
r Parking Spots / Areas
[Front] [Rear] [Side] [Other]
r Loading Docks/ Delivery Area
r Bus Lane
r Ramps
r Dumpsters/trash receptacles
r ______
Estimated Materials Used
Salt: ______bags or ______lbs.
Calcium: ______bags or ______lbs.
Walks
r De-Ice Sidewalks – All areas
r De-Ice Sidewalks – Partial
r Entrance door(s)
r Service doors
r Ramps
r Steps
r Walks [Front] [Rear] [Side] [Other]
r ______
Estimated Materials Used
Salt: ______bags ______lbs.
Calcium: ______bags ______lbs.
Site Check Only
r No Service Performed
This is a template that may not fit the exact needs of your location. Please customize this form to fit your needs. Contact the Multi-Line Program if you have any questions or would like to find out about additional snow/ice management resources.
802-223-6132 ext. 207 or