Health Check Format

LSP Name

LSP SV Name

Time & Date (Day) , (Month) , (Year) ( ( ) ) : ～ :

Place / Site ID

Work detail

Leader

th check ・ take action on site

・ previous illness : pay enough attention ex. diabetes, hypertension, heart disease, renal insufficiency, mental disease, nervous disease, dermatosis, etc
Check health Heatstroke Prevention Daily Report
NO. Worker Name previous
alcohol break-fast sleep time age 9:00 10:00 11:00 12:00 13:00 14:00 15:00 16:00 17:00 18:00
illness

1 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

2 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

3 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

4 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

5 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

6 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

7 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

8 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

9 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

10 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

11 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

12 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

13 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

14 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

15 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

16 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

17 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

18 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

19 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

20 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

21 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

22 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

23 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

24 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

25 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

26 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

27 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest
28 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

29 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest

30 □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest □water □rest