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frS .1 t:Emplcyee *
<br />fmployee Name
<br />OATE
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<br />5TARTTIME
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<br />r-JSelland Construction, Inc'
<br />(M)(w) trH) {F) (sA}
<br />Beginnlng
<br />Ending
<br />Accident Yes- No---
<br />GallonsofFuel: on** 115 0ff-Hwy
<br />lf AccidentwasTruck/Trailerloaded: Yes- No-
<br />TOTAL
<br />DAWN
<br />T'ME
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<br />Employee 5ignature Foreman APproval
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