Information

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Worksite Arrival/Parking

  • Traffic management assessed (Is your vehicle parked in a safe location?)

  • Traffic cones deployed?

  • Vehicle secured if unattended?

Assess/review the job and it's surroundings

  • Weather conditions suitable?

  • Light sufficient for all tasks?

  • All appropriate PPE Available and in use at all times?

  • Special Equipment/Tools Required?

Accessing customer's premises

  • Ground surfaces assessed for trips and slips? (Inside and Outside residence)

  • Environmental Hazards assessed? (Noise, Chemical, Health, Electrical)

  • Working at height assessed?

  • Safe access to equipment?

Ladder Usage

  • Ladder is in proper condition?

  • Ground surface level and clear?

  • Sufficient lean possible and used? (4:1 ladder angle)

  • Clear fall area assessed?

  • Ladder tied off/secure?

Roof Safe for Access

  • Roof is stable and sturdy for load bearing?

  • Roof material in satisfactory condition?

Aerial T-Pole

  • Pole integrity assessed?

  • Clear fall area assessed?

  • 4 Secure Anchor points?

  • Guy wires secure and unrestricted?

Additional comments

  • Additional comments

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The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.