• Is JSA Complete?

  • Has Onsite Personnel Signed The JSA?

Required PPE

  • Hard Hat

  • Safety Glasses

  • Face Shield / Goggles

  • Hearing Protection

  • Gloves

  • ANSI 107 Class II or III Safety Vest

  • Foot Protection / Safety Toe

  • FRC Clothing

  • Dust Mask


  • Excavation Type:

  • Is the excavation less than 20' deep?

  • Documented Inspection by Competent Person

  • Benched or Sloped Properly = Class A -3/4:1 Class B -1:1 Class C-1 1/2:1

  • Access / Egress Within 25' Of Entrants?

  • Trench Box/Shoring Proper

  • Trench Box Certifications

  • Spoil Pile Minimum 2-Feet From Excavation

  • Signs, Signals & Barricades

  • One Call Valid

  • Utilities Identified

Material Handling

  • Body Mechanics

  • Position of People

  • Manual Lifting Devices (Come-a-Longs, Chain falls, etc…)

  • Safety Latch

  • Slings

  • Hooks & Shackles

  • Wire Rope

  • Lifting Chains

  • Load Secure, Rigged Properly

  • Tag Lines Used


  • Authorized/Qualified Operator

  • Designated Signal Person

  • Seatbelt Used

  • Daily/Weekly/Annual Inspection


  • Dunnage

  • Trash

  • Trash Receptacles

  • Crew Trucks/Trailers

Material Storage

  • Material Stored Properly

  • Flammable/Combustible Storage

  • Pipe Chocked


  • GFCI/Assured Grounding Program

  • Cords/Tools – Inspected

  • Cords Routed Properly

Hot Work

  • Permit

  • Permit Conditions Followed

  • Fire Watch


  • Grinder Condition

  • Guards/Handles

  • Leads/Hoses/Gauges

  • Bottle Storage

Fire Protection & Prevention

  • Fire Suppression Equipment

  • Fire Extinguisher Inspection

  • Properly Rated/Size (BC versus ABC)

  • Combustible/Flammable Material Away from Hot Work

Traffic Control

  • Designated Flagger With Cones

  • Signs Posted per MUTCD

  • Escort Required/Used


  • Condition

  • Proper Type

  • Appropriate Location

  • Marking Hazards

Overhead Power Lines

  • Power Lines Marked with Goal Post and/or Signs

  • Designated Spotter


  • Signs, Signals & Barricades


  • Potential Energy Sources Identified

  • Isolated

  • Verified

  • Affected Personnel Informed


  • Restrooms & Potable Water Available

  • First Aid Kit

  • Confined Space

  • Fall Protection

Closing Comments

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. Any ratings or scores displayed in our Public Library have not been verified by SafetyCulture for accuracy. Users of our platform may provide a rating or score that is incorrect or misleading. You should independently determine whether the template is suitable for your circumstances. You can use our Public Library to search based on criteria such as industry and subject matter. Search results are based on their relevance to your search and other criteria. We may feature checklists based on subject matters we think may be of interest to our customers.