Information

  • Conducted on

  • Prepared by

1.0 PPE Correct

  • 1.1 Head Protection

  • 1.2 Eye/Face Protection

  • 1.3 Hand/Foot Protection

  • 1.4 Hearing Protection

  • 1.5 Clothing

  • 1.6 Respirator

2.0 Manual Lifting

  • 2.1 Correct body position

  • 2.2 Help for heavy items

  • 2.3 Hand placement

  • 2.5 Use of equipment

3.0 Line of Fire

  • 3.1 Hand/Body position

  • 3.2 Overhead hazards

  • 3.3. Rotating equipment

  • 3.4 Eyes on work or path

  • 3.5 Pinch/Shard edges identified & protected

4.0 Housekeeping

  • 4.1 Trash/Debris

  • 4.2 Cord/lead control

  • 4.3 Protruding items

  • 4.4 Correct barricades

5.0 Fall protection

  • 5.1 Trip hazard

  • 5.2 Fall arrest equip. use

  • 5.3 Correct ladder use

6.0 Tool Use

  • 6.1 Correct tool

  • 6.2 Used correctly

  • 6.3 Material secured

  • 6.4 Guards in place

  • 6.5 GFCI used

7.0 Equipment/Forklift/Skid Loader

  • 7.1 Seat belt use

  • 7.2 Inspection

  • 7.3 Equip. used properly

  • 7.4 Backing

9.0 Procedures

  • 9.1 Lockout/blinding

  • 9.2 Confined space

  • 9.3 Other procedure

10.0 Other

  • Item # - What is positive or at risk? / Corrective action or commendation?

  • Item # - What is positive or at risk? / Corrective action or commendation?

  • Item # - What is positive or at risk? / Corrective action or commendation?

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.