Blast Crew Pre-Task Checklist

• Job Site

• Manager

  Doug Nieder

  Tom Dowler

  MJ Russell

• Blaster in Charge

• Crew Members

• Conducted on

  Date

• Prepared by

• Location
  Address

• Document Number (leave blank)

Checklist

• Do all employees have proper PPE?

  Yes

  No

  N/A

• Are parking brakes set and wheels chocked?

  Yes

  No

  N/A

• Have blasting signs/cones been set up?

  Yes

  No

  N/A

• Have you notified the site supervisor and/or signed in?

  Yes

  No

  N/A

Task

• Summarize the task(s) for today's work

• Emergency meeting location

• Nearest hospital/urgent care

Hazards

• Weather

  Unsafe

  Fair

  Safe

• Ground Condition

  Unsafe

  Fair

  Safe

• Standing Water

  Unsafe

  Present

  Not Present

• Tripping Hazards

  Unsafe

  Present

  Not Present

• Fall Hazards

  Unsafe

  Present

  Not Present

• Utilities

  Unsafe

  Present

  Not Present

• Traffic

  Unsafe

  Present

  Not Present

• Parked Vehicles/Equipment

  Unsafe

  Present

  Not Present