Title Page

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Site setup checklist (check all that apply)

  • PPE

  • Signs/cones placed

  • Wheels chocked

  • Customer contacted

  • Stretch/warm up

  • Property damage noted

Recognized hazards (check all that apply)

  • Pedestrian/vehicle traffic

  • Co vehicle placement

  • Job access

  • Energized electric

  • Fire explosion

  • Struck by's

  • Slip/trip/fall hazard

  • Pinch point/caught betweens

  • Excessive noise

  • Eye injury

Hazard protection (check all that apply)

  • Hearing protection

  • High volt elec. protection

  • Barrier protection erected

  • Propane/gas tanks isolated

  • Material safety data sheet

  • Equipment inspection

  • Tool inspection

  • Flagger/traffic control

Pre task review (check all that apply)

  • Discuss yesterday's incidents

  • Site safety orientation complete ?

  • Job scope understood ?

  • Good catch documented ?

  • Site safety assessment completed ?

  • Other comments

Post-task checklist (check all that apply)

  • All excavations secured

  • Customer equipment secured

  • Signs/cones removed

  • Truck/trailer/equipment secured

  • On-site equipment secured

  • Add signature

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.