Information
-
Document No.
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Personnel
Work Area Preparation
-
Hot Work Permit: Permit posted, etc.
-
Spills and Slippery Surfaces: Identified and corrected
-
Tripping Hazards: Identified and corrected
-
Housekeeping: Area picked up and clean for safe work
-
Guards and Barriers: In place and working
PPE
-
Head Protective: Hard hats in use with overhead work
-
Eye and Face Protection: safety glasses and faceshield
-
Hearing Protection: In required areas
-
Hand Protection: Moving material, using knives etc.
-
Arm Protection: When using knives, chemical use etc.
-
Foot Protection: Wearing required steel toed shoes
-
Body Protection: When working w/ acids, chemicals etc
-
Respiratory Protection: When required
-
Fall Protection: When falls of 6' or greater, ladder use
Body Mechanics and Ergonomics
-
Lifting/Carrying/Pulling/Pushing: Body movement
-
Line of Fire: Body location, regarding machine ops.
-
Pinch Point: Body location between objects.
-
Path of Travel: Body location between equipment
-
Path of Travel: Climbing from one elevation to next
-
Path of Travel: Flat surface
Tools and Equipment
-
Selection: Proper tool or equipment for job
-
Condition: Tools & equipment in safe conditions for use
-
Use: Tools & equipment being used as intended
-
Mobile Equipment: Inspected prier to use, safe ops.
Follow Up
-
Is any follow up required?
-
Add media
Commendable behaviors observed:
-
Add media
