Title Page
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Job name
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Job number
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Conducted on
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Competent person
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Prepared by
General safety
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Did you start your day by stretching?
General information. Mark all that apply.
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What are the hazards associated with the job?
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Chemical burn
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Extreme weather
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Particles in eyes
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Over exertion
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Elevator load
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Falls over 6ft
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Over head work
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Pinch points
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Lead/asbestos
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Cranes/rigging
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Live utility work/electrical shock
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Using hazardous materials
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Trips/spills falls
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Fire/explosion
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Abrasion/cuts burns
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Cave ins
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Loud noise
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Sprains/strains
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Falling objects
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Vehicle traffic
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Power tools
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Other (explain)
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Have these hazards been explained to the employees?
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Considering your scheduled task for today, what specific steps will be taken to remain safe and efficient?
Personal protective equipment
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Fall protection
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Eye/face
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Respirator
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Hand
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Hearing
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Foot
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Coveralls
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Hard hat
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Class 2 safety vest
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Other types. (Specify)
Procedures/permits required
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Hot work
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Lockout/tag out
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Excavation
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Signs/barricades
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Confined space
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Crane lift
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Line break/hot tapping
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Utility shutdown
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Scaffolding
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Other (specify)
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Is fire watch attendant required?
Employee certification required
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Crane operator
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Forklift operator
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Mobile equipment operator
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Power actuated tool user
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Competent person
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CPR/AED/First aid
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Other (specify)
Tools and equipment
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User inspection is required on all tools, ladders, electrical cords, rigging and safety equipment. Has this been completed?
Hazardous materials
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Has the material storage area been identified and approved?
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Have sds been reviewed for health hazards prior to use?
Scaffolds/ladders
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Inspect all scaffolds/ladders before use. Has scaffold tag been signed?
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Does your ladder have a current inspection?
First aid and safety
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Identify below the location of the nearest first aid safety kit
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Are all employees aware of first aid location?
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Is first aid fully stocked and accessible?
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Is there a supply of drinking water on the roof?
House keeping
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Are trash receptacles available?
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Location?
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Was trash removal completed yesterday?
Fire protection
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Are flammable/combustible materials stored, separated, inspected and secured per the safety plan?
Fall protection
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Is fall protection required?
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Is an engineered system in place
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What type?
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Have all employees been instructed in its use?
Neck Stretch- Hold for 15-30- seconds- Repeat each side
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- Tilt head sideways without twisting the neck
-Using your hand, reach across head and move ear toward shoulder
-Do not pull head, use weight of arm alone
-Extend other arm -
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Neck Stretch- Hold for 15-30- seconds- Repeat each side
Chest Pull- Hold for 15-30- seconds- Repeat each side
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-Lace fingers together behind your back
-Roll shoulders back while pulling hands back a few inches behind your back -
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Chest Pull- Hold for 15-30- seconds- Repeat each side
Shoulder & Back of Upper Arm Stretch- Hold for 15-30- seconds- Repeat each side
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- Stand and place right hand on left shoulder
-With the left hand, pull right elbow across chest toward left shoulder and hold -
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Shoulder & Back of Upper Arm Stretch- Hold for 15-30- seconds- Repeat each side
Forearms & Wrist Stretch- Hold for 15-30- seconds- Repeat each side
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- Extend one arm forward keeping the elbow straight
-Bend the wrist upward, and use the other hand to gently pull fingers back toward you, stretching the muscles in the bottom of your forearm and wrist
-Then release the bend the same wrist downward, gently pulling it down and toward you -
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Forearms & Wrist Stretch- Hold for 15-30- seconds- Repeat each side
Thigh Stretch - Hold for 15-30- seconds- Repeat each side
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- Lift one leg and grasp with your arm
-Pull up on leg at ankle to stretch thigh
-Maintain balance by extending your opposite arm sideways -
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Thigh Stretch - Hold for 15-30- seconds- Repeat each side
Stretches inner thigh, groin- Hold for 15-30- seconds- Repeat each side
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-Stand with feet pointed straight ahead, a little more than shoulder width apart
-Bend right knee slightly and move left hip downward toward right knee -
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Stretches inner thigh, groin- Hold for 15-30- seconds- Repeat each side
Calf Stretch- Hold for 15-30- seconds- Repeat each side
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-Standing facing a wall or object, place your foot up against the wall
-Keeping a straight knee, lean forward until you feel a stretch in the calf and hold the position -
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Calf Stretch- Hold for 15-30- seconds- Repeat each side
Lower back stretch- Hold for 15-30 seconds- Repeat each side
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-Stand upright with your feet shoulder width apart
-Twist and lean forward to touch your toe with opposite hand
-Extend other arm up into the air behind you -
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Employee Signature
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Foreman Signature
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