Title Page

  • Job name

  • Job number

  • Conducted on

  • Competent person

  • Prepared by

General safety

  • Did you start your day by stretching?

General information. Mark all that apply.

  • What are the hazards associated with the job?

  • Chemical burn

  • Extreme weather

  • Particles in eyes

  • Over exertion

  • Elevator load

  • Falls over 6ft

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  • Over head work

  • Pinch points

  • Lead/asbestos

  • Cranes/rigging

  • Live utility work/electrical shock

  • Using hazardous materials

  • Trips/spills falls

  • Fire/explosion

  • Abrasion/cuts burns

  • Cave ins

  • Loud noise

  • Sprains/strains

  • Falling objects

  • Vehicle traffic

  • Power tools

  • Other (explain)

  • Have these hazards been explained to the employees?

  • Considering your scheduled task for today, what specific steps will be taken to remain safe and efficient?

Personal protective equipment

  • Fall protection

  • Eye/face

  • Respirator

  • Hand

  • Hearing

  • Foot

  • Coveralls

  • Hard hat

  • Class 2 safety vest

  • Other types. (Specify)

Procedures/permits required

  • Hot work

  • Lockout/tag out

  • Excavation

  • Signs/barricades

  • Confined space

  • Crane lift

  • Line break/hot tapping

  • Utility shutdown

  • Scaffolding

  • Other (specify)

  • Is fire watch attendant required?

Employee certification required

  • Crane operator

  • Forklift operator

  • Mobile equipment operator

  • Power actuated tool user

  • Competent person

  • CPR/AED/First aid

  • Other (specify)

Tools and equipment

  • User inspection is required on all tools, ladders, electrical cords, rigging and safety equipment. Has this been completed?

Hazardous materials

  • Has the material storage area been identified and approved?

  • Have sds been reviewed for health hazards prior to use?

Scaffolds/ladders

  • Inspect all scaffolds/ladders before use. Has scaffold tag been signed?

  • Does your ladder have a current inspection?

First aid and safety

  • Identify below the location of the nearest first aid safety kit

  • Are all employees aware of first aid location?

  • Is first aid fully stocked and accessible?

  • Is there a supply of drinking water on the roof?

House keeping

  • Are trash receptacles available?

  • Location?

  • Was trash removal completed yesterday?

Fire protection

  • Are flammable/combustible materials stored, separated, inspected and secured per the safety plan?

Fall protection

  • Is fall protection required?

  • Is an engineered system in place

  • What type?

  • Have all employees been instructed in its use?

Neck Stretch- Hold for 15-30- seconds- Repeat each side

  • - 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

    stretchneck2.jpg
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  • Neck Stretch- Hold for 15-30- seconds- Repeat each side

Chest Pull- Hold for 15-30- seconds- Repeat each side

  • -Lace fingers together behind your back
    -Roll shoulders back while pulling hands back a few inches behind your back

    chest pull.jpg
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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

  • - Stand and place right hand on left shoulder
    -With the left hand, pull right elbow across chest toward left shoulder and hold

    shoulder & arm strecth.jpg
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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

  • - 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

    Wrist Stretches.gif
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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

  • - 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

    thigh stretch.jpg
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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

  • -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

    groin.gif
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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

  • -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

    Standing-Calf-Stretch 2.jpeg
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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

  • -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

    lower back.jpg
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Employee Signature

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Foreman Signature

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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.