Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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Contractor Company Name
Untitled Page
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Contractor agrees to wear all PPE at all times when on site. This includes when operating mechanical equipment.
- Yes
- No
- N/A
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Contractor agrees that ladders and scaffolding are in good repair and free of damage.
- Yes
- No
- N/A
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Contractor agrees that Fire extinguishers must be in the immediate work area where applicable.
- Yes
- No
- N/A
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Contractor agrees that all exit and aisle ways must be free from obstruction.
- Yes
- No
- N/A
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Contractor agrees that the work area must be clean and free of recognized hazards and all equipment including tools will be stored away.
- Yes
- No
- N/A
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Contractor agrees that he/she must follow the facility LOTO (lockout tagout) program.
- Yes
- No
- N/A
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Contractor agrees that all equipment musat be properly guarded.
- Yes
- No
- N/A
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Contractor agrees that equipment and machinery safeguards are not to be bypassed.
- Yes
- No
- N/A
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Contractor agrees that all chemical containers must be labeled and SDS on file.
- Yes
- No
- N/A
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Contractor agrees that all power tools and welding equipment must be in good working order.
- Yes
- No
- N/A
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Contractor agrees that all hand tools are electrically insulated.
- Yes
- No
- N/A
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Contractor agrees that all 120-volt extension cords must be equipped with a GFCI.
- Yes
- No
- N/A
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Contractor agrees that all extension cords must be in good order and free from splices.
- Yes
- No
- N/A
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Contractor agrees, that if applicable, must be following the hot work permit program.
- Yes
- No
- N/A
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Contractor agrees, that if applicable, must be following the confined space program.
- Yes
- No
- N/A
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Contractor agrees, that if applicable, must be following the work at height program.
- Yes
- No
- N/A
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Contractor agrees that fall protection must be worn and is in good condition and is used properly.
- Yes
- No
- N/A
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Contractor agrees, that if applicable, they are trained in the company process safety management (PSM) program.
- Yes
- No
- N/A
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Has the contractor received the plant contractor safety orientation within the last 12 months?
- Yes
- No
- N/A
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Contractor agrees to wear hot gloves and face shield when being exposed to 50 volts or more.
- Yes
- No
- N/A
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Contractor agrees that their job vehicle/trailer will be parked properly and free from hazards.
- Yes
- No
- N/A
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Additional comments, remarks?
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Print name
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Signature
