CSUSA Service Tech Safety Inspection form

Have you completed your 5x5?

I am wearing my safety glasses.

I have all necessary PPE for this task and will use it as needed.

I understand our Lock Out Tag Out and Fall Protection policy and will follow them while performing my assigned tasks.

I will stop work if something is not safe and call my supervisor.<br>

I will adhere to my company's and our customer's safety rules and policies.