Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

Site Access/Egress Conditions

  • Are parking areas easily identifiable and accessible for company vehicles?

  • Please describe the hazards and recommended solutions.

  • From your vehicle to the designated work area, are there clear and safe means for transporting your tools and material?

  • Please describe the hazards to accessing your work area.

  • In the event of inclement weather (tornado, fire, lightning, etc.) where are the designated shelter areas on-site?

  • Verify information with the site owner before beginning work.

  • Is all equipment safely serviceable?

  • Which equipment is not safely serviceable?

  • Is there a specific need for special PPE or equipment for the task?

  • Please describe needed PPE or equipment.

Work Area Conditions

  • Is the work area clear of debris, trash, and other material that could cause a slip, trip, or fall injury?

  • Please describe the hazard associated with the housekeeping of the work area.

  • Is the work area clear of electrical and tripping hazards such as exposed wiring, devices, boxes, etc?

  • Please describe any electrical hazards in or around the work area.

  • Are fire extinguishers readily accessible in or around your work area(s)?

  • Have these extinguishers been inspected?

  • Are these extinguishers the proper type for the potential fire hazard of the equipment in the work area (see descriptions below)?

  • Please acquire the appropriate fire extinguisher for the task at hand before continuing work.

  • Class A: Fires in ordinary combustibles such as wood and paper.
    Class B: For use of flammable liquids like grease, gasoline, and oil.
    Class C: Suitable for use only on electrically energized fires.
    Class D: For use on flammable metals.

  • Are there any skylights on-site?

  • Is the skylight easily identifiable and properly barricaded to prevent falling through it?

  • Please describe the skylight hazard and recommended corrective actions.

  • Are there any fixed ladders on-site that are expected to be used at any point while performing work?

  • Is access to the ladder clear and safe of debris, materials, or other objects?

  • Please describe hazards to accessing the ladder.

  • Are there any broken rungs or rungs too close to the nearest object behind the ladder, preventing proper footing conditions?

  • Please describe the hazard to footing conditions on the ladder.

  • Is there sufficient space behind the climber to the nearest object while climbing?

  • Please describe the hazard.

  • Is a grab bar installed to assist the climber when mounting and dismounting from ladder?

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.