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
Site Access/Egress Conditions
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Are parking areas easily identifiable and accessible for company vehicles?
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Please describe the hazards and recommended solutions.
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From your vehicle to the designated work area, are there clear and safe means for transporting your tools and material?
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Please describe the hazards to accessing your work area.
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In the event of inclement weather (tornado, fire, lightning, etc.) where are the designated shelter areas on-site?
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Verify information with the site owner before beginning work.
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Is all equipment safely serviceable?
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Which equipment is not safely serviceable?
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Is there a specific need for special PPE or equipment for the task?
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Please describe needed PPE or equipment.
Work Area Conditions
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Is the work area clear of debris, trash, and other material that could cause a slip, trip, or fall injury?
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Please describe the hazard associated with the housekeeping of the work area.
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Is the work area clear of electrical and tripping hazards such as exposed wiring, devices, boxes, etc?
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Please describe any electrical hazards in or around the work area.
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Are fire extinguishers readily accessible in or around your work area(s)?
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Have these extinguishers been inspected?
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Are these extinguishers the proper type for the potential fire hazard of the equipment in the work area (see descriptions below)?
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Please acquire the appropriate fire extinguisher for the task at hand before continuing work.
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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?
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Is the skylight easily identifiable and properly barricaded to prevent falling through it?
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Please describe the skylight hazard and recommended corrective actions.
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Are there any fixed ladders on-site that are expected to be used at any point while performing work?
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Is access to the ladder clear and safe of debris, materials, or other objects?
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Please describe hazards to accessing the ladder.
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Are there any broken rungs or rungs too close to the nearest object behind the ladder, preventing proper footing conditions?
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Please describe the hazard to footing conditions on the ladder.
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Is there sufficient space behind the climber to the nearest object while climbing?
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Please describe the hazard.
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Is a grab bar installed to assist the climber when mounting and dismounting from ladder?