Field Safety Walk

• PO#

• Project Address

• Conducted on

  Date

• Prepared by

• Location
  Address

JHA

• A. WAS IT PRESENTED

  Pass

  Fail

  N/A

• B.STKY IDENTIFIED

  Pass

  Fail

  N/A

• C. MUSTER POINT/ MEDICAL FACILITY

  Pass

  Fail

  N/A

• D. JHA SIGNED

  Pass

  Fail

  N/A

• E. AED/ FIRST AID KIT LOCATION

  Pass

  Fail

  N/A

• F. HYDRATION PLAN

  Pass

  Fail

  N/A

WORK AREAS

• A. General Housekeeping

  Pass

  Fail

  N/A

• B. EXCAVATION 2-4-6-RULE

  Pass

  Fail

  N/A

• C. EXCLUSION ZONES / BLOCKING VEHICALS / CAUTION TAPE ETC..

  Pass

  Fail

  N/A

• D. WHEEL CHOCKS / IDOL TIMES

  Pass

  Fail

  N/A

• E. VALID LOCATES

  Pass

  Fail

  N/A

• F. PERMIT

  Pass

  Fail

  N/A

• G. PROPER PPE

  Pass

  Fail

  N/A

• H. SAFE DIGGING PRACTICES

  Pass

  Fail

  N/A

• I. STORM WATER SET UP

  Pass

  Fail

  N/A

• J. STANDARDS

  Pass

  Fail

  N/A

• K. QUALIFIED FITTER / OPERATOR

  Pass

  Fail

  N/A

• L. CALIBRATIONS

  Pass

  Fail

  N/A

• M. Fire Extinguisher Present

  Pass

  Fail

  N/A

Comments/Notes

• Job Comments

• Photos

  Media