Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Job Number

  • Personnel on job

Job site hazards

  • Job site accessable?

  • First aid kit on site?

  • Fire extinguisher are available?

  • Weather

  • Does the job have electricity

  • Job site has properly lighting?

  • Is the work space clear of debris

  • All floor openings covered

  • Openings have proper railings

  • Does the job have pinch points

  • Does the job have overhead hazards

  • Does the job have electrical hazards

  • Does the job contain trip hazards

  • Is alll material stored properly

PPE and Equipment

  • Are hard hats used

  • Is proper foot wear being used?

  • Proper eye protection being used?

  • Proper hand protection in use?

  • Fall protection being used

  • Proper respiratory protection being used?

  • Ladders free from damage

  • Electrical cords free from damage

  • Scaffolding free from damage?

  • Are power tools free from damage?

  • All equipment being properly used?

Any other concerns

  • Any other concerns or comments

Sign off

  • Sign off

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.