• Instruction: for any deviation from standard and/ expectation enter " no" and an action to address the deficiency.


  • Is a company vehicle in use?

  • Are all vehicles kept clean, neat and orderly and items adequately secured?

  • Inspect and test that all lights visible and operational ( low & high beam, brake, reverse, emergency, turning indicators, reversing souns and horn)?

  • Are all windshield wipers in good condition and operational, and is washer fluid container full?

  • Are seatbelts (airbag) in place and operational?

  • Are all windows clean, have no cracks that obstruct driver view, and are mirrors properly positioned?

  • Are all tires in good condition, appropriate (winter) and have appropriate tire pressure?

  • Are all fluid levels appropriate (oil, coolant, brake, transmission, etc.)?

  • Are the brakes functioning properly, and is the handbrake in good condition?

  • Are all doors and locks operating properly and can be secured?

  • Is all emergency equipment: fire extinguisher, first aid kit, winter survival and/ or summer gear, hi-visibility vest, readily available and in good condition?

  • Are chocks and cases available - as needed-?

  • Vehicle exterior is in good condition? Report any damage.

  • Is vehicle registration, insurance card, drivers license, company driver guide, fuel card present and current?

  • Are ladders and ladder racks (rungs, rails, feet, hardware) secure, available, in good condition and appropriate the work activities?

  • Is vehicle preventive maintenance completed per fleet schedule?


  • Is PPE in use or expected to be used?

  • Is head protection used in good condition, clean and with no cracks, dents, labels, chin strap, cradle system intact and < 5 years in use (see manufacture date).

  • Is respiratory protection (dust mask, half-mask, full-face mask) appropriate for the work, environment, readily available, employee have completed medical and spirometry (not for dust mask), completed annual training, cleaned, inspected, +/- pressure tested before use, cartridge exchange date clearly indicated, and stored in sealed bag or container.

  • Is eye protection (safety glasses with side shield, face-shield, welding helmet, full-face respirator, etc.) appropriate for the task, readily available, used where required, clean, has good visibility (no scratches),

  • Is hand (gloves, gauntlets) and arm protection (cutproof sleeves) appropriate for the work, readily available, used where required, in good condition, proper size, Iclean, inspected and properly stored?,

  • Is foot protection (construction safety boots, safety shoes) appropriate for the work, readily available, environmental conditions, clean, soles and upper in good condition?

  • Is hearing protection appropriate for the task, readily available, clean, inspected, stored and used where required?

Tools & Equipment

  • Are tools and/or equipment used or in area?

  • Are hand tools in good condition, appropriate for task - no mushroom heads, no-broken or cracked parts, secure grip?

  • Are pneumatic tools in good condition -hose/ whip secured by positive means, safety clips or retainers present and used?

  • Are fuel- powered tools/ equipment appropriate for task, securely stored to prevent fuel spills during transport, handling and storage, measures taken to prevent build- up of fumes and gases in enclosed spaces, and in good condition?

  • Are power tools (plugs, cords, prongs, body) parts present and in good condition - guards in place, double insulated or grounded, and no missing parts-?


  • Are extension cords, plugs and prongs appropriate for task, used only for temporary work, grounded or double insulated, GFI readily available, and in good condition?

  • Are all required lockout tagout devices (single key) and tags appropriate for the work, readily available, and in good condition?

  • Are electrical mats/ barriers - no rips , tears, holes- in good condition and appropriate for work conditions and hazards?

  • Are Amp meters ( multimeter, etc.) clean, with no damage, calibrated if required, batter testes, properly stored, appropriately used, readily available and in good condition?

  • Is all electrical PPE (selected per NFPA 70E, clothing FR, or per local requirement)appropriate for work, readily available and in good condition?

  • Are all heaters equipped with tip-over protection, appropriately used and in good condition?

  • Are all portable blowers properly set up, appropriate rating and use , and in good condition?

Compressed Gases & Equipment

  • Are compressed gases in use or stored?

  • Ia all PPE required for hot work (environment) - face- shield, body protection, gloves- elec. insulating gloves appropriate class, type, current inspection test date -less than 6 months- stored in. Ag with fingers upright, away from sunlight in designated bag- available and in good condition?

  • Are all gas cylinders turned off, stored upright with caps in place, secured and labelled appropriately, incompatible gases stored appropriately (distance and/ fire-rated wall), used with appropriate PPE, regulators and torches removed and/or disconnected from cylinders when not in use. And in good condition?

  • Is emergency response equipment for hot work - fire extinguisher, fire blanket etc. Readily available?

  • Are all torches, hoses, regulators and fittings (no leaks, auto shutoff tested, hoses and connections designed for expected pressures and service, equipped with backflow prevention or flash arrestor) in good condition?

  • Are all required permits (hot work, live electrical, confined space, etc.) in place, appropriate, properly filled out and communicated?

  • Is all fall protection equipment (harness, lanyard, SRLs, anchoring, etc.) a complete system ( 1 manufacturer) stored properly and within 5 year use limit?

High Risk Life Safety

  • Are all hazardous materials approved by HSE, SDS available, all containers appropriate, labelled, stored and secured properly? -- refrigerant logs are available and up-to -date

  • Are outdoor/ inclement weather supplies and equipment appropriate for the hazards encountered (heat or cold stress, remote location - communication- no safe drinking water, no biological hazards ( insects, snakes, rodents, wildlife), di- electric spray, shovels, sand, sunscreen, water, food, shelter, winter clothing, PFD)

  • Are all hand lines and ropes in good condition and appropriate for task - no cuts, abrasion, decay, burns, signs of wear-?

  • Is all air monitoring equipment for confined space entry - appropriate for work conditions and hazards expected, tested and calibrated per manufacturer requirements, appropriate calibration gases and test equipment available, and in good condition?

  • Are emergency rescue plans, equipment, tools, designated personnel, trained, appropriate fir work conditions and hazards expected, for CSE, work at height and other high risk activities?

  • Are all fuels (gasoline, kerosine, etc.) and flammable liquids stored, transported and transferred in appropriate containers (NFPA or local rating) with self-closing lids, flame/flash arrestors, 2-dary containment,capacity of container less than 5 gallons (15L), and in good condition?

Life Safety Critical and/or High Risk Work

  • Is any work performed at 4ft (1.2m) above level ground/structure?

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