Does the JSA identify appropriate PPE?
Has a work site assessment been completed?
Does the JSA list all activity and reference documents for the day?
Does the JSA identify appropriate job steps, potential hazards and mitigation steps?
Have all effected employees and visitors involved in the operational job task signed the JSA?
Did all involved discuss the hazardous areas associated with the operation, with mitigation steps to follow?
Did the employee sharing the JSA information ensure you the appropriate PPE to visit the location?
Did the employee sharing the JSA request you repeat the hazards and mitigation steps back to you?
Were the identified referenced documents available for review?
Were employees working according with the documented work task and activity?
If a critical activity is identified, has the supervisor been notified?
Did management or the supervisor use positive reinforcement for safe behavior observed?
Were employees effectively communicating with all involved while performing the job task?
Contractor Employee Name / Signature: