• Safe Work Permit #:

  • Supporting Info

  • Supporting Info

  • Job Description

  • CF Personnel / Contractor

  • Conducted on

  • Max Rivera

Job Safety Audit

  • F.T.R.A. Completed:

  • W.H.A.T. Completed:

  • Contractor JSA completed

Emergency Response

  • Do Employees know nearest Shelter in Place?

  • Do employees know nearest Rally Points?

  • Do Employees know where Nearest Safety Shower is?

  • Do Employees know where nearest EEBA's are?

  • Do Employees know where nearest Fire Extinguisher is?

Type of Work:

  • Cold Work?

  • Hot Work

  • Precautions Noted on Permit

  • Fire Watch noted on Permit / Log

  • Confined Space

  • Confined Space Permit issued

  • Atmospheric Testing performed

  • Does it require Continuous Testing?

  • Rescue Plan available

  • EHS Signature

  • Excavation

  • Excavation perimit issued

  • Excavation Permit #:

  • Line Break

  • Appropriate PPE for Chemical Exposure?


  • Positive Observations:

  • Positive Rewards:

  • At Risk Observations:

  • Corrective Action:


  • CF Contact:

  • Name

  • Contractor Supervisor:

  • Name:

  • Completed by: Max Rivera

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.