Job Safety Hazard Checklist

• Job Site

• Select date

  Date

• Job Site

• Technician Name

  Select Crowley, Scott Flanagan, Dave Olsen, Jeff Rider, Kyle Shears, Scott VanHorn, Aaron Weideman, Rob Willick, Todd

  • Crowley, Scott
  • Flanagan, Dave
  • Olsen, Jeff
  • Rider, Kyle
  • Shears, Scott
  • VanHorn, Aaron
  • Weideman, Rob
  • Willick, Todd

Think Through the Job Tasks

• Do you know and understand the scope of work and how to do it safely?

  Yes

  No

  N/A

• Is this a standard working procedure/activity?

  Yes

  No

  N/A

• Do you know the proper and safe method to execute the job from start to finish?

  Yes

  No

  N/A

• Do you have all the necessary PPE?

  Yes

  No

  N/A

• Do you have required work permits?

  Yes

  No

  N/A

• Do you have an action plan in case of fire or tornado?

  Yes

  No

  N/A

Stop the Hazard

• LOTO: Will LOTO be used?

  Yes

  No

  N/A

• Fall Protection: Tasks require work over 4 feet?

  Yes

  No

  N/A

• Electrical Work: Exposure to 50 volts or greater?

  Yes

  No

  N/A

• Material Handling: Will >50 lbs be handled?

  Yes

  No

  N/A

• Ergonomics: Long term stooping, bending or awkward position?

  Yes

  No

  N/A

• Slips or Trips: Liquid, ice, loose or fixed items in work area?

  Yes

  No

  N/A

• Ladders: Step or extension ladder needed to perform work?

  Yes

  No

  N/A

• HazCom: will chemicals be used?

  Yes

  No

  N/A

• Signature

  Sign