Title Page
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Document No.
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Job Name
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Job Number
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Building
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Conducted on
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Prepared by
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Personnel
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We're workers on-site?
General Safety
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Neat and orderly (housekeeping).
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Public access with exit routes clear.
Fire Protection
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Fire extinguisher and sprinklers clear.
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No combustible accumulation.
Scaffolding
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Scaffolding appears level.
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Scaffolding tag system used.
Heavy Equipment / Crane
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Protected from the public.
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Signal person in place.
Work Procedures
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Fall protection used (+6 ft.)
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Ground, wall openings guarded.
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Electrical - no exposed wires.
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NOT creating dust or public disturbance.
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Notes: