Title Page

  • Document No.

  • Job Name

  • Job Number

  • Building
  • Conducted on

  • Prepared by

  • Personnel

  • We're workers on-site?

General Safety

  • Neat and orderly (housekeeping).

  • Public access with exit routes clear.

Fire Protection

  • Fire extinguisher and sprinklers clear.

  • No combustible accumulation.

Scaffolding

  • Scaffolding appears level.

  • Scaffolding tag system used.

Heavy Equipment / Crane

  • Protected from the public.

  • Signal person in place.

Work Procedures

  • Fall protection used (+6 ft.)

  • Ground, wall openings guarded.

  • Electrical - no exposed wires.

  • NOT creating dust or public disturbance.

  • Notes:

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.