Job Activities

Is a lockout required?

Working on/near live electrical?

Confined space?

Working from heights?

Other activities in area :

Hazards

Hazards (Enviormental)

Wind Chill

Airborne Particles

Vapours

Hot/cold surfaces, materials

Noise

Lighting

Heat Stress

Wind

Controls used :

Hazards (Body)

Fall Potential

Pinch Point

Electric Shock

Housekeeping

Slip - Trip

Flying Particles

Thermal Burn

Manual Lifting KG

Sharp Objects

Work Over Head

Falling Objects

Proper Positioning

Hazards (Chemical)

Chemicals Identified

MSDS Reviewed

System Under Pressure

Chemical Burn

Skin/Eye Irritation

Inhalation

Radiation

Communications

Are you working alone?

Contact Person :

Phone Number :

Equipment

Scissor Lift

Personal Basket

Forklift

Boom-type Lift

Crane

Chainfall

Is the equipment in good condition?

Do you have the proper rigging?

Have you done an inspection of the surrounding area?

Are the hand tools in good condition?

Is the scaffold in good condition?

Is the ladder in good condition?

Is the ladder secure?

Do I have the right ladder for the job?

Safety Barriers

Fixed Barricades (used if tape has potential to become damaged)

(Tape) Danger (used to keep people out)

(Tape) Caution (used to alert people to hazards)

Barricade Tags (required with barricades)

Are signs of warning required?

Are holes covered?

Are handrails in good condition?

Emergency Equipment

Is a fire extinguisher required?

Safety shower # :

Eyewash # :

Muster point :

Closest Door # :

ERT contact (confined space) :

Comments :

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.