Title Page
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Safety Focus
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Conducted on
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Project
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Project #
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Foreman's Name (Print)
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Location
Reconized Hazards
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Recognized Hazards (Check all that apply)
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Arc Flash/Blast
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Back Injury
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Caught In/Between
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Cave-Ins
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Chemical Exposure
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Confined Space
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Cuts/Abrasions/Punctures
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Electric Shock
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Equipment Handling
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Eye Injuries
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Falling from Height
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Falling/Fixed Objects
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Fire Explosion
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Foot Injuries
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Head Injuries
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Houskeeping
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Impalement
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Ladders/Stairwells
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Materials Handeling
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Noise
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Overexertion
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Overhead Work
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Penetrations/Holes
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Pinch Points
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Rigging
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Slips/Trips/Falls
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Strains/Sprains
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Temperature Ext.
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Underground Utilities
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Weather Conditions
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Other
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Other
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Other
Hazard Abatement
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Hazard Abatement (Check All that Apply)
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Appropriate Clothing/Boots
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Arc Flash/Blast Suit
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Barricades/Barriers
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Chemical Suits
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Class 2 High Vis vests
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Connections/Fittings
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DO NOT ATTEMPT!
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Emergency Contacts
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Emergency Plan
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Eye Protection
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Fall Protection
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Fire Extinguishers
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Fire Watch
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GFCI
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Gloves
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Grounding Devices
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Gaurdrails
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Guide/Signal Man
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Hard Hats
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Hearing Protection
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Housekeeping
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Insulation
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Isolation
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JHA
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Ladders/Stairways
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Lockout/Tagout
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Permits
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Proper Lifting Techniques
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Rebar Caps
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Respiratory Protection
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Right Tool for the Job
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Shoring/Sloping/Trench Box
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Tag Lines
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Utility Locate Service
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Warm Up/Stretch Out
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Weather Gear
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Other
Review
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Discuss incidents from yesterday.
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Safety orientation complete?
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Project scope understood?
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Safety equipment onsite? (First Aid, Harness, Etc.)
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Proper permits issued?
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Check all that apply.
- Confined Space
- Hot Work
- Scaffold
- Excavation
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Rigging and Lifting Plan in Place?
Crew Covered in this Plan
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Add signature
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At risk Employees (New to task):
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Other Comments:
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Site Superintendent
