Title Page
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Job Number
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Safety Observations
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First Impression
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Tailgate Meeting Conducted
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Detailed DHA?
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Public Protection
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KDC Forms and Permits
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DOL, HIPP, MPN, Emerg Evac, SWP Maps, OSHA, KDC
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First Aid Kit
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Fire Prevention
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Trenching
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Heat Illness Prevention Compliance
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Scissor Lift Safety
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Ladder Safety, Labels and Usage
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Fall Protection - usage, risk etc...
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Tools
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Electrical
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Housekeeping
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Impalement Protection
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SWPPP and Dust Control
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PPE Compliance
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Certs etc...for tools, lifts or eqip
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Material Handling - rigging, hoisting etc..
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Scaffold Safety
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Rolling Scaffold
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Sanitation
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Trip and Fall
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Safety Data Sheet Compliance
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KDC Required Plans<br>~~~~~~~~~~~~~<br>*Ped Pro Plan<br>*Emery Evac<br>*Hot Work<br>*Trench<br>*Scaffolding<br>*LOTO<br>*Demo<br>*Silica Management
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Comments/Suggestions
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Signature
