• Haz Assessment Thoroughly Completed

  • Sign In Sheets

  • DOL Poster

  • KDC rules posted

  • MPN and map posted

  • Incident Reporting instructions posted

  • Emergency Evac


  • Pedestrian / Public Protection Plan

Fall Protection/Prevention

  • Scissor lift safety and compliance

  • Fall protection if exposed to a free fall six feet or more

Scaffold Compliance

  • Scaffold Safety

  • Scaffold Permit

Trenching Excavation

  • Permit

  • Access Egress 4ft or >

  • Cave In Protection

  • Fall Protection 6ft or >

Electrial / Tools

  • Tool safety

  • Electrical Safety - GFCI, Temp Power, Cords, Open Panels, LOTO


  • Ladder Safety including manufacturing labels

  • Ladder usage and set up


  • Housekeeping [Interior & Exterior]

  • Caught In-between/Struck By

  • Any trip and fall hazards

Safety Plans - Required Permits

  • Silica Awareness Plan

  • Hot Work Permit

  • Fall Protection Plan 15 or>

  • Scaffold Plan

  • Pedestrian Protection Plan (Signed)

  • Crane Plan

  • Equipment safety

  • Water in compliance with HIPP

  • Fork, Aerial Lift Certs

  • Powder Actuated Tool Lic


  • PPE Compliance - Z87.1, N95, N100, Hardhats, Gloves, Hearing P, Class II Vests


  • Dust Control

  • Add signature

  • Comments

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