Title Page
-
Document No.
-
Supervisor/Foreman
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Personnel
-
Pre Task and/or JHA filled out?
-
Has the crew taken a break within the last hour?
-
Any crew member showing signs of heat Stress?<br>If At Risk is entered please list actions taken.
-
Is a cool down area available? (shade, truck)
-
Does the crew know the signs and symptoms of heat Stress? If not coaching must be performed.
-
Is water provided?
-
Add signature
