Information

  • Job Number

  • Job

  • Conducted on

  • Prepared by

  • Competent Person

Keller requirements are met, including PPE, site safety plan, housekeeping, hospital map, emergency numbers, daily tool box talks,

  • Comments

1) Fall Hazards---aerial lifts, ladders, roof, scissors lifts and scaffolds. Includes railings and guarding of holes.

  • Comments:

2) Struck By Hazards---vehicles, falling material, suspended loads, etc.

  • Comments:

3) Electrical---GFCI, overhead, underground, tools, guarded from contact, etc.

  • Comments:

4) Caught In-Between---under crane or forklift loads, pinch points, vehicle, material, etc.

  • Comments:

Excavations including soil classification and means of protection, slope, shoring, step back, trench box.

  • Comments:

Additional Comments or Concerns

  • Comments:

  • Prepared By:

  • Competent Person on Site:

  • Construction Manager:

  • Safety, Training, & Quality Control Services:

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