Information
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Site conducted
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Job Number
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Job
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Conducted on
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Prepared by
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Competent Person
Keller requirements are met, including PPE, site safety plan, housekeeping, hospital map, emergency numbers, daily tool box talks,
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Comments
1) Fall Hazards---aerial lifts, ladders, roof, scissors lifts and scaffolds. Includes railings and guarding of holes.
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Comments:
2) Struck By Hazards---vehicles, falling material, suspended loads, etc.
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Comments:
3) Electrical---GFCI, overhead, underground, tools, guarded from contact, etc.
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Comments:
4) Caught In-Between---under crane or forklift loads, pinch points, vehicle, material, etc.
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Comments:
Excavations including soil classification and means of protection, slope, shoring, step back, trench box.
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Comments:
Additional Comments or Concerns
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Comments:
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Prepared By:
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Competent Person on Site:
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Construction Manager:
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Supervisor
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Subcontractor Competent Person
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Subcontractor Competent Person
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Subcontractor Competent Person