Information

  • Site conducted

  • 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:

  • Supervisor

  • Subcontractor Competent Person

  • Subcontractor Competent Person

  • Subcontractor Competent Person

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.