Title Page

  • Conducted on

  • Prepared by

  • Location

Sequence of Job Steps

  • Write jobs steps below.

  • Is this a Normal or Abnormal process?

Potential Hazards (Check all potential hazards and address how they are being controlled.)



Strains (Back)

Sharp Edges

Moving Equipment

Pinch Points





Flammable Liquids or Gases

Lockout/Tagout Issues

Confined Space Entry

Forklift Operation

Overhead Crane Operation

Loading/Unloading Trailers


Required Training (Check required training required to complete job.)

  • Forklift Operation

  • Overhead Crane

  • Lockout/Tagout

  • Machine Operation

  • Non Permit Required -Confined Space Entry

Required PPE (Check required training required to complete job.)

  • Hard Hat

  • Cut Resistant Gloves

  • Hyflex

  • Cotton Sleeves

  • Kevlar Sleeves

  • Steel Toed Boots

  • Safety Glasses

  • Face Shield

Ergonomic Reminders

  • Do workers have to stretch to reach things

  • Direct Pressure on hands

  • Are excessive forces needed

  • Poor posture is required to complete some tasks

  • Excessive bending past 30 degrees

  • Work tables are a standard size

Environmental Compliance

  • Oil or hydrolic fluids handled on this job?

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.