• Note: This document must be completed by NII's Supervisor on the project, is valid for one shift only, and must be maintained / posted at the jobsite.

  • Job

  • Location

  • Date

  • Supervisor

  • Safe Job / Energy Control Procedures

  • Description of Work

Task Safety Checklist

Personal Protective Equipment

  • Eye and Face Protection

  • Hand Protection

  • Head Protection (Brim Forward)

  • Respiratory Protection

  • Foot Protection (Metatarsal)

  • Torso Protection

  • Welding Shield

  • Leather Sleeves / Coat

  • Leather Sleeves / Coat

  • Long Sleeve Shirts

  • Fire Retardant Clothing

  • Cut Resistant Protection

  • Specialized Clothing

  • Personal Gas Detectors Required

Energized Equipment

  • Locks Out Verified

  • All Locks Labeled / Tagged

  • Broken / Exposed Wiring

  • Personal Gas Detectors Required

Fire Protection

  • Proper Fire Extinguisher

  • Flammable Materials Removed

  • Fire Blankets

  • Fire Watch Required

  • Area Needs to be Flagged

Tools

  • Proper Tools for the Job

  • Ladder Inspection

  • Hand Tools in Good Condition

  • Air Hoses Secured

  • Oxygen / Acetylene

  • Flash Back Arrester In Place

Permits **

  • Work Permit

  • Excavation

  • Confined Space

  • Hot Work

  • SDS Available

  • Special Written Procedures

  • SDS Available

Housekeeping

  • Work Surface Level

  • Aisles, Stairs, Floors Cleaned

  • Storage of Materials

Material Handling / Equipment Inspection

  • Cranes or Cherry Pickers

  • Rigging Checked

  • Cables, Ropes, Slings

  • Chain Falls

  • Pre-Lift Required

  • Come-a-long

  • Mobile Equipment

Fall Protection

  • Rope Grabs

  • Retractables

  • Vertical Lifelines

  • Horizontal Lifelines

  • Guardrail System

  • Floor Openings Protected

Miscellaneous

  • Ladders Secured

  • Scaffolds Inspected

  • Rebar Protected

  • Pinch Points

  • Trailer Inspection

  • GFI Protection In Place

  • No Touch Policy Reviewed

  • Asbestos Policy & Procedure

  • Asbestos Policy & Procedure

  • Spill Reporting Procedure

  • Asbestos Policy & Procedure

  • Emergency Signals & Numbers

  • Danger Zone Identification

  • Danger Zone Identification Other

  • Danger Zone Control Measures

  • High Gas Energy Areas: Personal gas detectors are required for all individuals entering or working in these areas.

Post Task & Inspection Checklist

  • Job Complete

  • If Job Incomplete - Temporary

  • Provisions, Barricades, Safety

  • Locks, Lighting in Place, Etc...

  • Housekeeping Inspected

  • All Guarding Replaced

  • Permits Closed

  • Equipment Secured

  • Operations Notified

Job Emergency Numbers

  • Ambulance

  • Fire

  • Medical

  • Security

  • Environmental

  • Materials Management

  • Hazmat

  • Chemical Emergencies

  • DOT

  • Safety / Industrial Hygiene Office

  • Asbestos Emergencies

  • SDS Center

  • Guard Shack

  • Other Emergency Numbers

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