Title Page

  • Document No.

  • Client / Site

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  • Location

To be Completed by Supervisor or Foreman of Those Performing the Work

  • All operators have 1 year HPWV experience with this activity. Any operators with less than 1 year experience have been trained, are identified as “apprentices” below, and are under an experienced operator’s close monitoring/control.

Personal Protective Equipment

  • Are Safety glasses and Face Shield being worn?

  • Is hearing protection being worn?

  • Are Protective Gloves being worn?

  • Are Hard Hats being worn?

Equipment Safety Checks

  • Hoses checked for condition, secured, properly arranged, and rated for a minimum 3 times the highest working pressure.

  • High-pressure hose connections tightened and inspected for cracks, leaks or chips in the housing?

  • High pressure hose has been check for leaks, punctures and breaks?

  • Is couplings or hoses are leaking SHUT OFF MACHINE IMMEDIATELY! Do not attempt to repair hose. Red tag and remove from service.

  • Relief device rating checked against the lowest rated components?

  • Equipment guards in place (trigger guards, rotational guards)?

  • Work site barricaded, hearing protection signs posted when required, and free of tripping hazards?

  • Shut off controls are operating properly?

  • Trigger assembly and pressure gun are in working condition with no breaks, cracks or bad couplings?

  • Pressure wand if free of cracks and in working condition

  • Rotating nozzles have been inspected and are in working condition?

  • Is the battery operating and free of defects?

  • Has all electrical in the washing area been LOTO or de-engerizied

Fire Safety and Prevention

  • Fire Extinguisher located near the pressure washer but no closer than 10 feet?

  • Is the pressure washer being operated in a well ventilated area?

  • Fuel tanks is in working condition with no cracks, breaks or leaks?

  • Always allow the pressure washer to cool for 2 minutes before fueling

  • Foreman Signature

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