Title Page
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
To be Completed by Supervisor or Foreman of Those Performing the Work
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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
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Are Safety glasses and Face Shield being worn?
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Is hearing protection being worn?
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Are Protective Gloves being worn?
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Are Hard Hats being worn?
Equipment Safety Checks
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Hoses checked for condition, secured, properly arranged, and rated for a minimum 3 times the highest working pressure.
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High-pressure hose connections tightened and inspected for cracks, leaks or chips in the housing?
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High pressure hose has been check for leaks, punctures and breaks?
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Is couplings or hoses are leaking SHUT OFF MACHINE IMMEDIATELY! Do not attempt to repair hose. Red tag and remove from service.
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Relief device rating checked against the lowest rated components?
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Equipment guards in place (trigger guards, rotational guards)?
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Work site barricaded, hearing protection signs posted when required, and free of tripping hazards?
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Shut off controls are operating properly?
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Trigger assembly and pressure gun are in working condition with no breaks, cracks or bad couplings?
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Pressure wand if free of cracks and in working condition
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Rotating nozzles have been inspected and are in working condition?
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Is the battery operating and free of defects?
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Has all electrical in the washing area been LOTO or de-engerizied
Fire Safety and Prevention
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Fire Extinguisher located near the pressure washer but no closer than 10 feet?
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Is the pressure washer being operated in a well ventilated area?
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Fuel tanks is in working condition with no cracks, breaks or leaks?
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Always allow the pressure washer to cool for 2 minutes before fueling
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Foreman Signature
