Title Page

  • Conducted on

  • Prepared by

  • Location

Reviewed Department

  • Which department are you reviewing?

PPE

  • Are bump hats properly worn with no modification (example: additional stickers, markings, ...)?

  • Are Z87 rated safety glasses properly used by all team members (includes prescription safety glasses with side shields)?

  • Is hearing protection (ear plugs/ear muffs) properly used by all team members?

  • Are cut resistant gloves used on the free hand of the team member while using utility knives?

  • Are cut resistant gloves used while handling glass or metal materials?

Signature

  • Supervisor's Signature

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.