Title Page

  • Site conducted

  • Value Stream

  • Cell

  • Cell

  • Cell

  • Cell

  • Cell

  • Cell

  • Cell

  • Cell

  • Cell

  • Cell

  • Area

  • Conducted on

  • Performed By

Facility Requirements

  • Yellow PPE pictogram posted in work cell

  • Safety Glasses with sideshields used (Note employees observed in non-compliance)

  • Safety Toed Shoes used (Note employees observed in non-compliance)

Task Specific Requirements

  • Glove use meets task requirements

  • Proper Apron / Coveralls use

  • Welding Clothing / High Visibility Clothing

  • Sleeves (Above Elbow & Covering Wrist)

  • Head Protection

  • Face Shield / Goggles

  • Respirator Use & Storage

  • Hearing Protection

Inspect PPE for the Following

  • All PPE used is free from defects

  • PPE protects from existing hazards

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.