Pre-Job Safety Instructions (PSI)

• Audit Title

• Client / Site

• Conducted on

  Date

• Project

• Task Location

• Date of Instruction

  Date

Hazards(Check all that Apply)

• Environmental Hazards

• Spill Potential

• Weather Conditions

• MSDS Reviewed

• Ventilation Required

• Heat Stress/Cold Exposure

• Other Workers in Area

• Lighting Levels Too Low

• Housekeeping

• Activity Hazards

• Welding/Grinding

• Burn/Heat Sources

• Compound Gasses

• Energized Equipment in Area

• Electrical Cords/Tools - Conditions

• Equipment/Tools Inspected

• Critical Lift Meeting Required

• Lockout Procedures in Place

• Airborne Particles

• Ergonomics Hazards

• Working in a Tight Area

• Parts of Body in Line of Fire

• Working Above your Head

• Pinch Points Identified

• Repetitive Motion

• Work at Heights Hazards

• Barricades, Flagging & Signs

• Hole Coverings in Place

• Protect from Falling Items

• Powered Platforms

• Others Working Overhead/Below

• Fall Arrest

• Ladders

• Access/Egress Hazards

• Scaffold(inspection and tagged)

• Slip/Trip Potential Identified

• Required Permits in Place

• Excavations

• Personal Limitations/Hazards

• Clear Instructions Provided

• Trained to Use Tool and Perform Task

• Distractions in Work Area

• Working Alone(communication)

• Lift Too Heavy/Awkward Position

• External Noise Levels

• Physical Limitations

• Ensure PPE Requirements

• Monogoggles/Face Shield

• Gloves(kevlar or leather)

• Coveralls(fire retardant)

• Hearing Protection

• Respirator

• Additional PPE Required

• Additional PPE Required

• Additional PPE Required

• Other

Plans to Eliminate or Control the Hazards

• It is important that all HAZARDS/CONCERNS have action plans to eliminate or control them, and that these plans are put in place prior to start of task.

• Task

• Hazard

• Control

• Task

• Hazard

• Control

• Task

• Hazard

• Control

• Task

• Hazard

• Control

• Task

• Hazard

• Control

• Task

• Hazard

• Control

• Task

• Hazard

• Control

• Task

• Hazard

• Control

• Task

• Hazard

• Control

• Task

• Hazard

• Control

Do not sign until you understand and agree with the PSI

• Name and Company

  Sign

• Name and Company

  Sign

• Name and Company

  Sign

• Name and Company

  Sign

• Name and Company

  Sign

• Name and Company

  Sign

• Name and Company

  Sign

• Name and Company

  Sign

• Name and Company

  Sign

• Name and Company

  Sign

• Name and Company

  Sign

• Name and Company

  Sign

• Foreman's Signature

  Sign

• Supervisors Signature

  Sign