Title Page
-
Site conducted
-
Conducted on
-
Prepared by
-
Vendor
-
CBRE Work Order Number
-
MMC Number
-
Reviewed SOW details and supporting documents
-
All Instructions are fully understood
PPE REQUIRED
-
Proper Gloves
-
Hearing Protection
-
Face Shield
-
Goggles
-
Safety Glasses
-
Arc Flash Protection Needed
- Yes
- No
- N/A
-
Fall Protection Required
HAZZARDS IDENTIFIED
-
Heat Stress Apparent
-
Elevated Work/Overhead Work Apparent
-
Sharp Edges Apparent (Cuts)
-
Slips Trips and Falls Apparent
-
Inhalation of Hazzordous Chemicals Apparent
-
Electrified Equipment Apparent
-
Spills/Leaks Apparent
-
Burns (Thermal or Chemical) Aparent
-
Insects Apparent
-
Fire Life Safety Put on Test
-
Weather OK for Work
-
Hot Work Permit
GENERAL SAFETY
-
Eye Wash Available Near
-
Tool Inspection
-
Signs/Barricades/Signals in place if Needed
-
LOTO Completed if Needed
-
Aware of Fire Estinguisher Locations
-
GFCI Outlets Available
-
Ladder Tags Current
-
Confined Space Work
- Yes
- No
- N/A
-
Signature
