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