Information
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Conducted on
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Location
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Location
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Task
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Do I understand the scope of the task?
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Are the weather conditions safe to work in (high wind, rain, sun)?
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Do I have safe access to the work area?
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Are my eyes, hands and hearing protected?
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Is there any interference with other work in the area?
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Do I have to isolate to control sources of energy?
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Am I fit to perform this task (aware, rested, alert)?
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Is anyone in the work crew not wearing the right PPE?
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Are my tools and equipment in good working condition?
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Is the work area free from trip hazards?
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Can anything fall on/strike me or others?
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Have I checked for snakes and spiders?
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Do I feel safe doing this task?
Personnel
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Name
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Signature
