Rent-A-Fence Safety Observation Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• CREW MEMBER NAMES

1 PERSONAL PROTECTIVE EQUIPMENT

• 1.1 Worker is wearing safety glasses

  Yes

  No

  N/A

• 1.2 Worker is wearing leather gloves

  Yes

  No

  N/A

• 1.3 Worker is wearing work boots or shoes

  Yes

  No

  N/A

• 1.4 Worker is wearing hard hat

  Yes

  No

  N/A

• 1.5 Worker is wearing hearing protection when compressor or pounder is operating

  Yes

  No

  N/A

• 1.6 Worker is wearing a Hi-Visibility T-shirt or vest

  Yes

  No

  N/A

2 BODY USE AND POSTITION

• 2.1 Worker bends knees to lift fence panel at a point below their knees to lift up and carry panel

  Yes

  No

  N/A

• 2.2 When climbing on or off of truck or trailer, worker is using 3 points of contact (both hands holding onto handles or vehicle, and one foot on step, vehicle, or ground)

  Yes

  No

  N/A

• 2.3 Worker uses heel palm of hand on the edge of the panel to lift and carry

  Yes

  No

  N/A

• 2.4 Worker is looking where he is walking

  Yes

  No

  N/A

• 2.5 Worker has both feet on the truck or trailer deck / designated platform while unloading fence panels

  Yes

  No

  N/A

COMMENTS

• Add media

  Media

• Signature of observer

  Sign