Title Page
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Conducted on
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Prepared by
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Location
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Supervisor
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Store
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Job Number
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Have you Signed into Store
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Have you logged onto the relevant task?
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Have you checked the Asbestos Register for your area of work?
Main Task being performed
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Enter the main task here.
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Are there any Sub Tasks?
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Subtasks
Subtask
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Enter sub task here
Hazard Recognition - What Could Happen to us?
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Click Add to Add Hazard
Hazard
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Enter Hazards here
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How badly would we most likely be jurt
Negate the Hazards Above.- How can we work safely?
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Click to add safety measure.
Safety Measure For Hazard
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How will we negate the hazard
PPE that should be used
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Hard Hat
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Reflective Vest
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Gloves
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Glasses
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Protective Footwear
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Respiratory Protection
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Hearing Protection
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Cutting Goggles
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Face Shield
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Harness/Lanyard
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Tyvek Suit
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Other
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Click Add other PPE
Other PPE
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List other PPE here
Keep Safety First In All Tasks
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Do we have the training and experience to perform this task safely?
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DO NOT BEGIN WORK. Notify your supervisor.
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Does everyone understand how to do their individual tasks?
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DO NOT BEGIN WORK. Notify your supervisor.
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Do we have the appropriate tools and materials and know how to use them?
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DO NOT BEGIN WORK. Notify your supervisor.
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Are we qualified to operate and work around all equipment on project
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DO NOT BEGIN WORK. Notify your supervisor.
Awareness Checklist
Awareness Checklist
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Is special training needed?
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What special training is needed?
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Click to add special training
Special Training
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List Training Here
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Are permits required?
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Select required permits.
- Confined Space
- Hotwork
- Other
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Click to add other permits
Other Permits
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Can any body part get caught in, struck by, or caught between objects?
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Are the employees working with sharp or rough materials that require PPE
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Can pushing, pulling, lifting bending, or twisting cause strain? If greater than 50 pounds get help.<br>
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Do tools, machines, or equipment present any hazards?
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Can the worker slip trip or fall?
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Are there flammable, explosive, or electrical hazards?
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Choose one of the hazards
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Fall hazards from one level to another?
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Danger of falling into water?
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Is excessive noise or vibration a problem?
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Is there a danger from falling objects?
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Is lighting a problem?
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Can weather conditions affect safety?
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Will there be contact with acids, toxic, or caustics?
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Will there be exposure to dust, fumes, or mist?
Employee Verifications
Verification
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Leaders Signature
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Click to add attendee.
Attendee
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Attendees signature
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Photo of attendees