Title Page

  • Conducted on

  • Prepared by

  • Location
  • Supervisor

  • Store

  • Job Number

  • Have you Signed into Store

  • Have you logged onto the relevant task?

  • Have you checked the Asbestos Register for your area of work?

Main Task being performed

  • Enter the main task here.

  • Are there any Sub Tasks?

  • Subtasks

  • Subtask
  • Enter sub task here

Hazard Recognition - What Could Happen to us?

  • Click Add to Add Hazard

  • Hazard
  • Enter Hazards here

  • How badly would we most likely be jurt

Negate the Hazards Above.- How can we work safely?

  • Click to add safety measure.

  • Safety Measure For Hazard
  • How will we negate the hazard

PPE that should be used

  • Hard Hat

  • Reflective Vest

  • Gloves

  • Glasses

  • Protective Footwear

  • Respiratory Protection

  • Hearing Protection

  • Cutting Goggles

  • Face Shield

  • Harness/Lanyard

  • Tyvek Suit

  • Other

  • Click Add other PPE

  • Other PPE
  • List other PPE here

Keep Safety First In All Tasks

  • Do we have the training and experience to perform this task safely?

  • DO NOT BEGIN WORK. Notify your supervisor.

  • Does everyone understand how to do their individual tasks?

  • DO NOT BEGIN WORK. Notify your supervisor.

  • Do we have the appropriate tools and materials and know how to use them?

  • DO NOT BEGIN WORK. Notify your supervisor.

  • Are we qualified to operate and work around all equipment on project

  • DO NOT BEGIN WORK. Notify your supervisor.

Awareness Checklist

Awareness Checklist

  • Is special training needed?

  • What special training is needed?

  • Click to add special training

  • Special Training
  • List Training Here

  • Are permits required?

  • Select required permits.

  • Click to add other permits

  • Other Permits
  • Can any body part get caught in, struck by, or caught between objects?

  • Are the employees working with sharp or rough materials that require PPE

  • Can pushing, pulling, lifting bending, or twisting cause strain? If greater than 50 pounds get help.<br>

  • Do tools, machines, or equipment present any hazards?

  • Can the worker slip trip or fall?

  • Are there flammable, explosive, or electrical hazards?

  • Choose one of the hazards

  • Fall hazards from one level to another?

  • Danger of falling into water?

  • Is excessive noise or vibration a problem?

  • Is there a danger from falling objects?

  • Is lighting a problem?

  • Can weather conditions affect safety?

  • Will there be contact with acids, toxic, or caustics?

  • Will there be exposure to dust, fumes, or mist?

Employee Verifications

Verification

  • Leaders Signature

  • Click to add attendee.

  • Attendee
  • Attendees signature

  • Photo of attendees

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.