Safety Inspection

• Inspection Type

• Division

  Select 1 2 3 4 7 8 9 10 11 12 Tree Co 16

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  • Tree Co
  • 16

• Conducted on

  Date

• Prepared by

• Location
  Address

• Employee Name/Division/Crew/Truck Number

PPE

• Hat for sun protection

  Yes

  No

  N/A

• Boots in good condition

  Yes

  No

  N/A

• New way long sleeve shirts & pants worn

  Yes

  No

  N/A

• Hardhat

  Yes

  No

  N/A

• Hearing Protection/ Tapones Oreja

  Yes

  No

  N/A

• Extra PPE

  Yes

  No

  N/A

• Gloves/ Guantes

  Yes

  No

  N/A

• Safety Glasses or goggles/ Lentes

  Yes

  No

  N/A

Pesticides

• Pesticide Binder (N8/ Poison Control & Clinic info, SDS')

  Yes

  No

  N/A

• Pesticide Safety Products (Soap, paper towels, tyvek)

  Yes

  No

  N/A

• Locked Pesticide Box & Sprayer

  Yes

  No

  N/A

• Chemicals Labeled

  Yes

  No

  N/A

• Pesticide PPE

  Yes

  No

  N/A

• Chemicals stored and labeled properly

  Yes

  No

  N/A

• SDS for chemicals onboard/sprayed

  Yes

  No

  N/A

Vehicle

• Daily use reports completed accurately

  Yes

  No

  N/A

• F/A kit onboard and stocked

  Yes

  No

  N/A

• Cones around truck

  Yes

  No

  N/A

• Water Filled and Cups

  Yes

  No

  N/A

• Fire Extinguisher/ Serviced within the past year

  Yes

  No

  N/A

• Truck medical clinic posting

  Yes

  No

  N/A

• Heat Illness Prevention Program

  Yes

  No

  N/A

• Tires, Lights, License Plate, Mirrors in serviceable condition

  Yes

  No

  N/A

• Tools in serviceable condition/ Secured

  Yes

  No

  N/A

Trailer

• Hub seals in place

  Yes

  No

  N/A

• Yes

  No

  N/A

• Yes

  No

  N/A

• Tires/ Leaf Springs in good condition

  Yes

  No

  N/A

• Yes

  No

  N/A

• Fuel/ Fertilizer stored properly

  Yes

  No

  N/A

• Fuel properly mixed (1.3oz/gal)

  Yes

  No

  N/A

Final

• Additional Findings/Comments

• Employee Signature

  Sign

• Inspector Signature

  Sign