Title Page
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Conducted on
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Supervisor:
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Building Name:
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Building Address:
Pre-Job Safety Meeting
Pre-Job Meeting Checklist
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Select Muster Point
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Review Hazard Assessment
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Reviewed Vehicle & Equipment Inspections
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Reviewed Fall Protection Plans (lifts or working within guardrails does not require a fall protection plan)
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Reviewed all job specific Emergency Response Procedures?
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Other Safety Items Discussed (warnings about roofs, extra safety precautions, etc.):
Signatures
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I hereby certify that all information is accurate and that an actual inspection was conducted as per company policy.
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Crew Manager's Printed Name and Signature:
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Worker Attendance:
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Worker's Printed Name and Signature:
