• BODY MECHANICS: Close to load, proper lifting, squared up to task (no twisting), using mechanical lift if possible, assisted if too heavy.

  • ASCEND/DESCENS: 3 points of contact.

  • PINCH POINTS: Body parts kept clear from crush point, pinch points, and cuts.

  • EYES ON TASK: Face/head in direction of travel. Watch hands engaged in tasks.

  • LINE OF FIRE: Not working/standing in path of equipment/materials that may shift, relieve pressure, move, or fall.

  • OVEREXTENDED/CRAMPED: Overextending to pass materials/working in cluttered cramped areas that limit movement.

  • STAY TO RIGHT: When passing material take one step to the right of personbelow


  • TOOL SELECTION/USE: Right tool used in the manner intended.

  • TOOL CONDITION: Tools inworking order.

  • TOOLS INSPECTION: Color coede as per quarter.

  • EQUIPMENT SELECTION/USE: guards in place, de-energized for maintenance.

  • EQUIPMENT CONDITION: Electrical cords fray free.


  • RESPIRATORY PROTECTION: Selection, condition, and use of respirator

  • FIT TEST: Respirator fit test completed if required.

  • EYE PROTECTION: Proper eye/face protection present and in use.

  • HAND PROTECTION: Proper hand/arm protection present and in use.

  • HEARING PROTECTION: Hearing protection in use - Double hearing protection in use if required.

  • PROTECTIVE CLOTHING: Proper protective clothing in use (FRC, Latex suit, life vests, etc.).

  • FOOT PROTECTION: Proper footwear worn.

  • HEAD PROTECTION: Proper use of hard hat (bib forward).

  • HARNESS: Proper wear/use of harness.

  • LANYARD SELECTION: Proper lanyard selection for the job (retractable, 6ft lifeline, etc.).

  • LANYARD USE: Proper wear/use of lanyard.

  • ANCHOR POINT: Tied off to suitable anchor.


  • NRTR / JSP COMPLETED: All components of the NRTR / JSP completed prior to starting work.

  • WORKPLACE DESIGN: Is jobsite designed to prevent possible contact with hazards.

  • MAJOR STEPS OF TASK: Key steps of the task noted on NRTR / JSP.

  • HAZARD IDENTIFIED: Are hazards identified and noted on NRTR.

  • AREA-SPECIFIC HAZARDS: Are area specific hazards identified.

  • SAFE PLAN OF ACTION: Safe work plan developed to avoid and minimize exposure to risk.

  • SIGNED BY SUPERVISOR: Supervisor signed NRTR / JSP within first hour of work starting.

  • SIGNED BY CREW: All crew members signed NRTR / JSP prior to starting work


  • WALKING SURFACES: Walking surfaces free of hazards.

  • WORKING SURFACES: Working surface free of hazards.

  • ADEQUATE ILLUMINATION: Adequate lighti g for the work being performed.

  • HOUSEKEEPING: Proper housekeeping.

  • STORAGE: Storage area neat and orderly.


  • COMMUNICATION OF HAZARDS: All known hazards communicated prior to starting.

  • CONFINED SPACE: Confined space procedure followed.

  • LOTO: Lock-Out / Tag-Out procedure followed.


  • FORKLIFT DAILY INSPECTION: Inspection completed and documented.

  • FORKLIFT CERTIFICATION: Driver has current forklift certification.

  • SEAT BELTS: Driver (and passengers) wearing seatbelt(s).


  • Comments and/or remarks.

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