Service Job Safety Hazard Checklist

• Technician Name

  Select Tom Baker Mark Black Rick Buys Chris Chruscial Mike Clark Craig Cullin Doug Curtis Jeremy Curtis Jeff Dorman Tim Freeland Jason Ferguson Steve Hausserman John Juarez Tony Kucera Bret Secondi Ron Strick Jason Triplett Jim Triplett Ron VanderWest Dusten Wells

  • Tom Baker
  • Mark Black
  • Rick Buys
  • Chris Chruscial
  • Mike Clark
  • Craig Cullin
  • Doug Curtis
  • Jeremy Curtis
  • Jeff Dorman
  • Tim Freeland
  • Jason Ferguson
  • Steve Hausserman
  • John Juarez
  • Tony Kucera
  • Bret Secondi
  • Ron Strick
  • Jason Triplett
  • Jim Triplett
  • Ron VanderWest
  • Dusten Wells

• Job Site

• Select date

  Date

Think Through the Job Tasks

• Do you know and understand the scope of work and how to do it safely?

  Yes

  No

  N/A

• Is this a standard working procedure/activity?

  Yes

  No

  N/A

• Do you know the proper and safe method to execute the job from start to finish?

  Yes

  No

  N/A

• Do you have all the necessary PPE?

  Yes

  No

  N/A

• Do you have required work permits?

  Yes

  No

  N/A

• Do you have an action plan in case of fire or tornado?

  Yes

  No

  N/A

Stop the Hazard

• LOTO: Will LOTO be used?

  Yes

  No

  N/A

• Fall Protection: Tasks require work over 4 feet?

  Yes

  No

  N/A

• Electrical Work: Exposure to 50 volts or greater?

  Yes

  No

  N/A

• Material Handling: Will >50 lbs be handled?

  Yes

  No

  N/A

• Ergonomics: Long term stooping, bending or awkward position?

  Yes

  No

  N/A

• Slips or Trips: Liquid, ice, loose or fixed items in work area?

  Yes

  No

  N/A

• Ladders: Step or extension ladder needed to perform work?

  Yes

  No

  N/A

• HazCom: will chemicals be used?

  Yes

  No

  N/A

• Signature

  Sign