Technician Name

Job Site

Select date
Think Through the Job Tasks

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

Is this a standard working procedure/activity?

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

Do you have all the necessary PPE?

Do you have required work permits?

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

Stop the Hazard

LOTO: Will LOTO be used?

Fall Protection: Tasks require work over 4 feet?

Electrical Work: Exposure to 50 volts or greater?

Material Handling: Will >50 lbs be handled?

Ergonomics: Long term stooping, bending or awkward position?

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

Ladders: Step or extension ladder needed to perform work?

HazCom: will chemicals be used?

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.