Title Page

  • Work order # or Job #

  • Tech name

  • Employee #

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • 1. JHA is complete and accurate

  • 2. Is employee wearing all required PPE?

  • 3. Is your van clean and organized?

  • 4. Fire extinguisher in Vehicle?

  • 5. First Aid/Body fluid kit in vehicle?

  • 6. Vehicle accident forms?

  • 7. Is there drinking water available?

  • 8. Have your ladders been inspected and in good condition?

  • Any Safety Violations found?

  • Signature for Safety form packet?

  • Pictures

  • Notes

  • Name of technician

  • Name of Auditor

  • Add media

  • Name of Project Manager

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.