Title Page

  • Conducted on

  • Prepared by

  • Location

Pre-Check

  • Reviewed Workers Compensation EMR (experience modifications rate), DART (days away from work, restrictions, or job transfer)

  • Reviewed OSHA Inspection Reports Violation (OSHA.gov)

  • Reviewed DOT SAFER FMCSA Database

  • Reviewed OSHA Log and Recent Incidents

  • Reviewed Client's Injury & Illness Prevention Program (Safety Manual)

  • Review list of Job employees will be ask to do

  • Hazards workers will be exposed to

  • Protective measures in place to protect workers

  • Skills Required, certifications, etc

  • Employee training onsite (Includes staffing employees)

Onsite Assessment

  • Housekeeping (Is facility clean and are work areas free of obvious slips trip and fall hazards)

  • Exit Routes (Are they accessible, clearly marked and free and clear of obstructions/hazards)

  • Machinery (Tools and machinery in safe working condition, Machine guarding present and fixed)

  • PPE (PPE Required in facility, consistent proper usage, training, employer provides)

  • Ergonomics (Working from nuetrual work positions encouraged, Lifting/handling aides, design of work stations)

  • Emergency Preparedness (First Extinguishers and first aid kits present, training, staffing employees included, etc.)

  • Open Door/Suggestion Box Policy

  • HAZCOM (Presence of SDS's, Training, etc.)

  • Hearing Conservation Exposures (HEaring protection, PPE, Training, Audiograms, etc.)

  • Any Confined Space Work (Permit or non permit required confide spaces)

  • Ladder Safety (Authorized employees only, program, training,

  • Work at Heights (Fall Protection)

  • Electrical (Frayed wiring, block electrical panel boxes. open circuits/boxes, temporary wiring use as permanent wiring)

  • Lock Out Tag Out [LOTO] (Affected Employee/Authorized Employees)

  • Forklift Operations (Staffing Employees operate fork lifts, Training Certification, battery changing procedures, Fuel change outs)

  • Eye Wash Stations

  • Storage Racks (Load Limits maintained)

  • Loading Docks (Dock Bay closed, Trailers Chocked, Loading Ramp Load Limit Appropriate)

  • Chris Abbs, Safety Manager - Recruit Specialized Staffing

  • Date & Time

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.