Daily Proper PPE Check
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Today's Date
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Job Name
PPE Check
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
-
Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
-
Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
-
Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
-
Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
-
Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
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Name
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Hard Hat, Safety Vest, Safety Toe Shoes, Safety Glasses, Ear Protection, Gloves
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Witness Initials
T&D JSA
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Date
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Job Name
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Job Number
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Job Address
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Superintendent
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JSA Completed By
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Other Contractors On-Site
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Rally Location Point
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Emergency Number
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Eyewash/First Aid Kit Location
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Nearest Medical Facility
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WPA (outage) required
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If Yes, Name/Contact of person holding WPA
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Voltage of Line & Circuit Name
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Minimum Approach Distance
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Excavation Required
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Locate Number
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Concrete Pour Card Required
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Pour Card Completed by
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Equipment Check List Completed
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Yesterdays Safety
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Quality
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Production
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Crew Suggestions, Concerns
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Todays Job Description
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Fall Back Work
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Stretch & Flex
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Steps to Perform Task
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Potential Hazards
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Protective Measures & PPE Required
Mid-Day Review
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Post-Break Review
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Name
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Name
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Name
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Name
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Name
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Name
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Name
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Name
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Name
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Name
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Name
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Name
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Name
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Name
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Name
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Name
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Name
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Name
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Name
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Name
Identifying Hazards
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Using Safety Wheel Identify Hazards on the Jobsite
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Using Hierarchy of Controls Triangle, What techniques can be used to alleviate the hazards identified.
