Title Page

  • Conducted on

  • Prepared by

  • Branch Location/Job Name/Employee Name
  • Client / Site

  • Mechanics Name

Safety Documentation:

  • Does Employee have a safety manual?

  • Is the Daily Jobsite Inspection Checklist documented?

  • Has a Job Hazard Analysis been completed and discussed with all Employees on site?

  • Are the applicable F.P.P.checked off and incorporated into the JHA<br> Personal Protective Equipment<br> Lock-Out/Tag-Out/Try-Out<br> Jumpers<br> Live Electrical Troubleshooting<br> Mechanical Stored Energy<br> Cartop and Pit Access<br> Barricades<br> Fall Protection<br> False Cars and Running Platforms<br> Hoisting and Rigging<br>

  • Are the applicable 5 Behavioral Safety Traps checked off and incorporated into the JHA<br> Lack of Awareness<br> Diminishing the Risk<br> Lack of Concentration<br> Unintentional Pressure<br> Fear Factor<br>

  • Have the Running Platform and cable climber checklists been properly documented?

Clothing & Personnel Equipment:

  • Are Employees wearing proper footwear?

  • Is all required PPE being worn, is it serviceable, and does it fit correctly?

Electrical Safety:

  • Are all power cords in use plugged into GFCI?

  • Are all cords serviceable and grounded?


  • Are energy sources locked & tagged out as required by TKE policy?

  • Can the employees demonstrate proper Lockout/Tagout procedure?

Fall Protection:

  • Are all guardrails of proper construction, in place & in good repair?

  • Are employees tying off correctly?

  • In the event of a fall, is there a rescue plan?

  • Is the proper lanyard being used (retractable preferred)?

  • Is all fall protection equipment serviceable?

Fire Protection:

  • Are work areas clear of fire hazards?

  • Is a Hot-Work permit required (welding or cutting)?

First Aid:

  • Are adequate first aid supplies on hand?

  • Do employees know the emergency action plan?

Hand & Power Tools:

  • Are power tools in good condition & do they have guards if required?

Hazard Communication:

  • Are SDS's available on site for all chemicals and cleaners?

  • Are all containers and chemicals clearly marked with contents?

Hoisting Equipment:

  • Is all hoisting equipment on site marked with, legible, rated capacity?

  • Is all hoisting equipment serviceable?

Material Handling:

  • Do employees use proper lifting technique? (back vertical & lifting with legs)

  • Is all material handling equipment in good condition? (wheels, handles, pins, etc.)


  • Does the jobsite have adequate lighting?

  • Do the employees have flashlights or headlamps?


  • Are ladders in good condition & with non-metal side rails?

  • Are ladders being used properly & for all access over 19" when stairs or ramp are not provided?

Slips and Trips:

  • Are good housekeeping practices being followed?

Welding, Cutting & Compressed Gasses:

  • Are regulators, hoses and torch in good condition?

  • Are Oxygen and Acetylene bottles properly stored?

  • Are arc welder leads in good condition with no splices within 10' of the end?

Ask questions regarding FPP. -

  • Is Employee knowledgeable on FPP

  • Have employees demonstrate, at a minimum, proper Lockout/Tagout and Fall Protection procedures.

  • Are there any OTHER UNSAFE CONDITIONS, equipment or actions? If yes, explain below. N/A if there are none

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.