Title Page

  • Date

  • Address
  • Prepared by

  • Job Site

  • Division

  • First Name, Last Name

  • Employee Number

  • Employee Phone Number

  • Position

  • Truck Number

  • Trailer

  • Crew Size

  • Account Manager

  • Tempature

BASIC NEEDS / DOCUMENTS REQUIRED

  • WATER/CUPS/CONTAINER: Enough. Clean. Drinkable. Fresh. Suitably Cool. Free. 2 gals/person (80°F).

  • REST AREAS: Restrooms. Break-Lunch. Enough Shade (80°F). Buddy System (95°F). Water Breakes.

  • DOCUMENTS ON-SITE: Heat Illness Program. Safe Practices. First Aid/CPR Trained person.

  • IIPP: Dose EE knows what the IIPP is? Dose EE Knows where to locate the IIPP?

OPERATIONS

  • MATERIAL HANDLING: Loading equipment. Lifting Techniques. Wheelbarrel Safety.

  • EQUIPMENT SECURED & Attended: Metal Cord Availabe. Lock.

  • SAFE EQUIPMENT & Hand Tools: Good Conditions. Adequately Guarded. Safe Use. Know Repair Process.

  • PPE-Personal Protective Equipment: Gloves. Glasses. Ear Plugs. Masks. Slip-Resistant Shoes. Vests.

  • LADDER: Safe/Proper Use. Good Condition. Check Defects Before Use. Train EE before using!

  • BURLAPS: Size. Placement: Not On Pedestrian Path. Cones. Proper Lifting.

  • JAYWALKING: Working Too Close To Traffic. Parking Lots. Safety Vest. Aware of Moving Vehicles.

  • STORM DRAIN Contamination. Do Not Dispose Anything In Storm Drains.

  • HOUSEKEEPING: Sources of Trips, Slips, & Falls. Tools & Materials Organized in a Safe Manner.

  • CHEMICALS: Safe Use & Storage. Backpacks. Tags. SDS Pack. Labeled Containers. Clean Towels & Soap. PPE.

  • PROPERTY DAMAGE: Proper Use of Weed Eater & Other Equipment That Can Damage Client’s Property.

  • STORAGE?: Clean & Organized. Containers Labeled. Electrical System. Fire Extinguisher. First Aid Kit.

VEHICLE/TRAILER

  • PREVENTION: Fire Extinguisher Full. First Aid Kit Complete. Seat Belts. Camera.

  • PAPERWORK: Registration. Proof of Insurance. Trailer Permit. PlateTabs Not Expired. Colission Paperwork.

  • TRAFFIC CONTROL: Procedure. Cone Placement. Enough Cones. Use Spotter When Maneuvering.

  • VEHICLE: Tires. Lights. Brakes. Mirrors. Horn. Plates. TRAILER: Gate. Lights. Wires.

  • INSIDE: Clean/Organized: Behind Seats. Dashboard Clear. Floor. Glove Compartment.

  • OUTSIDE: Clean/Organized. Paint. Logo. Windshield. Safe Side Panels.

  • TRAFFIC RULES: Driver Aware of Traffic Rules. Speed Limit. Stop at Rail Road Intersections, etc.

COMMUNICATION

  • PHONE: Radio. Cell. Supervisor & Office Phone #s Available. Personal Phone Policy.

  • EMERGENCY Procedures. What to Do. Aware of Jobsite Location at All Times. When to Call 911.

  • MEDICAL CLINIC: Phone & Address Posted & Available. Knows How to Get to Clinic.

  • MANNERS: Proper Etiquette. Stop Activities Near Pedestrians. Smile. Minimal Interaction w/Clients.

  • APPEARANCE: Professional Mission Apparel. Shirt's, Hat (No Logo) and Safety Vest.

  • INJURED Workers? If any… Restrictions. Modified Work Proper Procedure & Limitations.

  • TRAINING RECORDS: If any specialty equipment is being used.

  • OTHER HAZARD IDENTIFICATION: Actions Taken. (Explain)

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.