Title Page
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Date
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Address
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Prepared by
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Job Site
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Division
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First Name, Last Name
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Employee Number
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Employee Phone Number
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Position
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Truck Number
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Trailer
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Crew Size
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Account Manager
Tempature
BASIC NEEDS / DOCUMENTS REQUIRED
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WATER/CUPS/CONTAINER: Enough. Clean. Drinkable. Fresh. Suitably Cool. Free. 2 gals/person (80°F).
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REST AREAS: Restrooms. Break-Lunch. Enough Shade (80°F). Buddy System (95°F). Water Breakes.
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DOCUMENTS ON-SITE: Heat Illness Program. Safe Practices. First Aid/CPR Trained person.
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IIPP: Dose EE knows what the IIPP is? Dose EE Knows where to locate the IIPP?
OPERATIONS
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MATERIAL HANDLING: Loading equipment. Lifting Techniques. Wheelbarrel Safety.
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EQUIPMENT SECURED & Attended: Metal Cord Availabe. Lock.
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SAFE EQUIPMENT & Hand Tools: Good Conditions. Adequately Guarded. Safe Use. Know Repair Process.
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PPE-Personal Protective Equipment: Gloves. Glasses. Ear Plugs. Masks. Slip-Resistant Shoes. Vests.
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LADDER: Safe/Proper Use. Good Condition. Check Defects Before Use. Train EE before using!
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BURLAPS: Size. Placement: Not On Pedestrian Path. Cones. Proper Lifting.
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JAYWALKING: Working Too Close To Traffic. Parking Lots. Safety Vest. Aware of Moving Vehicles.
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STORM DRAIN Contamination. Do Not Dispose Anything In Storm Drains.
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HOUSEKEEPING: Sources of Trips, Slips, & Falls. Tools & Materials Organized in a Safe Manner.
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CHEMICALS: Safe Use & Storage. Backpacks. Tags. SDS Pack. Labeled Containers. Clean Towels & Soap. PPE.
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PROPERTY DAMAGE: Proper Use of Weed Eater & Other Equipment That Can Damage Client’s Property.
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STORAGE?: Clean & Organized. Containers Labeled. Electrical System. Fire Extinguisher. First Aid Kit.
VEHICLE/TRAILER
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PREVENTION: Fire Extinguisher Full. First Aid Kit Complete. Seat Belts. Camera.
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PAPERWORK: Registration. Proof of Insurance. Trailer Permit. PlateTabs Not Expired. Colission Paperwork.
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TRAFFIC CONTROL: Procedure. Cone Placement. Enough Cones. Use Spotter When Maneuvering.
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VEHICLE: Tires. Lights. Brakes. Mirrors. Horn. Plates. TRAILER: Gate. Lights. Wires.
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INSIDE: Clean/Organized: Behind Seats. Dashboard Clear. Floor. Glove Compartment.
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OUTSIDE: Clean/Organized. Paint. Logo. Windshield. Safe Side Panels.
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TRAFFIC RULES: Driver Aware of Traffic Rules. Speed Limit. Stop at Rail Road Intersections, etc.
COMMUNICATION
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PHONE: Radio. Cell. Supervisor & Office Phone #s Available. Personal Phone Policy.
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EMERGENCY Procedures. What to Do. Aware of Jobsite Location at All Times. When to Call 911.
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MEDICAL CLINIC: Phone & Address Posted & Available. Knows How to Get to Clinic.
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MANNERS: Proper Etiquette. Stop Activities Near Pedestrians. Smile. Minimal Interaction w/Clients.
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APPEARANCE: Professional Mission Apparel. Shirt's, Hat (No Logo) and Safety Vest.
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INJURED Workers? If any… Restrictions. Modified Work Proper Procedure & Limitations.
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TRAINING RECORDS: If any specialty equipment is being used.
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OTHER HAZARD IDENTIFICATION: Actions Taken. (Explain)