Protective Equipment

Wears Reflective Clothing (Uniform, Vest)

Wears Gloves

Wears Hearing Protection (If applicable)

Does Not Wear Loose Clothing or Jewelry

Wears a Hard Hat

Wears Recommended Slip-Resistant Footwear

Wears Eye Protection (Goggles, Safety Glasses)

Landfill/Transfer Station Equipment

Operates At Proper Speed (Conditions)

Proper Distance From Other Vehicles

Safety Equipment (Fire Extinguisher)

Back-Up Alarms

Equipment Condition

Fire Prevention

Stores Flammables in Flammable Storage Cabinet

Removes Combustible Material Prior to Welding

Completes and Follows Hot Work Permit

Slips and Falls

Keeps Alert for Medical Waste, Sharps, and Needles

Uses Cab, Body, Handrails

Watches Where Stepping

Reports/Cleans Liquid Spills Immediately

Lockout / Tagout (LOTO)

Does Not Remove Guards or Safety Devices without LOTO

Uses LOTO when servicing/maintaining equipment

Test Lockout Before Working

Near Miss Identified

If yes, complete Near Miss Incident Reporting Form

Observer comments, positive and corrective

Employee Signature
Site Manager Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.