Work Base Site Safety Checklist

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Worksite & Location

• Supervisor:

• Job Title:

• The work environment is well lit, ventilated, clean and orderly, and there are adequate rest room facilities

  Yes

  No

  N/A

• Exits, fire extinguishers, rest rooms or dangerous and off limit areas are clearly marked

  Yes

  No

  N/A

• Noise levels are low enough to allow verbal communication

  Yes

  No

  N/A

• Worksite supervisors are aware of Sierra Nevada Job Corps Center accident procedures and policies

  Yes

  No

  N/A

• Worksite supervisors are aware of the need for close supervision and that inappropriate behavior such as “horseplay” is not to be tolerated

  Yes

  No

  N/A

• Worksite supervisors have arranged for adequate supervisions of students in the absence of the immediate supervisor

  Yes

  No

  N/A

• Worksite supervisors are aware that students under 18 are prohibited by law from operating or using heavy equipment, power-driven machinery, toxic, flammable or explosive substance, motor vehicles, climbing scaffolds or ladders over 4 ft

  Yes

  No

  N/A

• Worksite is equipped with fire extinguishers, first aid kits, telephone (in case of emergency), all in operable condition.

  Yes

  No

  N/A

• Worksite supervisors will require students to use safety equipment, e.g. safety helmets, goggles, gloves, boots, coveralls and rain gear when necessary

  Yes

  No

  N/A

• Worksite will not allow student to work with mold, asbestos or lead based paint. Will notify SNJCC W.B.L.C. if found on worksite

  Yes

  No

  N/A

• Worksite follows all COVID-19 safety procedures and precautions necessary for safety

  Yes

  No

  N/A

General conditions of safety at this site are adequate to allow Work Based Learning placements(s)

• Work Based Learning Specialist:

  Sign

• Date:

  Date

• Employer Representative:

  Sign

• Date:

  Date

• SNJCC Safety Officer

  Sign

• Notes: