Title Page

Items to Review

People

  • Unsafe Acts

  • Unsafe Work Procedure

  • Improper tool use

  • Improper Equipment use

  • Not Using PPe

Equipment

  • Ladders/Scaffolds

  • Power Tools

  • Adequate Supply of PPE

  • Fire Extinguisher

Materials

  • Housekeeping

  • Controlled Products

  • MSDS Sheets

  • Storage & Stacking

  • Rough Edges

Environment

  • Noise

  • Ventilation

  • Lighting

  • Ice/Snow/Temperature

Wostco Site Inspection

  • Job site insepected

  • Date Completed

  • Site Supervisor

  • Inspection completed by:

  • Worker Safety Rep:

  • Hazards Present

  • Hazard
  • Hazard

  • Severity Ranking

  • 1 = Immediate Danger (Death, Disaster)
    2 = Serious (Major Injury or Damage)
    3 = Minor (Non-Serious Injury or Damage)
    4 = Negligible (first aid or less)
    5 = Not Applicable

  • Probability

  • A = Probable (Immediate or Soon)
    B = Reasonably Probable (Eventually)
    C = Remote (Could Happen at Some Point)
    D = Extremely Remote (Not likely to Happen)

  • Hazards Control

  • Action Completed By:

  • Date Completed

Committee

  • committee Signature

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