Title Page

  • Date

  • Job Name

  • Job Number

  • Prepared by

  • Signature

  • Location
  • Employees Present

  • Western States on site date OR back to site?

General Contractor

  • General Contractor / Owner

  • Job Contract

  • Did you talk to the site superintendent?

  • Name & Phone Number

  • Did you visit the job trailer / office?

  • Superintendent walked job site with you.

  • GC requires all employees attend site specific orientation?

  • Notes

Construction

  • How far along is construction? Stage?

  • Will the job site require a man-lift?

  • Slab-Type

  • All-Terrain

  • Has the underground fire line been run and stubbed up into the building?

  • Has it been flushed and WSFP been provided the flushing paperwork?

  • Notes

Submittal / Permitting

  • Has the project been designed?

  • Has the design been submitted?

  • Has the submitted design been approved?

  • WSFP has pulled all required permits

  • Notes

Material Handling

  • Does contractor have a forklift on site?

  • Is contractor willing to allow WSFP to use the forklift to unload material OR unload our material for us?

  • Is there an established material lay-down area?

  • If yes: location?

  • Notes

Safety / Risk Management

  • If any of the following are checked as "Yes," please notify your Safety Manager.

  • Was the building built before 1980?

  • Are there any asbestos or potentially asbestos containing materials? ASK GC!

  • Is any part of WSFP scope to be completed in a confined space?

  • Is any part of WSFP scope to be completed from a scaffold?

  • Is any part of WSFP scope to be completed in an excavation or trench?

  • Does any part of WSFP scope involve Hot Work? Use of torch or other open flame?

  • Is WSFP required to develop a site specific safety plan?

  • For the following questions, notify your safety manager if you need assistance or employees do not have necessary training.

  • Are the GC provided fall protection measures adequate? Look at Guardrails, Lifelines (horizontal and vertical), Safety Nets, Warning Lines, Fall Protection Procedures, Controlled Access Zones, etc.

  • Do all WSFP personnel working at this site have necessary training, including but not limited to: Basic 8, WSFP New Hire Orientation, OSHA 10/30, Lift Training (Boom, Scissor, Fork), First Aid/CPR, Confined Space, etc.

  • Will there be any WSFP employees on this site with LESS THAN 1 YEAR work experience with WSFP?

  • Notes

Additional Media / Notes

  • Additional Notes

  • Pictures

  • Drawing, if needed

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.