Pre-Job Inspection Checklist

Please submit a Safety Form daily.

First Name *

Last Name *

Select a date *

Job # *

Contractor

Personl Hazards *

Instructions for each task

Ability to perform the task

Ability to use tools properly

Distractions in the work area

Working Alone

Weather conditions

Noise conditions

Other

Preventative Measures for Personal Hazards

Activity Hazards *

Cutting / Nailing material

Handling materials

Airborne particles

Working with / near gas

Working with / near electrical

Preventative Measures for Activity Hazards

Environmental Hazards *

Climate conditions

Ventilation required

Heat exposure

Cold exposure

Lighting levels

Housekeeping

Other

Preventative Measures of Environmental Hazards

Ergonomic Hazards *

Working in tight areas

Working above your head

Pinch points identified

Repetative movements

Preventative Measures of Ergonomic Hazards

Access Hazards *

Nearby excavations

Falling debris

Powered platforms

Heights / Ladders / Scaffolding

Slippery surfaces

Confined space

Preventative Measures of Access Hazards

PPE Requied *

Foot protection

Hearing protection

Eye protection

Safety harness

Hand protection

Respiratory protection

Head protection

Skin protection

Your Signature *

Clear