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SUPERVISOR: DATE:
JOB DESCRIPTION: LOCATION:
EMPLOYEE NAME: EMPLOYEE SIGNATURE:
EMERGENCY PROCEDURES
WORK TASKCORRECT TOOLSELECTRICAL LOCK & TAG OUTCHEMICAL CONTROLSWELDING CONTROLS
GROUND LEVEL FOOTERFIRE EXTINGUISHERFIRST AIDWELFARE
WORK AREA BARRICADEDWARNING SIGNAGE REQUIREDTRAFFIC MANAGEMENT REQUIRED
LABORERSPPEPRE-BRIEFING
QUARTERLY INSPECTEDDAILY INSPECTEDGOOD CONDITIONON FIRM SURFACE: SILLS / BASEPLATES / CASTORS?
ENVIRONMENTLADDERS / STAIRS SECURED AND PROPER ANGLE?
SECURED FROM TIPPING - TIES AND BRACING?STANDARDS PLUMB, LEDGERS & TRANSOMS LEVEL?
PLANKING SECURED & IN GOOD CONDITION?GUARD RAILS / MID-RAILS / TOE BOARDS?
RC ROADS DEPTHOT WORKELECTRICALOTHER:
EQUIPMENTCAN OTHER MEANS APART FROM SCAFFOLD BE USED?
SAFETY TASK ANALYSIS RISK REDUCTION TALK (STARRT)
SCAFFOLDING
PERMITSSEC (overhead)MARAFIQRC INDUSTRIAL SECURITY
