Southland Industries

EMPLOYEE: *

FOREMAN/SUPERVISOR: *

PROJECT(S): *

MONTH: *

,20

Trade:

Date:

Plan out your work before you start and throughout your day.

Tasks(Check all that apply)

What additional tasks are you performing?

Hazards(Check all that apply)

What additional hazards are present?

SAFETY PRECAUTIONS(Check all that apply)

What additional precautions must be taken?

SAFE WORK PRACTICES(Check all that apply)

Know the location of the closest emergency exit, fire extinguisher, and first aid kit to your work area.

Make sure you have the correct size and type of ladder and that it is setup and being used properly.

Ensure that all power cords are inspected and free of damage, and laid out to minimize trip hazards.

Use the right tool for the job. Use the tool the way the manufacture designed it to be used.

Flammable and compressed gasses must be properly used, secured, transported and stored properly when not in use.

SAFE WORK PRACTICES (Check all that apply)

Fall protection equipment must be inspected before each use and stored properly when not in use.

Ensure your work area has proper lighting and ventilation. Stay clear of work causing dust, mists, or vapors.

Do not run on the jobsite. Do not listen to music or use headphones. Cell phones may only be used on breaks.

Smoking, including the use of e-cigarettes, is only permitted in approved areas.

Clean up after you make a mess. Housekeeping should be conducted on an on-going basis.

EMPLOYEE SAFETY REPORT (Check all that apply)

I reported a Safety Hazard

I resolved a Safety Issue

I had a Safety Suggestion

SAFETY CHECKLIST (all boxes must be checked. If the answer is YES to any questions, contact your Foreman/Supervisor before proceeding)		YES	NO
Attend daily 2 Minute Start Up meeting	Do today's tasks require special training/certification?
Bring any Safety Issues to your Foreman immediately	Do today's tasks require special tools or equipment?
Don't take chances - if in doubt ask your Forman	Do today's tasks require review of Safety Data Sheets?
Insure that your work are is free of hazards	Will weather be a safety concern today?
Wear all required Personal Protective Equipment	Are barricades/warning tape or safety signs required?
Inspect all tools and equipment before use	Is the weight of the materials your handling more than 50lbs?
Be trained with all tools before use	Are there any new crew members that require support?
There are enough personnel to complete the task	Are you working in trenches or confined spaces?
Has a pre task plan been completed for high risk work	Are ladders visually inspected prior to use?
Do you know who to contact in an emergency