Daily Job Site Safety Briefing

Office Location

Today's Date

Date

Time

Hour Minutes

AM/PM Option

Employee #1

first and last name

Employee #2

first and last name

Employee #1 Has All PPE?

if NO employee cannot work

Employee #2 Has All PPE?

if NO employee cannot work

Has Hastings Stick Been Properly Inspected and Determined Safe To Use?

if NO explain why in comments section at end of form

What Job Task is Being Done Today?

Location of Job Site

city and state

Name and Distance to Closest Medical Facility

hospital or urgent care and mileage

Temperature

Sky Condition

Precipitation

Conduct a safety review of your job location and immediate surroundings where you will be working. Check for potential safety hazards and discuss as a team the associated control measures:

What type of environment is your job located in?

if environment is Other, please specify in comments section at end of form

Utilities Next to Road: Vehicular Traffic, Working and Walking, City or Rural

Other

Utilities at Rear of Lot: Fenced or Open, Residential or Commercial, City or Rural

Other

Environmental: Insects, Foliage & Weather- What do you anticipate encountering?

Other

Utilities, Poles and Spans

Other

What is the posted speed limit in your work area?

If there are various posted speed limits, check the highest posted limit.

What class safety vest must be worn?

*Always keep the pole between you and oncoming traffic. Increase situational awareness and avoid pinch points*

Comments, Notes and Observations

Has your job site been deemed safe to proceed for work?

Daily Job Site Safety Briefing Form