Project Safety Protocol Assessment Form
Please complete this form to assess the implementation and effectiveness of safety protocols for your project.
Project Name
*
Assessor's Full Name
*
First Name
Last Name
Date of Assessment
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Role/Position of Assessor
*
Safety Protocols Evaluation
*
Rows
Compliant
Partially Compliant
Non-Compliant
Not Applicable
Site access control measures are in place
1
2
3
4
Personal Protective Equipment (PPE) is available and used appropriately
5
6
7
8
Safety signage is visible and clear
9
10
11
12
Emergency exits are accessible and marked
13
14
15
16
First aid kits are available and stocked
17
18
19
20
Fire extinguishers are present and inspected
21
22
23
24
How would you rate overall compliance with safety protocols on site?
*
1
2
3
4
5
Are all workers trained in emergency procedures?
*
Yes
No
Partially
Are safety incidents or near-misses reported and documented?
*
Always
Sometimes
Never
Which of the following safety equipment is present and in good condition? (Select all that apply)
*
Hard hats
Safety goggles
High-visibility vests
Gloves
Safety harnesses
Other
Comments or Suggestions for Improving Safety
Submit Assessment
Should be Empty: