Daily Safety Plan Form
Complete this form each day to ensure all safety aspects are reviewed and addressed before work begins.
Date of Safety Plan
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Job Site Location
*
Supervisor/Person in Charge
*
First Name
Last Name
Team Members Present (List all)
*
Work Activities Planned for Today
*
Potential Hazards Identified
*
Slips, Trips, and Falls
Electrical Hazards
Chemical Exposure
Working at Heights
Heavy Equipment Operation
Other
Safety Measures and Controls to Be Implemented
*
Personal Protective Equipment (PPE) Required
*
Hard Hat
Safety Glasses
Gloves
High-Visibility Vest
Respirator/Mask
Other
Emergency Contacts (Name and Phone Number)
*
Were there any incidents or near misses reported yesterday?
*
Yes
No
Additional Comments or Safety Concerns
Submit Safety Plan
Should be Empty: