Window Cleaning Safety Plan

Project/Job Name

Date of Window Cleaning

Date

Location/Address of Worksite

Street Address

Street Address Line 2

CityState / ProvincePostal / Zip CodeCountry

Company or Team Name

Supervisor/Lead Name

First NameLast Name

Personnel Involved (List names of all workers)

Description of Window Cleaning Task

Identify Hazards Present (select all that apply)

Safety Equipment to Be Used

Fall Protection Measures in Place

Emergency Procedures (briefly describe what to do in case of an emergency)

Emergency Contact Name

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Additional Notes or Comments