Worksite Closeout Checklist Form
Document the completion and verification of your worksite closeout. Ensure all key tasks are finalized and recorded.
Project/Site Name or ID
*
Closeout Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Name of Responsible Person
*
First Name
Last Name
Completion Status
*
Please Select
Complete
Partial
Not Complete
Are there any outstanding or remaining issues?
*
No
Yes (please specify below)
If yes, list outstanding or remaining issues
Inspection Completed
*
Yes
No
All Documentation Submitted
*
Yes
No
Utilities/Safety Systems Status
*
Please Select
All Disconnected and Safe
Some Active (explain below)
Client/Stakeholder Sign-off Name
*
First Name
Last Name
Submit Closeout
Should be Empty: