Job Safety Sign-Off Form
Complete this Job Safety Sign-Off Form to confirm all safety requirements have been reviewed and met prior to starting work.
Worker Name
*
First Name
Last Name
Job Site or Location
*
Department or Team
*
Supervisor Name
*
First Name
Last Name
Date of Sign-Off
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Shift or Work Period
*
Task or Work Area Description
*
Pre-Work Safety Checklist
*
Personal protective equipment (PPE) inspected and worn
Work area inspected for hazards
Tools and equipment checked
Emergency procedures reviewed
Permits and documentation in place
Other (please specify)
Incident or Hazard Notes
Signature: I have reviewed all safety requirements and am ready to proceed.
*
Submit Sign-Off
Submit Sign-Off
Should be Empty: