Temporary Worker Safety Checklist Form
Complete this checklist before or during your shift to ensure a safe working environment for all temporary workers.
Temporary Worker's Full Name
*
First Name
Last Name
Site Supervisor's Full Name
*
First Name
Last Name
Worksite Location
*
Date of Shift
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Shift Start Time
*
Hour Minutes
AM
PM
AM/PM Option
Personal Protective Equipment (PPE) Provided and Worn
*
Yes
No
Not Applicable
Safety Briefing Received and Understood
*
Yes
No
Any Hazards Identified at the Worksite?
*
Yes
No
Are Emergency Exits and Contacts Known?
*
Yes
No
Additional Comments or Observations
Submit Checklist
Should be Empty: