Worksite Vetting Form

Worksite Vetting Form
RECOMMENDATION
This Worksite Vetting Checklist assesses the physical safety of a potential worksite. It does not cover all possible hazards and safety regulations. Additional judgment must be used on the part of the Monitor completing the evaluation.
Date

MonthDayYear
Date
Name of Person Vetting This Site
SITE TYPE

Other
AFFILIATION
Site Name:
Worksite for which partner agency?
Worksite for which partner agency?
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Contact Person:
Title:
Phone:
Format: (000) 000-0000.
Fax:
Email:
example@example.com
YOUTH WORK EXPERIENCE
Number of youth requested for site:
What type of work experience will this worksite location provide?
Briefly describe the youth work experience that will be provided at this worksite location
Will this site have multiple locations
If yes, how many?
Every worksite location must be vetted and every worksite location must submit a NFWA.
Is the work site:
Number of supervisors assigned:
In case of bad weather (i.e., rain, excessive heat) participants will:

Does the worksite have the following accommodations?

Rows	Yes	No	N/A
Clean work environment
Restrooms with locking doors, and sink with soap and running water
Adequate lighting
Drinking Water
Safe noise level
Fire/Emergency exits
First aid kit
Personal protective equipment such as hard hats, gloves, safety glasses (if applicable)
ADA Accessible

Are Youth required to: