• Supervisor's Safety Checklist

  • CONFIDENTIAL - The contents of this form will only be visible to yourself and your supervisor. 

  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Type of Form
  • Have all workers/subcontractors received site specific orientation?*
  • 1. Hazard Identification and Control*
    Rows

  • Supervisors must be aware of potential and actual hazards in the workplace and inform workers about them. They are also responsible for implementing control measures to mitigate these hazards.

  • 2. Safety Documentation*
    Rows

  • Will tasks today require additional safety paperwork:

  • Equipment check (PME):*
  • Are there any addtional workers/crews submitting this form?*
  • Have you received paperwork from Worker/Crew?*
  • Fall Protection plan:*
  • Are there any addtional workers/crews submitting this form?*
  • Have you received paperwork from Worker/Crew?*
  • Harness Inspection:*
  • Are there any addtional workers/crews submitting this form?*
  • Have you received paperwork from Worker/Crew?*
  • Confined Space permit:*
  • Are there any addtional workers/crews submitting this form?*
  • Have you received paperwork from Worker/Crew?*
  • Hot work permit:*
  • Are there any addtional workers/crews submitting this form?*
  • Have you received paperwork from Worker/Crew?*
  • Ground disturbance permit:*
  • Are there any addtional workers/crews submitting this form?*
  • Have you received paperwork from Worker/Crew?*
  • 3. Training and Competency*
    Rows

  • Supervisors are responsible for providing workers with adequate safety training and instruction, ensuring they understand how to perform their tasks safely. Additionally, supervisors must ensure that contractors are competent for the work they are assigned. This means assessing their skills, knowledge, and experience.

  • 4. Inspections*
    Rows
  • Did you perform your own informal walk around?*
  • Date*
     - -
    2 digit month, 2 digit day, 4 digit year
  • 5. Investigations*
    Rows

  • Supervisors play a crucial role in investigating workplace incidents and near misses, identifying root causes, and implementing corrective actions to prevent recurrence.

  • 6. Enforcing Safety Procedures*
    Rows
  • 7. Emergency Preparedness*
    Rows
  • Send Copy to Manager's Email*
  • Should be Empty: