Complete this mandatory safety assessment before commencing any work activities on site. This form must be submitted daily and retained for safety records.
Assessment Date & Time
Site Location/Project Name
Work Area/Zone
Assessor/Supervisor Name
Number of Workers Present Today
Is there a designated Safety Officer on site today?
Evaluate current environmental factors that could impact safety during work operations.
Current Weather Conditions
Clear and Dry
Light Rain
Heavy Rain
High Winds
Extreme Heat
Extreme Cold
Fog/Reduced Visibility
Other
Rate Overall Site Lighting Conditions (1=Poor, 5=Excellent)
Are there any extreme temperature concerns affecting worker safety?
Is air quality or dust level a potential hazard today?
How would you rate current site housekeeping and cleanliness?
Are all walkways, stairways, and access routes clear and unobstructed?
Inspect and verify all equipment and machinery intended for use today meets safety standards.
Daily Equipment Inspection Checklist
Equipment/Machinery ID | Last Service Date | Condition Rating (1=Unsatisfactory, 5=Excellent) | Safe to Operate? | Operator Certified? | |
|---|---|---|---|---|---|
Are there any equipment defects or malfunctions identified?
Are all machinery guards and safety devices in place and functional?
I confirm that all equipment operators have been briefed on today's operational safety requirements
Verify that appropriate PPE is identified, available, and properly used for today's tasks.
Select all PPE categories REQUIRED for today's work activities:
Head Protection (Helmets)
Eye Protection (Goggles/Face Shields)
Hearing Protection (Earplugs/Earmuffs)
Respiratory Protection (Masks/Respirators)
Hand Protection (Gloves)
Foot Protection (Safety Boots)
High-Visibility Clothing
Fall Protection (Harnesses)
Chemical Protective Clothing
Other:
Have all workers been trained on proper PPE selection, use, and maintenance?
Rate overall PPE compliance and availability on site (1-5 stars)
Systematically identify and evaluate potential hazards specific to today's work activities and site conditions.
Daily Hazard Register
Hazard Type | Location/Activity | Risk Level (1=Low, 5=Critical) | Control Measures Implemented | Responsible Person | Risk Adequately Controlled? | |
|---|---|---|---|---|---|---|
Are there any high-risk activities requiring special permits or authorizations today?
Have all workers been briefed on today's specific hazards and control measures?
Confirm that emergency response systems are functional and all personnel are prepared to respond effectively.
Is there a qualified first aider on site today?
Nearest Hospital/Medical Facility Name and Distance
Have all workers been briefed on emergency evacuation routes and procedures today?
Provide details on specific work tasks planned for today and associated safety considerations.
Describe primary work activities planned for today:
Are there any changes to the planned work method or sequence today?
Are all necessary isolations, lockouts, or tagouts completed for safe work?
Are temporary structures (scaffolding, shoring, platforms) inspected and tagged safe?
Is there adequate signage and barricading to protect workers and the public?
By signing this declaration, you confirm that a thorough hazard assessment has been completed, all identified risks have been adequately controlled, and it is safe to proceed with work activities.
I confirm that this assessment has been reviewed with all workers on site today
I acknowledge that all hazards identified have appropriate control measures implemented
I understand that work must stop immediately if new hazards are identified or conditions change
Is it safe to proceed with today's work activities based on this assessment?
Assessor/Supervisor Signature
Signature Date & Time
Additional Comments or Observations: