SCL - Hafer Equipment

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Safety Check Lists

PA 1 Call (1-800-242-1776)

* Indicates required field

Notified *

First

Last

Date *

Verification Number *

Owner *

Location *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Contact Person *

Phone Number *

Project *

Date *

Special Notes *

Personal Protective Equipment

Hard Hats (as required) *

Yes No N/A

Comment *

Eye Protection (as required) *

Yes No N/A

Comment *

Hearing Protection (as required) *

Yes No N/A

Comment *

Respiratory Protection (as required) *

Yes No N/A

Comment *

Protective Clothing (as required) *

Yes No N/A

Comment *

Safety Belts & Lanyards (as required) *

Yes No N/A

Comment *

Proper Ventilation in Place *

Yes No N/A

Comment *

Accident / Incident Reporting

Emergency Phone Numbers Posted on the job site *

Yes No N/A

Comment *

Fire Protection

Smoking in designated areas only *

Yes No N/A

Comment *

Fire extinguisher on site *

Yes No N/A

Comment *

Fire extinguisher inspected monthly *

Yes No N/A

Comment *

Approved safety cans *

Yes No N/A

Comment *

Are all containers properly labeled? *

Yes No N/A

Comment *

Gas cylinders properly secured *

Yes No N/A

Comment *

Fire watch (as required) *

Yes No N/A

Comment *

Gas tests peformed *

Yes No N/A

Comment *

Sewer & Catch basins safeguarded *

Yes No N/A

Comment *

Additional Comments *

Excavations

Shoring (as required) *

Yes No N/A

Comment *

Excavation, barricades maintained *

Yes No N/A

Comment *

Access ladders provided *

Yes No N/A

Comment *

Loose material & debris at least 2 feet from edge of excavation *

Yes No N/A

Comment *

Elevated Work Surfaces

Ladders *

Yes No N/A

Comment *

Secured & safety feet on bottom of ladder *

Yes No N/A

Comment *

Fiberglass or wooden ladders used/inspected *

Yes No N/A

Comment *

Scaffolding *

Yes No N/A

Comment *

Scaffold properly Secured *

Yes No N/A

Comment *

Overhead work area identified & barricaded *

Yes No N/A

Comment *

Planking secured (nailed, wired, cleated) *

Yes No N/A

Comment *

Guard rails (42") required *

Yes No N/A

Comment *

Toe boards required *

Yes No N/A

Comment *

Electrical

Explosion proof electrical connections used *

Yes No N/A

Comment *

GFIC protection required *

Yes No N/A

Comment *

Lockout/tagout procedure enforced *

Yes No N/A

Comment *

Tools properly grounded & maintained *

Yes No N/A

Comment *

Tools & extension cords *

Yes No N/A

Comment *

Received periodic inspection *

Yes No N/A

Comment *

General Work Area

Hoses, welding leads & electrical line properly coiled *

Yes No N/A

Comment *

Combustibles & flammables removed *

Yes No N/A

Comment *

Loose debris & materials cleaned up daily *

Yes No N/A

Comment *

Mobile Equipment

Lift area properly barricaded *

Yes No N/A

Comment *

Backup alarms operable *

Yes No N/A

Comment *

Unauthorized riding of equipment prohibited *

Yes No N/A

Comment *

Outriggers used as required *

Yes No N/A

Comment *

Storage

Area restrictions identified *

Yes No N/A

Comment *

Waste handling & disposal discussed *

Yes No N/A

Comment *

Chemicals labeled *

Yes No N/A

Comment *

Special Programs

Hazardous material information (SDS) *

Yes No N/A

Comment *

Hazardous material information communicated to all contract employees *

Yes No N/A

Comment *

Hazard work permit issued *

Yes No N/A

Comment *

Safety meeting held *

Yes No N/A

Comment *

Removal/Installation Forms (if required)

Tank handling activity report (THAR) *

Yes No N/A

Comment *

Notification of contamination form *

Yes No N/A

Comment *

Tank warranty form *

Yes No N/A

Comment *

Dispenser warranty form *

Yes No N/A

Comment *

Miscellaneous

Fire Marshall notified *

Yes No N/A

Comment *

Building inspector notified *

Yes No N/A

Comment *

Weights & measures notified *

Yes No N/A

Comment *

Tank(s) tested *

Yes No N/A

Comment *

Line(s) tested *

Yes No N/A

Comment *

Manifest filled out properly *

Yes No N/A

Comment *

Automotive Checklists

6 Point Brake Check (Class A) *

1. Start engine, make sure air pressure is between 120 psi and 125 psi. 2. In gear, engine off, turn-key on release, park brakes (trailer and tractor). Apply service brake, after initial drop make sure no more than 4 psi are lost in one minute duration. 3. Fan brakes (pump), between 50 and 80 psi, low air warning device will come on (or buzzer). 4. Continue fanning brakes, between 20 and 45 psi T.P.V. spring brakes or trailer brakes and tractor parking brakes should apply (buttons will pop out). Start engine, let air pressure build up until 120 psi. 5. Push in tractor brakes (yellow valve released) trailer brakes applied, put in low gear, attempt to move forward => trailer tug check. 6. Release trailer brakes, apply tractor brakes, put in low gear, attempt to move forward => tractor tug check 7. Push in tractor and trailer brakes, roll forward, apply pressure to brake until stopped => rolling brake check.

Simulated Down Hill *

Check your brakes Check your mirrors Turn on right mm signal Move to farthest right lane(when clear) Down shift to lowest gear Take your foot off clutch Turn on four way flashers Light steady pressure on brakes to the bottom of the hill Both hands on steering wheel Do not shift gears

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