Safety Checklists

These checklists are provided by the Maine Department of Labor SafetyWorks! program as a guide to assist employer in compliance with safety and heath regulations. It is the responsiblity of the employer to modify these documents to meet site-specific hazards.

Respirators / Respiratory Protection

Qualitative Respirator Fit Test - Evaluates fit of respirators to ensure safe use.

Checklist for Respiratory Protection Programs - Helps ensure your facility has met all requirements for a respiratory protection program.

Checklist for Respirator Selection - Helps you select a respirator that is appropriate for the hazards present at the worksite.

Checklist for Respirator Fit Testing - Items that are required for employees who are using tight fitting respirator facepieces.

Checklist for Medical Evaluation for Respirator Use - Information that must be provided to health care provider that is clearing an employee for respirator use.

Respirator Program Evaluation Checklist - Checklist for program administrators to use.

Respirator Inspection and Cleaning Checklist - Provides items to inspect and clean on tight fitting respirators.

Voluntary Respirator use 1910.134 Appx. D - Employers guide to what information must given to employees who wish to wear respirators on a volunteer bases.

Respirator Medical Evaluation Form - Appendix C to 1910.134: OSHA Respirator Medical Evaluation Questionnaire (Mandatory)

Qualitative Fit Test Form - This form is for fit testing tight fitting respirators using the saccharine method.

Lockout Tagout

Lockout Tagout form for Equipment - Forms for lockout/tagout procedures,programs and equipment.

Lockout / Tagout Procedures Inspection Form - At least annually an inspector will review the Hazardous Energy Control Procedure with all authorized employees and actually observe the use of the procedure.

LOTO Lock Removal Procedure Form - Provides the proper procedure for removing a LOTO device when the device owner is not availible to remove it.

Lockout Procedure for Dump Body Trucks - Example Lockout Procedure for Maintenance on Dump Body Truck

Sample Lockout Procedure for Front Loader - Lockout Procedure for Maintenance on Front Loader

Lockout Procedure for Water Pump - Detailed sample lock out procedure for a waste water pump.

Lock out procedure annual review form. - Annual Lockout - Tagout Administrative review of detailed writen procedures of lockouts for equipment.

Lockout Tagout Training Form - Ensures that training has been received on the Mandatory Lockout - Tagout Program. Provides checklist of items to be trained on.

Forklift Use

Forklift Operator Checklist - Daily checklist for safe operation of forklifts

Performance Test for Forklift Operators - Form that allows the employer to evaluate forklift operators skills at the work site.

Construction

Confined Space Hazard Form - Guides employers and employees on the hazards that need to be assessed prior to entering a confined space.

Permit Required Confined Space Entry Form - Provides employers and employees with permits that are requied to enter PRCS. Air quality, rescue needs and addresses other hazards

Confined Space Alternate Procedure Checklist - Provides employors and employees with a list of hazards that need to assessed prior to entering a Confined Space other that a PRCS.

Safety Harness Inspection Checklist - Provides a safety checklist for fall protection body harnesses. Check stitching,D-rings and other critical items of harnesses and lanyards.

ENERGIZED ELECTRICAL WORK PERMIT - When live electrical must be performed all vested parties must be notified. All questions must be answered by the qualified electrician on this permit and turned over to the supervisor for approval.

Construction Jobsite Checklist - Checklists for Construction related exposures.

Staging Checklist - Daily stationary staging checklist,

Workzone Safety Checklist - Workzone safety items that may be required,

Facility Inspection Checklist(MS Excel Version) - Provides guidance to employers for the periodic inspection of thier facilities.

Crane Inspection Form - Provides basic items on cranes that need to be inspected on a daily bases. (Hooks, steps, attachments, safety glass, drums ect..)

Torch and Welding Hot Work Permit - List items that need to be addressed prior to cutting and welding to prevent fires in the workplace.

Crane Pre- Operational General Checklist - Provides a critical item checklist to the crane operator prior to operating.

Wire Rope Inspection Report - Part of crane inspection concerning the condition of wire ropes on cranes and other material lifting devices.

Daily Visual Overhead-Crane - Provides a basic checklist of critical crane items for operators to inspect.

Electrical Task Assessment Checklist - Provides a checklist from NFPA 70E to ensure all safety items have been addressed when the need to work on live electrical systems.

Overhead Crane Monthly Inspection Form - Items that are required to be checked on overhead mobile cranes provided by United States Crane Certification Bureau.

Hydraulic Jack Inspection Checklist - Provides items to be inspected every 6 months to ensure safe and proper functioning of jacks.

Personal Protective Equipment (PPE)

PPE Assessment Form Version 2 - Assist employers in training employees on PPE needs for a task. Provides area to document training.

Checklist on Need for PPE on Tasks - Assist employers in determining which areas of the body may need PPE depending on the tasks being performed.

PPE Assessment Form - Basic form list "task", "hazard", "PPE recommendation". A sample page is provided.

PPE Assessment Version 3 - Detailed box check off of tasks PPE needed.

Chemical Hygiene

Chemical Lab Annual Training Checklist - Provides a list of topics that annual training is required for employees that work in small scale labs. (Schools, Water Treatment Plants)

Chemical Lab Safety Inspection Checklist - Provides a list of chemical lab safety items that need to be checked periodically for employee safety.

Fire Departments

Ground Ladder Checklist - Checklist for safety inspection of ground ladders.

Traffic Control at Emergency Scenes -

Fire Department Ladder Safety Checklist -

Workzone Safety Checklist - Workzone safety items that may be required,

Respirator Inspection and Cleaning Checklist - Provides items to inspect and clean on tight fitting respirators.

Fire Department Annual PPE Inspection - Detailed fire department turn-out gear inspection checklist.

Facility Inspection Checklist (MS Word Version) - Provides guidance to employers for the periodic inspection of thier facilities.

FIRE DEPARTMENT DRIVER OPERATOR EVALUATION CHECKLIST - provide documentation that an individual has completed the required minimum training before receiving authorization from the Chief Officer to drive fire department apparatus.

Other

Workstation Checklist - Helps identify risk factors contributing to work-related discomfort or problems at workstations.

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