Safety Meeting Checklist - April 2015

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Appendix I

Safety Meeting Checklist


Date : ___________________________
1. Devotional or Prayer and a general Habitat orientation.
2. Introduction of Future Homeowner (if present)
3. Identification of Site Leader and House Leads.
4. Encouragement to offer Hazard Reports – self corrected or reported to Site Leader.
5. Evacuation Plan and location of plan posted on site.
6. Location of first aid kit and identification of those with First Aid and CPR training.
7. Location of fire extinguishers.
8. Reminder to return all tools and PPE (clean).
9. Day’s work plan.
10. Safety Talks specific to that day’s work.
11. Training on appropriate tools or equipment.
12. Establishment of competent persons for power tool use and roof work.
13. Crew assignments.

The following person presented the Safety Meeting:


Signature ___________________________________ Print Name _________________________________________

The following persons, by signing, state that they were present at the Safety Meeting and the above items were
covered in an understandable way:

1. _________________________________________ 14. _________________________________________

2. _________________________________________ 15. _________________________________________

3. _________________________________________ 16. _________________________________________

4. _________________________________________ 17. _________________________________________

5. _________________________________________ 18. _________________________________________

6. _________________________________________ 19. _________________________________________

7. _________________________________________ 20. _________________________________________

8. _________________________________________ 21. _________________________________________

9. _________________________________________ 22. _________________________________________

10. _________________________________________ 23. _________________________________________

11. _________________________________________ 24. _________________________________________

12. _________________________________________ 25. _________________________________________

13. _________________________________________ 26. _________________________________________


The following sign stating that he/she was not present for the Safety Meeting but were given the above items at
another time or watched a video recording of the Safety Meeting:

1. ________________________________________ 4. ________________________________________

2. ________________________________________ 5. ________________________________________

3. ________________________________________ 6. ________________________________________

The following participated in training for _______________________________________________________:

1. ________________________________________ 4. ________________________________________

2. ________________________________________ 5. ________________________________________

3. ________________________________________ 6. ________________________________________

The following participated in training for _______________________________________________________:

1 ________________________________________ 4 ________________________________________

2 ________________________________________ 5 ________________________________________

3 ________________________________________ 6 ________________________________________

I inspected my Personal Fall Arrest System and have been trained in its use:

1. ________________________________________ 4. ________________________________________
2. ________________________________________ 5. ________________________________________
3. ________________________________________ 6. ________________________________________

Hazard Reporting
Reporter: ______________________________________ Date: ___________________________

Identified Hazard: ____________________________________________________________________

_____________________________________________________________________________________

Corrective Measure Taken: ______________________________________________________________

_____________________________________________________________________________________

_____________________________________________________________________________________

Hazard Addressed in Health and Safety Policy? _____ Yes _____ No (check one)

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