Safety Checklists

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

Respiratory Plan for Fire Departments - This sample plan concerns respirator use in general industry and construction workplaces as regulated in 29 CFR 1910.134.

General Respiratory Plan - Sample respiratory plan for general industry and construction workplaces (not for fire departments).

Emergency Action Plan - Workplaces must have an emergency action plan to ensure employee safety in case of emergency. Companies with 10 or more employees must have this plan in writing.

Hazard Communication Plan - REVISED - Any workplace that has hazardous materials must have a written Hazard Communication program. Because most chemical products, even cleaning products, are consider hazardous, most workplaces need a Hazard Communication program. Revised program includes labeling changes under the Global Harmonization System.

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

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

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

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

Medical Evaluation Checklist - Checklist for administrators to use.

Checklist for Respiratory Maintenance and Care -

Chemical Hygiene Plan - Non-production laboratories where small scale chemical experiments are conducted must have a chemical hygiene plan under OSHA's Laboratory Standard (29 CFR 1910.1450). This sample plan is for secondary schools.

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)

Silica Program - Model program to assist employers with high levels of silica exposures with monitoring, record keeping and training.

Hearing Conservation Program (Construction) - Assists employers in developing a hearing conservation program.

Asbestos Exposure Program - This Asbestos Operations and Maintenance Program has been developed to eliminate and control hazards associated with asbestos containing materials located at your site.

Confined Space Program - Sample Permit Required Confined Space program. Identifying spaces, equipment used, employee responsibilities, etc.

N-95 Respiratory Protection Program - State of Maine public sector employers who require N-95 respirators to be used are required to have this program in place. This is a guide to be in compliance.

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

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

Hearing Conservation Program (General Industry) - Policy to assist employers who are required to have a hearing conservation program in general industry.

Qualitative Fit Test Form (Saccharine Method) - This form is for fit testing tight fitting respirators using the Saccharine Method.

Hepatitis B Vaccine Declination Form - Sample Hepatitis B Vaccine Declination form. The employer shall have a signed copy on file if an employee chooses not have the Hepatitis B Vaccine.

Hepatitis B Vaccination Employer Record - Employer record of employee hepatitis B vaccinations or declination.

Check List for Proper Use of Respirators -

Checklist for Breathing Air Quality and Use -

Respirator Medical Evaluation Questionnaire -

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.

Work Zone Traffic Control Inspection Form -

Workzone Check List -

Construction Jobsite Checklist - Checklists for construction-related exposures.

Staging Checklist - Daily stationary staging checklist.

Flagger Safety Checklist - Workzone safety items that may be required.

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

Torch and Welding Hot Work Permit - List of 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.

Silica Program - Model program to assist employers with high levels of silica exposures with monitoring, record keeping and training.

Hearing Conservation Program (Construction) - Assists employers in developing a hearing conservation program.

Asbestos Exposure Program - This Asbestos Operations and Maintenance Program has been developed to eliminate and control hazards associated with asbestos containing materials located at your site.

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.

Trench Inspection and Entry Authorization Form -

Daily Trenching Log -

Excavation Checklist -

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

Respiratory Plan for Fire Departments - This sample plan concerns respirator use in general industry and construction workplaces as regulated in 29 CFR 1910.134.

Fire Department Ladder Safety Checklist -

Volunteer Firefighter Model Policy - Public Law 296 provides volunteer firefighters protection from discipline or discharge, in certain employment situations, on the grounds that the volunteer firefighter arrives late or does not arrive to work because the volunteer firefighter is responding to certain emergencies to which the fire department is called to respond. The law allows written agreements between employees and employers to supersede the terms of the proposed law. This model policy/agreement has been developed as an option for employers to use.

Traffic Control Safety Checklist (Sample One) -

Traffic Control Safety Checklist (Sample Two) -

Medical Evaluation Checklist - Checklist for administrators to use.

Flagger Safety Checklist - Workzone safety items that may be required.

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

Fire Department and EMS Blood Borne Exposure Plan - Provides fire department and EMS with a guide for all areas that are required to be part of a BBP exposure plan.

Fire Department Driver Operator Evaluation Checklist - This checklist documents that an individual has completed the required minimum training before receiving authorization from the Chief Officer to drive fire department apparatus.

Fire Department Restriction Form - This checklist should be used by fire departments for documenting activity restrictions for members who have not completed required tasks/trainings.

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 worksite.

Safe Operation of Forklifts (2) Daily Checklist - Daily checklist items for safe operation of forklifts.

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.

Control of Hazardous Energy Sources (Lockout/Tagout) - Workplaces where employees do maintenance or repair work need a written Lockout/Tagout program to protect against unexpected startup of equipment.

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/Tag Out Program - Program to assist employers in ensuring employees are using procedures to isolate energy sources prior to maintenance and other duties of equipment in the workplace.

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 lockout procedure for a wastewater pump.

Lockout Procedure Annual Review Form. - Annual Lockout/Tagout Administrative review of detailed written 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.

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

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

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

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

Confined Space Permit Form (Sample One) - Guides employers and employees on the hazards that need to be assessed prior to entering a confined space.

Confined Space Permit Form (Sample Two) - Provides employers and employees with permits that are required to enter PRCS. Addresses Air quality, rescue needs and other hazards.

Confined Space Alternate Procedure Checklist - Provides employers and employees with a list of hazards that need to be assessed prior to entering a confined space other than that of a PRCS.

Energized Electrical Work Permit - When live electrical work 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.

Responding to Domestic Violence Abusers in the Workplace - This toolkit was designed to help employers and workers create a comprehensive response to domestic violence in the workplace.

Synthetic Sling Inspection Form -

Chain Sling Inspection Form -

OSHA 300 Injury Reporting Forms - Provides OSHA 300, 300A Summary form and 301 forms.

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 occurs.

Flammable Liquids Storage - An employer guide to proper storage procedures for flammable liquids.

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

Safety Training Sign Off Sheets - Provides needed documentation for employers to track employee training that has been conducted.

Pallet Jack Inspection Form - Items to be inspected on a pallet jack prior to operations at the begining of the shift.

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

Employer's Report of Occupational Injury or Disease - First report of occupational injury or disease form. (Source: Workers' Compensation Board.)

Training and Information Checklist -

Healthcare Covid Log -