Dan Ellstrom - Week 13: Chemical Hazards (routes of entry) - 03/25/2026

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This form documents that the training specified above was presented to the listed participants. By signing below, each participant acknowledges receiving training on the abovementioned subject. They understand that this training was only a general overview of the subject and that they should contact their supervisor with any questions or concerns.

A. Personal Factors

1. Rushing

Safe

Unsafe

N/A

2. Hand Placement/Body Position

Safe

Unsafe

N/A

3. Foot Placement

Safe

Unsafe

N/A

4. Safety Awareness

Safe

Unsafe

N/A

5. Lifting/Pushing/Pulling

Safe

Unsafe

N/A

B. Forklift Inspection

1. Check Engine Oil Level

Safe

Unsafe

N/A

2. Examine Battery

Safe

Unsafe

N/A

3. Inspect Hydraulic Fluid Level

Safe

Unsafe

N/A

4. Check Engine Coolant Level

Safe

Unsafe

N/A

5. Hydraulic Cylinders

Safe

Unsafe

N/A

C. PPE

1. Hard Hat

Safe

Unsafe

N/A

2. Safety Glasses

Safe

Unsafe

N/A

3. Hearing Protection

Safe

Unsafe

N/A

4. Safety Shoes

Safe

Unsafe

N/A

5. Fall Protection

Safe

Unsafe

N/A

D. Procedures

1. Confined Space Entry

Safe

Unsafe

N/A

2. Welding Permits

Safe

Unsafe

N/A

3. Proper Rigging

Safe

Unsafe

N/A

4. Lock out/Tag out

Safe

Unsafe

N/A

5. Fall Protection Plan

Safe

Unsafe

N/A

6. Other Safety Procedures

Safe

Unsafe

N/A

E. Equipment & Tools

1. Guards

Safe

Unsafe

N/A

2. Electrical Cords & GFCIs

Safe

Unsafe

N/A

3. Rigging

Safe

Unsafe

N/A

4. Power Tools

Safe

Unsafe

N/A

5. Hand Tools

Safe

Unsafe

N/A

F. Vehicles Aerial Lifts & Forklifts

1. Speed

Safe

Unsafe

N/A

2. Fall Protection

Safe

Unsafe

N/A

3. Forklift Rigging

Safe

Unsafe

N/A

4. Outriggers

Safe

Unsafe

N/A

5. Conditions i.e. Aerial Guardrails

Safe

Unsafe

N/A

G. Ladders-Scaffolds

1. Condition

Safe

Unsafe

N/A

2. Tie-offs

Safe

Unsafe

N/A

3. Guard Rails

Safe

Unsafe

N/A

4. Proper Use

Safe

Unsafe

N/A

5. Placement

Safe

Unsafe

N/A

H. Area Inspection

1. Lighting

Safe

Unsafe

N/A

2. Overhead Hazards

Safe

Unsafe

N/A

3. Traffic-Pedestrian

Safe

Unsafe

N/A

4. Traffic-Vehicle

Safe

Unsafe

N/A

5. Air Quality

Safe

Unsafe

N/A

6. CAZ Marking & Barricades

Safe

Unsafe

N/A

Comments/Site Observation