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RICHARD MROZ - Week 27: Machine Safeguarding (Interlocking) - 07/10/2026
Name
(Required)
First
Last
Email
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Date
MM slash DD slash YYYY
Did you conduct this Toolbox Talk?
(Required)
Yes
No
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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
Δ
