This form must be completed daily by all FDB supervisors, or anyone working alone, and must be handed in EVERY WEEK. If you answer NO to any item, explain the safety issue, complete a risk assessment and record the score. Once controls are in place, record the reduced score.
⚠️ General Site Safety — Potential Hazards
💥 Explosives & Blasting Materials — BLASTERS ONLY
🔧 Equipment Inspection
🦺 Personal Protective Equipment
🗣️ Tailgate Talk Topic
🏠 Housekeeping
🌦️ Weather Conditions
📝 End of Day Follow-Up / Notes
✍️ Crew Signatures
HAZARDS AND SITE SAFETY RULES WERE REVIEWED, PPE HAS BEEN INSPECTED AND I WAS TOLD TO WEAR MY PPE BY MY SUPERVISOR TODAY. I fully acknowledge and understand the information in this Job Safety Analysis and Site Inspection and acknowledge that I am to always wear my PPE on every jobsite.
Tap to sign
✅ Supervisor / Lone Worker Sign-Off
By signing below, the Supervisor/Lone Worker confirms this FDB Daily Job Hazard Analysis and Site Inspection is complete and accurate to the best of their knowledge and reflects site conditions at the time of sign-off. The signatory confirms workers assigned are competent, have the required training/qualifications and any applicable licences/certifications (including WHMIS and fire extinguisher training where required), and that work will stop and this DJSA will be updated if conditions change.