Contractor Safety Checklist
CONTRACTOR INFORMATION
Contractor Name
Project Work
Duration of Service
Date
Contractor’s Onsite Responsible Representative:
Name:
Cell Phone:
Boise State Representative:
Cell or Desk Phone:
Instructions: Check “Yes” when requirements are applicable and details have been or need to be
discussed/reviewed. Check “No” if not applicable to your work or scope of services. This checklist must be
completed prior to work commencing. Please forward this completed form to Architecture and Engineering Services
(AES).
Medical Emergencies call 911 – physical address may be located on egress signs
Yes
No
Building Access
Yes
No
Parking
Yes
No
Security Access
Yes
No
Restrooms/Breaks/Smoking
Yes
No
Building Emergency/ Evacuation Procedures
Yes
No
Use of Chemicals/products and SDSs
Yes
No
All unused chemicals and products will be removed from site and will be properly
Yes
No
disposed by the contractor.
Work Isolation: Safe routing, placement of cords, tools, ladders, equipment, water
Yes
No
Other
Welding/Cutting/Open Flame - Does work require a Hot Work Permit?
Yes
No
Other
Hazardous tools to include power equip, compressed gas, jack hammers etc.
Yes
No
List
PPE Needed
Yes
No
Confined Space
Yes
No
Energy Isolation
Yes
No
Demolition Activities
Yes
No
Working from heights, boom lifts, scissor lifts, fall protection
Yes
No
Use of ladders
Yes
No
Blocking exits/egress
Yes
No
Other
Heavy lifting, rigging
Yes
No
Working on IT systems
Yes
No
Tunneling/Underground
Yes
No
Staging area required
Yes
No
Work affects fire detection/suppression system -alarms, sprinklers, fire pump
Yes
No
Interruption of emergency equip use – safety showers, ventilation, phone
Yes
No
Other
Area will require barricades/caution tape to keep people out of work area
Yes
No
Other
Work will require containers for trash, recycling, and metal collection
Yes
No
Are your employees trained for the hazards they will encounter on the job?
Yes
No
Ensure a standard of good conduct and proper housekeeping will be maintained on
Yes
No
site at all times.
Will there be an impact to landscaped areas?
Yes
No
Describe potential impacts and accommodations (noise, dust, odors etc.) associated with the project:
SIGNATURES
The undersigned have reviewed and participated in the contractor safety checklist and orientation concerning
hazards and conditions in the facilities in which work is to be performed. The scope and schedule of services have
been reviewed and discussed to minimize the potential for incidents, injuries impacts to the environment, and
workplace disruptions and interruptions.
Individuals below have received and reviewed information regarding the location of emergency safety equipment as
well as the procedures to follow in the event of an emergency evacuation.
Name
Signature
Employer
Date
All Subcontractors will be held accountable for these safety standards while working on the Boise State
campus. If a contractor “subs” this work to others, they are responsible for insuring this information has been
delivered or will require that the sub-contractor meets with Boise State representatives prior to starting work.
Other: For any item checked as “other” please note the work and your plan to mitigate the hazard.
All campus safety forms can be found on the EHSS Website: http://operations.boisestate.edu/EHS/workplace-safety/