FARM WORKER SAFETY CHECKLIST

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--- PERSONAL PROTECTIVE EQUIPMENT (PPE) ---
[ ] Hard Hat Condition (Good, Damaged - Replace, Not Used/Available)
[ ] Eye Protection (Goggles/Face Shield) (Used, Not Used, Not Required)
[ ] Gloves Type (Nitrile, Rubber, Leather, Not Required)
[ ] Gloves - Remaining Pairs (if applicable)
[ ] Hearing Protection (Earplugs/Muffs) (Used, Not Used, Not Required)
[ ] PPE Inspection Photo (if issues found)
[ ] Notes on PPE Condition or Issues

--- EQUIPMENT OPERATION ---
[ ] Tractor Operating Hours
[ ] Engine RPM at Idle
[ ] Tire Condition (Front) (Good, Fair, Poor)
[ ] Tire Condition (Rear) (Good, Fair, Poor)
[ ] Last Maintenance Date
[ ] Maintenance Notes/Observations
[ ] Hydraulic Fluid Level
[ ] Brake System Check (Pass, Fail)

--- HAZARD COMMUNICATION ---
[ ] SDS Location(s) - List all locations where Safety Data Sheets (SDS) are kept.
[ ] SDS Review Frequency (Monthly, Quarterly, Annually)
[ ] Which Hazardous Materials are Present on the Farm? (Pesticides, Fertilizers, Herbicides, Fuel, Solvents, Other (Specify in LONG_TEXT))
[ ] If 'Other' Hazardous Material Selected, Please Specify:
[ ] Quantity of Pesticide in Stock (Estimate):
[ ] Last SDS Review Date:

--- EMERGENCY PROCEDURES ---
[ ] Briefly describe the emergency (e.g., injury, fire, equipment failure)
[ ] Exact Location of Incident
[ ] Number of Individuals Involved
[ ] Type of Emergency Response Needed (First Aid, Fire Department, Ambulance, Police, Other)
[ ] Date of Emergency
[ ] Time of Emergency
[ ] Equipment/Resources Used During Response (First Aid Kit, Fire Extinguisher, Radio, Cell Phone, Other)
[ ] Signature of Person Reporting Emergency

--- WORKING CONDITIONS ---
[ ] Ambient Temperature (Â°C)
[ ] Humidity (%)
[ ] Noise Level (dB)
[ ] Lighting Adequacy (Adequate, Sufficient, Insufficient)
[ ] Ergonomic Hazards Observed (Repetitive Motions, Awkward Postures, Heavy Lifting, Vibration, None)
[ ] Additional Observations/Comments

--- TRAINING AND CERTIFICATION ---
[ ] Tractor Safety Training Completed? (Yes, No, N/A)
[ ] Last Pesticide Application Certification Date
[ ] First Aid/CPR Certified? (Yes, No, N/A)
[ ] Number of Hours of Machinery Operation Training
[ ] Next Certification Expiration Date
[ ] Specific Safety Courses Completed (Select all that apply) (Lockout/Tagout, Forklift Operation, Confined Space Entry, Grain Bin Safety)
[ ] Upload Certification Document(s)

--- FARM VEHICLE SAFETY ---
[ ] Last Vehicle Inspection Date
[ ] Vehicle Odometer Reading
[ ] Vehicle Condition (Excellent, Good, Fair, Poor)
[ ] Tire Condition (Good Tread, Fair Tread, Low Tread, Damaged)
[ ] Brake Functionality (Working Properly, Needs Adjustment, Not Working)
[ ] Tire Pressure (PSI)
[ ] Inspector Signature

--- CONFINED SPACE ENTRY ---
[ ] Entry Date
[ ] Entry Start Time
[ ] Entrant Name
[ ] Attendant Name
[ ] Reason for Entry
[ ] Oxygen Level (%)
[ ] Hydrogen Sulfide (H2S) Level (ppm)
[ ] Ventilation Status (Adequate, Insufficient, Not Required)
[ ] Entrant Signature

--- END OF TEMPLATE ---
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