Site Safety Plan Registration Form

Owner

Construction Superintendent

General Contractor

Proposed temporary construction equipment (for each phase):

Examples include: Sidewalk shed, scaffolding, overhead protection, construction fence, construction gate locations, sliding gate standpipes, temporary stairs, waterfilled barriers, tree protection, roof protection, excavator, pile driver, mini excavator, bobcat, forklift, ladder, vertical/horizontal netting, elevator platform, washout box, cranes, hoists, etc.

Type of Building:
Will you need a DOT Permit to store material or garbage on a parking lane?
Do you have a pre-construction survey?
Do you have the following requied paperwork for the project? (Check all that apply)
Do you have a Construction Fence Plan?
Do you have an access agreement with your neighbors?
Do you have all safety equipment necessary for the job?

Examples include: Harnesses, retractable lanyard, caution tape, safety glasses, gloves, earplugs, fire extinguishers, etc.

Check all plans that will be emailed (or upload them here):
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Photos of Site (add up to 5)

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