Daily Safety Task Instruction (DSTI)
Form
Date: ___________________________
Project / Site Name: ___________________________
Supervisor / Team Leader: ___________________________
Task / Activity for the Day: ___________________________
Location: ___________________________
1. Work to be Done
____________________________________________________________________________
2. Identified Hazards
- __________________________________________________
- __________________________________________________
- __________________________________________________
3. Safety Precautions / Controls
- __________________________________________________
- __________________________________________________
- __________________________________________________
4. Emergency Arrangements
First Aider on Site: ___________________________
Emergency Contact / Number: ___________________________
Nearest Clinic / Hospital: ___________________________
5. PPE Required
☐ Hard Hat
☐ Safety Boots
☐ Gloves
☐ Safety Glasses
☐ Hearing Protection
☐ High-Visibility Vest
☐ Other: ___________________________
6. Worker Acknowledgement
I have attended this DSTI, understood the hazards and safety controls, and agree to follow
instructions.
Name & Surname Signature
Supervisor’s Name & Signature: ___________________________
