Interstate 65 in Louisville will close between the Watterson Expressway (I-264) and downtown Louisville (Jefferson Street) from June 1- July 31 to speed progress on replacing 3 aging bridges.
The closure will save at least a year of construction restrictions, and a signed detour will be in place. Local street closures and ramp closures will also be needed.
Learn more at I65CentralCorridor.com.

Safety Form Library

​​​​​​​​​​​​​Forms Home page header.png  ​​
​​​Nam​​e​TC #
​Safety & Health Administration Guide Exhibit 
​​Note on TC Form use vs. BOOTS 

Form Blank - Printable
(Link)
​TC Form - Editable
(Link)
​BOOTS Safety Observation Equivalent - No user license
(Link)
Completed Sample Form
(Link)
​Guide / Reference Material
(Link)
​Training Report​
​TC25-2
​9009

TC 25-2 Training Report - blank form.pdf
TC 25-2.docx

TC 25-2 Training Report - SAMPLE.pdf
​Personal Protective Equipment (PPE) Acknowledgement
​TC25-3
​9012

TC 25-3 Personal Protective Equipment (PPE) Acknowledgement - blank form.pdf
TC 25-3.docx 


TC 25-3 PPE Acknowledgement - SAMPLE.pdf



​Notice of Safety Violation​
​TC25-105
​9003
TC 25-105 Notice of Safety Violation - blank form.pdf
TC 25-105.docx

 

TC 25-105 Notice of Safety Violation - SAMPLE.pdf
​Jobsite Setup Inspection
​TC25-110
​9005
​TC form superseded by BOOTS Jobsite Setup Observation 
TC 25-110 Jobsite Safety Observation - blank form.pdf
TC 25-110.docx
BOOTS Jobsite Setup Observation
TC 25-110 Jobsite Setup Inspection - SAMPLE.pdf
​Job Safety Analysis (JSA) & PPE Hazard Assessment
​TC25-156
​9001

JHA form blank - PDF.pdf
JHA form blank - MS Word.odt


​Fall Protection Equipment Inspection Log
​TC25-157
​9019

TC 25-157 Fall Protection Equipment Inspection Log - blank form.pdf
TC 25-157.xlsx

TC 25-157 Fall Protection Equipment Inspection Log - SAMPLE.pdf
Fall Protection Equipment Inspection Guide.pdf
​Daily Trench & Excavation Inspection 
​TC25-158
​9016

TC 25-158 Excavation & Trench Inspection - blank form.pdf
TC 25-158.xlsx
BOOTS Excavation & Trenching Checklist
TC 25-158 Daily Trench & Excavation Inspection - SAMPLE.pdf
​Facility Safety Inspection
​TC25-159
​9004
​TC form superseded by BOOTS Facility Safety Observation 
TC 25-159 Facility Safety Inspection - blank form.pdf
TC 25-159.xlsx
BOOTS Facility Safety Observation
TC 25-159 Facility Safety Inspection -Sample.pdf
​Energized Electrical Work Permit
​TC25-160
​9017
TC 25-160 Energized Electrical Work Permit - blank form.pdf
TC 25-160.xlsx
BOOTS Energized Electrical Work Permit​
TC 25-160 Energized Electrical Work Permit - SAMPLE.pdf
​Confined Space Permit
​TC25-161
​9015
TC 25-161 Confined Space Entry Permit - blank form.pdf
TC 25-161.xlsx
BOOTS Cofined Space Permit Form
TC 25-161 Confined Space Permit - SAMPLE.pdf
​Confined Space - Permit Required Space Checklist




​Use to determine Permit-Required status as precursor to TC25-161 Permit.



BOOTS Permit Required Confined Space Checklist

​Job Safety Brieifing
​TC25-163
​9002
TC 25-163 Job Briefing - blank form.pdf
TC 25-163.xlsx

TC 25-163 Job Safety Briefing - SAMPLE.pdf
​Powered Industrial Truck Inspection - Internal Combustion Power
​TC25-165
​9028
​BOOTS Forklift Inspection Checklist is an alternative, not replacement for TC form
TC 25-165 Internal Combusition Industrial Truck Daily Operation Checklist - blank form.pdf
TC 25-165.xlsx

TC 25-165 Powered Industrial Truck Inspection - Internal Combustion power (SAMPLE).pdf
​Powered Industrial Truck Inspection - Electric Power
​TC25-166
​9029
TC 25-166 Electric Industrial Truck Daily Operation Checklist - blank form.pdf
TC 25-166.xlsx

TC 25-166 Powered Industrial Truck Inspection - Electric Powered - SAMPLE.pdf
​Air Sampling Report
​TC25-167
​9014
TC 25-167 Air Sampling Report - Blank form.pdf
TC 25-167.xlsx
TC 25-167 Air Sampling Report - SAMPLE.pdf
​Aerial Device / Bucket Truck Daily Checklist
​TC25-168
​9007
TC 25-168 Aerial Device Bucket Truck Daily Checklist - blank form.pdf
TC 25-168.xlsx
TC 25-168 Aerial Device Bucket Truck Daily Checklist - SAMPLE.pdf
​AED Post-Event Review
​TC25-169
​9025
TC 25-169 Automated External Defibrillator (AED) Post-Event Review - blank form.pdf
TC 25-169.xlsx
TC 25-169 AED Post Event Review - SAMPLE.pdf
​AED Maintenance Checklist
​TC25-170
​9024
TC 25-170 Automated External Defibrillator (AED) Maintenance Checklist - blank form.pdf
TC 25-170.xlsx
TC 25-170 AED Maintenance Checklist - SAMPLE.pdf
​Operators Daily Check Sheet
​TC74-11
​9006

BOOTS Vehicle Safety Check
BOOTS Vehicle Safety Check
​Respiratory Protection: Medical / Occupational History Questionairre 

​9031
​​Respirator Medical Questionnaire - blank form.pdf

Respiratory Protection: Physician Approval for Respirator Assignment

9032​Respirator Medical Questionnaire - blank form.pdf
​Respiratory Protection: Respirator Informaton for Physician
​9033
Respirator Use Information for Physician - blank form.pdf
Hepatitis B Vaccine Declination


​9034
HBV Vaccine Declination 2025.pdf

​Ladder Safety Inspection
​9020
​​TC form superseded by BOOTS Ladder Inspection Checklist.
Ladder Inspection Checklist - blank form.pdf

BOOTS Ladder Inspection Checklist

Ladder Safe Use Guide.pdf
​Bomb Threat Checklist


​9022
DHS Bomb-Threat Checklist - blank form.pdf
​Bench Grinder Safety Checklist


​9027
Bench Grinder Safety Checklist.pdf

​Pressure Washer Safety Checklist


​9035
Pressure Washer Checklist.pdf
​Electrical Safety Checklist

​none
​none

BOOTS Electric Safety Checklist

​Fire Safety Inspection
​none

​none




BOOTS Fire Safety Inspection
​Hand & Power Tools Inspection Checklist
​none

​none




BOOTS Hand & Power Tools Inspection Checklist

​Hot Work Permit to Work - Pre Work Inspection Checklist
​none

​none

​​

BOOTS Hot Work Permit Checklist
​Lockout / Tagout (LOTO) Inspection Checklist

​none

​none





BOOTS LOTO Checklist

​Machine Guarding Checklist

​none

​none





BOOTS Machine Guarding Checklist

​Scaffolding Inspection Checklist
​none

none
BOOTS Scaffolding Inspection Checklist




​​

Department of Aviation

Airport Zoning Commission

Department of Rural and Municipal Aid

Local Programs
Local Public Agencies

Department of Vehicle Regulation

Drive.ky.gov
Motor Vehicle Commission

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