Title Page

  • Unit/Area

  • Date/Time

  • Prepared by

  • Company

  • Prepared by

  • Company

  • Prepared by

  • Company

  • Prepared by

  • Company

  • Location
  • FALL PROTECTION

  • All fall protection in the system being worn and used properly?

  • 100% fall protection for all workers when 6' or higher including aerial lifts?

  • Rebar- protected and reinforced steel rebar caps?

  • Perimeter guardrails in place (38-42 & mid way for mid-rail)?

  • Equipment Inspection Color Code current? (PURPLE)

  • Anchor point for fall arrest system adequate?

  • MOBILE EQUIPMENT & VEHICLES

  • Daily inspection logs/tag on crane or aerial lifts and updated for the current date?

  • Are trained spotters being utilized?

  • Annual inspection sticker on lifts?

  • Audible alarms working? (back-up)

  • Qualified operators? (verify training)

  • Wheels chocked when required ?

  • Load limits observed?

  • Driver/operator visual obstructions?

  • Load secured?

  • Critical lift paperwork completed? Pre-lift meeting held?

  • SCAFFOLDS

  • Competent person identified on tag?

  • Tag updated if used for current shift?

  • Scaffold grade planks used?

  • Wood is not used near hot processes?

  • Planks have minimum 12" overlap or are fastened down?

  • No more than 1" between planks?

  • Top rail, mid-rail and toe board in place or noted on tag?

  • Screw jacks have baseplates and mudsills or casters for mobile scaffolds?

  • Baseplates nailed to mudsills?

  • Platforms over 10' have falling object protection?

  • Builders or users are tied-off to components with pelican hooks in vertical position unless they are steel?

  • Builders or users are only tied off to complete rails? (corner to corner)

  • Access ladders extend 3' above deck?

  • SRL used if platform height to next lower level is 20 ' or more (ladder cage is allowed between 20'-30')?

  • EXCAVATIONS

  • Adjacent structures protected and supported?

  • All materials and equipment are > 2' from edge of excavation?

  • Rescue plan known?

  • CRANES/HOISTING/RIGGING

  • Swing radius barricaded or equivalent?

  • HOT WORK/WELDING/CUTTING

  • Only tools allowed on the Safe Work Permit are being utilized in the field?

  • PERSONAL PROTECTIVE EQUIPMENT (PPE)

  • Hard hat is being worn at all times and is being worn properly? ( facing forward, suspension in place)

  • Does PPE in the field match the Safe Work or Confined Space Permit?

  • FIRE PROTECTION & PREVENTION

  • Re-fueling in open areas only and equipment is not running while being re-fueled?

  • ELECTRICAL

  • Electrical Verification locks are in place on the Breakers and LOTO station?

  • Are the correct type of Power cords being used? (no outlet type boxes)

  • WALKING/WORKING SURFACES & LADDERS

  • A-Frame ladders are fully open when being used?

  • Extension ladders, job-made ladders and fixed ladders extend 3 ft. above top access?

  • Fixed ladders are protected by swing gates, guillotine bars or chain and are fixed in the closed position?

  • Are stairs, ramps and ladders clear of debris and materials on rungs, side rails and access points?

  • Are floor openings protected by either hard barricades or floor covering that is secured and marked "HOLE"?

  • PERMITTING SYSTEMS

  • Attendant can verify how to how and who to contact in the event of an emergency?

  • Attendant OR Workers identify nearest safety shower/eyewash?

  • Was the First Entry JSA completed prior to the first entry?

  • Was the First Entry JSA completed prior to the first entry?

  • HOUSEKEEPING

  • Waste is being disposed of regularly and daily clean-up of site is being completed?

  • Are unit boundary chains secured and have signage attached to prevent unauthorized access?

  • EMERGENCY PROCEDURES

  • Do workers know how and where to shelter-in-place?

  • Do workers know who to contact for an SDS?

  • BARRICADES & SIGNS

  • All elevated work platform including: vessel decks, scaffold platforms and mechanical lifts have snow fence, fire blanket or similar materials secured to railings to protect from dropped objects?

  • HAND & POWER TOOLS

  • Do grinders have a handle, guards and either a dead man switch or interlock?

  • Are tools unplugged and stored away when not in use?

  • OTHER

  • DEFICIENCY NOT NOTED ELSEWHERE

  • Description:

  • DEFICIENCY NOT NOTED ELSEWHERE

  • Description:

  • DEFICIENCY NOT NOTED ELSEWHERE

  • Description:

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.