Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
9.3 WORK SITE SAFETY INSPECTION CHECKLIST (FORM)
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WEEKLY
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MONTHLY
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QUARTERLY
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Location:
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Crew Size:
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Site Supervisor:
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Inspection Date:
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Time of Inspection (24hr. Clock):
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Project Name:
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Contractor:
Priority Index: (1-Imminent Danger) (2-Serious) (3-Minor) (4-Accaptable) (5-Not Applicable (N/A))
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Inspected Items
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PJHA Procedures (Priority)
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Inspected Items
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Protection of Public (Priority)
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Inspected Items
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Excavation (Priority)
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Inspected Items
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Condition of Equipment (Priority)
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Inspected Items
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PPE-hats boots glasses (Priority)
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Inspected Items
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Fire retardant overalls (Priority)
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Inspected Items
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Housekeeping-overall (Priority)
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Inspected Items
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Ladders (Priority)
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Inspected Items
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Fire Extinguishers (Priority)
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Inspected Items
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Fall Protection (Priority)
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Inspected Items
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First aid & kits (Priority)
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Inspected Items
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Operator Certificates (Priority)
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Inspected Items
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Traffic control/barricades (Priority)
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Inspected Items
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Other PPE-vests gloves (Priority)
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Inspected Items
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Welding equipment (Priority)
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Inspected Items
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Material storage (Priority)
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Inspected Items
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Site Access (Priority)
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Inspected Items
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Confined Space Entry (Priority)
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Inspected Items
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Mobile lift equipment docs. (Priority)
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Inspected Items
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Posted safety documents (Priority)
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Inspected Items
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OH &S regs. on site (Priority)
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Inspected Items
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Lifting techniques (Priority)
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Inspected Items
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Tools-use storage maintenance (Priority)
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Inspected Items
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Grounding device (Priority)
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Inspected Items
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Propane Gas cylinders hose gauges (Priority)
Corrective Actions
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Priority
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Description
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Priority
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Description
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Priority
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Description
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Priority
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Description
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Priority
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Description
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Priority
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Description
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Priority
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Description
Corrective Action
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By Whom
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Date/Time
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By Whom
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Date/Time
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By Whom
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Date/Time
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By Whom
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Date/Time
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By Whom
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Date/Time
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By Whom
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Date/Time
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By Whom
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Date/Time
Inspection Team Signature(s):
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Print & Sign Name: Supervisor/Foreman:
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Print & Sign Name: Worker:
