Information
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Job Number
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Job Name
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Conducted on
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Prepared by
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Location
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Personnel
1.0 Administration
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1.1 Documented Pre-Construction Meetings?
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1.2 Frequent safety Inspections completed?
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1.21 Date of last inspection
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1.3 SDS available or accessible?
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1.4 Job site postings state and federal current? <br>
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1.5 Jobsite Crisis Management Plan? Phone Tree?
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1.6 Safety meetings completed?
2.0 Safety Plans
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2.1 Site Specific Safety Plan
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2.2 Site Specific Safety Plan for Subcontractors?
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3.3 Other?
3.0 JHA/JSA/PTP/Work Permits
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3.1 Job description adequate?
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3.2 JHA completely understood by all?
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3.3 JHA hazards and precautions match?
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3.4 Quality of JHA steps and hazards?
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3.5 Other?
4.0 Personal Protection
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4.1 Proper PPE worn by all workers?
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4.11 Hi-viz clothing?
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4.12 Shirts with sleeves and long pants? (No sweatpants)
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4.13 Proper footwear? Substantial, leather, ankle supporting boots or shoes; no tennis shoes.
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4.14 Hard hats?
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4.15 Glasses? Side shields?
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4.2 Proper gloves in use?
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4.3 Job-specific PPE as required?
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4.31 Double eye/face protection (glasses and face shield or goggles) while performing abrasive cutting, chipping, grinding, roto-hammering above waist level, or overhead drilling, cutting or demolition?
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4.4 Locks and tags in place?
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4.5 Other?
5.0 Safety Equipment
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5.1 Fire extinguisher(s) in place?
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5.2 Fire extinguisher(s) inspections complete?
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5.3 Eyewash available? Not expired?
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5.4 First aid kit available?
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5.5 First aid kit stocked properly?
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5.6 Other?
6.0 General
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6.1 Lighting?
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6.2 Ventilation?
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6.3 Nails removed from lumber?
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6.4 List other Sub-Contractors on site?
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6.5 Other?
7.0 Tools and Equipment
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7.1 Proper tools in use/used properly?
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7.2 Guards/safety devices in place?
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7.3 Tools in good condition?
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7.4 Other?
8.0 Body Positioning/Movement
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8.1 Line of fire risk?
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8.2 Attention to task?
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8.3 Pinch points?
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8.4 Proper lifting?
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8.5 Pushing/pulling under control/balance?
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8.6 Avoid/protected from sharp edges?
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8.7 Other?
9.0 Housekeeping
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9.1 Work areas clean and neat?
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9.2 Trash cans available/emptied?
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9.3 Materials properly staged/stored?
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9.4 Barricades up where applicable?
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9.5 Barricades maintained?
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9.6 Other?
10.0 Fall Protection
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10.1 Floor/wall openings protected?
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10.2 Guardrails in place?
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10.3 Warning lines used?
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10.4 Guardrails/warning lines installed correctly?
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10.5 100% fall protection over 6' achieved?
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10.6 Proper fall protection equipment?
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10.7 Fall protection inspections complete?
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10.8 Fall Protection Work Plan for work over 6'?
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10.9 Other?
11.0 Working at Height/Scaffolding/Ladders
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11.1 Decking complete w/o holes?
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11.2 Scaffold tag in place/current?
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11.3 Area below barricaded?
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11.4 Ladder (portable) inspection complete?
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11.5 Proper ladder set up?
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11.5 Proper ladder use?
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11.6 Ladder extends 3' above landing?
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11.7 Cage on vertical ladder over 25'? Rest platform(s)?
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11.8 Other?
12.0 Walking Working Surfaces
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12.1 Aisles/stairs/floors clear/clean?
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12.2 Designated walking area?
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12.3 Holes/depressions guarded?
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12.4 Other?
13.0 Vehicles/Mobile Equipment
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13.1 Pre-use inspection complete?
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13.11 Vehicle lights, horn, etc. operational?
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13.2 Speed limit and traffic controls followed?
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13.3 Spotter used when appropriate?
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13.4 Other?
14.0 Electrical
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14.1 Assured Grounding complete? Correct color (Q1-white, Q2-green, Q3-red, Q4-orange)?
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14.2 GFCI use on all power cords/tools?
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14.3 Panel covers installed? Dead fronts installed?
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14.4 Panels labeled and unobstructed?
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14.5 Exposed wiring/knockouts?
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14.6 Extension cords in good shape?
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14.7 Cords protected from traffic?
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14.8 Other?
15.0 Welding/Grinding/Temporary Power
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15.1 Hoses, leads, cords hung properly?
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15.2 Welding cables/temp cords free of damage?
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15.3 Double eye/face protection (glasses and face shield or goggles) while performing abrasive cutting, chipping, or grinding?
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15.4 Sparks controlled?
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15.5 Fire watch present?
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15.6 Fire watch trained?
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15.7 Other?
16.0 Cranes/Lifting/Hoisting/Rigging
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16.1 Crane(s) inspected/documented?
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16.2 Operator NCCCO certificate?
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16.3 Qualified signal-person? Documentation onsite?
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16.4 Qualified rigger? Documentation onsite?
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16.5 Ground is level/firm?
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16.6 Rigging is inspected/undamaged?
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16.7 Tag lines/softeners used?
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16.8 Critical Lift Plan done, if required?
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16.9 Overhead powerlines considered?
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16.10 Personnel not under suspended loads?
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16.11 Other?
17.0 Excavation Work
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17.1 Locates completed and visible?
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17.2 Daily inspection conducted?
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17.3 Daily inspection documented?
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17.4 Over 4' inspected by competent person?
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17.5 Excavation shored/sloped/benched?
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17.6 Spoils pile at least 2' from edge?
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17.7 Other?
18.0 Confined Space
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18.1 Attendant trained and alert?
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18.2 Confined space signs posted at entrance(s)?
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18.3 Personnel in confined space(s) checked in/out?
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18.4 Ventilation in place/adequate?
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18.5 Other?
19.0 Cylinders/Hazardous Materials/Flammables/Combustibles
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19.1 Flammable/O2 bottles stored separately?
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19.2 Gas cylinders upright/secured/capped?
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19.3 Cylinder valves closed when not in use?
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19.4 Proper storage containers for flammables/combustibles?
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19.5 Secondary labeling for chemicals?
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19.6 Hazardous materials survey complete?
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19.61 Areas of work containing lead identified?
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19.62 Lead products abated properly?
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19.63 All other hazardous materials identified?
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19.64 All other hazardous materials abated properly?
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19.65 Asbestos containing materials identified?
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19.66 Asbestos containing materials abated properly?
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19.7 Other?
20.0 Iterim Life Safety Measures
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20.1 Signage?
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20.2 Dust control? Barriers? Penetrations blocked?
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20.3 Badging?
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20.4 Fire extinguishers?
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20.5 Clear stairwells/exits?
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20.6 Other?
Corrections
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Section 1. Corrections made? By whom? When?
