Information

  • Job Number

  • Job Name

  • Conducted on

  • Prepared by

  • Location
  • Personnel

1.0 Administration

  • 1.1 Documented Pre-Construction Meetings?

  • 1.2 Frequent safety Inspections completed?

  • 1.21 Date of last inspection

  • 1.3 SDS available or accessible?

  • 1.4 Job site postings state and federal current? <br>

  • 1.5 Jobsite Crisis Management Plan? Phone Tree?

  • 1.6 Safety meetings completed?

2.0 Safety Plans

  • 2.1 Site Specific Safety Plan

  • 2.2 Site Specific Safety Plan for Subcontractors?

  • 3.3 Other?

3.0 JHA/JSA/PTP/Work Permits

  • 3.1 Job description adequate?

  • Complete Description?

  • 3.2 JHA completely understood by all?

  • 3.3 JHA hazards and precautions match?

  • 3.4 Quality of JHA steps and hazards?

  • 3.5 Other?

4.0 Personal Protection

  • 4.1 Proper PPE worn by all workers?

  • 4.11 Hi-viz clothing?

  • 4.12 Shirts with sleeves and long pants? (No sweatpants)

  • 4.13 Proper footwear? Substantial, leather, ankle supporting boots or shoes; no tennis shoes.

  • 4.14 Hard hats?

  • 4.15 Glasses? Side shields?

  • 4.2 Proper gloves in use?

  • 4.3 Job-specific PPE as required?

  • 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?

  • 4.4 Locks and tags in place?

  • 4.5 Other?

5.0 Safety Equipment

  • 5.1 Fire extinguisher(s) in place?

  • 5.2 Fire extinguisher(s) inspections complete?

  • 5.3 Eyewash available? Not expired?

  • 5.4 First aid kit available?

  • 5.5 First aid kit stocked properly?

  • 5.6 Other?

6.0 General

  • 6.1 Lighting?

  • 6.2 Ventilation?

  • 6.3 Nails removed from lumber?

  • 6.4 List other Sub-Contractors on site?

  • 6.5 Other?

7.0 Tools and Equipment

  • 7.1 Proper tools in use/used properly?

  • 7.2 Guards/safety devices in place?

  • 7.3 Tools in good condition?

  • 7.4 Other?

8.0 Body Positioning/Movement

  • 8.1 Line of fire risk?

  • 8.2 Attention to task?

  • 8.3 Pinch points?

  • 8.4 Proper lifting?

  • 8.5 Pushing/pulling under control/balance?

  • 8.6 Avoid/protected from sharp edges?

  • 8.7 Other?

9.0 Housekeeping

  • 9.1 Work areas clean and neat?

  • 9.2 Trash cans available/emptied?

  • 9.3 Materials properly staged/stored?

  • 9.4 Barricades up where applicable?

  • 9.5 Barricades maintained?

  • 9.6 Other?

10.0 Fall Protection

  • 10.1 Floor/wall openings protected?

  • 10.2 Guardrails in place?

  • 10.3 Warning lines used?

  • 10.4 Guardrails/warning lines installed correctly?

  • 10.5 100% fall protection over 6' achieved?

  • 10.6 Proper fall protection equipment?

  • 10.7 Fall protection inspections complete?

  • 10.8 Fall Protection Work Plan for work over 6'?

  • 10.9 Other?

11.0 Working at Height/Scaffolding/Ladders

  • 11.1 Decking complete w/o holes?

  • 11.2 Scaffold tag in place/current?

  • 11.3 Area below barricaded?

  • 11.4 Ladder (portable) inspection complete?

  • 11.5 Proper ladder set up?

  • 11.5 Proper ladder use?

  • 11.6 Ladder extends 3' above landing?

  • 11.7 Cage on vertical ladder over 25'? Rest platform(s)?

  • 11.8 Other?

12.0 Walking Working Surfaces

  • 12.1 Aisles/stairs/floors clear/clean?

  • 12.2 Designated walking area?

  • 12.3 Holes/depressions guarded?

  • 12.4 Other?

13.0 Vehicles/Mobile Equipment

  • 13.1 Pre-use inspection complete?

  • 13.11 Vehicle lights, horn, etc. operational?

  • 13.2 Speed limit and traffic controls followed?

  • 13.3 Spotter used when appropriate?

  • 13.4 Other?

14.0 Electrical

  • 14.1 Assured Grounding complete? Correct color (Q1-white, Q2-green, Q3-red, Q4-orange)?

  • 14.2 GFCI use on all power cords/tools?

  • 14.3 Panel covers installed? Dead fronts installed?

  • 14.4 Panels labeled and unobstructed?

  • 14.5 Exposed wiring/knockouts?

  • 14.6 Extension cords in good shape?

  • 14.7 Cords protected from traffic?

  • 14.8 Other?

15.0 Welding/Grinding/Temporary Power

  • 15.1 Hoses, leads, cords hung properly?

  • 15.2 Welding cables/temp cords free of damage?

  • 15.3 Double eye/face protection (glasses and face shield or goggles) while performing abrasive cutting, chipping, or grinding?

  • 15.4 Sparks controlled?

  • 15.5 Fire watch present?

  • 15.6 Fire watch trained?

  • 15.7 Other?

16.0 Cranes/Lifting/Hoisting/Rigging

  • 16.1 Crane(s) inspected/documented?

  • 16.2 Operator NCCCO certificate?

  • 16.3 Qualified signal-person? Documentation onsite?

  • 16.4 Qualified rigger? Documentation onsite?

  • 16.5 Ground is level/firm?

  • 16.6 Rigging is inspected/undamaged?

  • 16.7 Tag lines/softeners used?

  • 16.8 Critical Lift Plan done, if required?

  • 16.9 Overhead powerlines considered?

  • 16.10 Personnel not under suspended loads?

  • 16.11 Other?

17.0 Excavation Work

  • 17.1 Locates completed and visible?

  • 17.2 Daily inspection conducted?

  • 17.3 Daily inspection documented?

  • 17.4 Over 4' inspected by competent person?

  • 17.5 Excavation shored/sloped/benched?

  • 17.6 Spoils pile at least 2' from edge?

  • 17.7 Other?

18.0 Confined Space

  • 18.1 Attendant trained and alert?

  • 18.2 Confined space signs posted at entrance(s)?

  • 18.3 Personnel in confined space(s) checked in/out?

  • 18.4 Ventilation in place/adequate?

  • 18.5 Other?

19.0 Cylinders/Hazardous Materials/Flammables/Combustibles

  • 19.1 Flammable/O2 bottles stored separately?

  • 19.2 Gas cylinders upright/secured/capped?

  • 19.3 Cylinder valves closed when not in use?

  • 19.4 Proper storage containers for flammables/combustibles?

  • 19.5 Secondary labeling for chemicals?

  • 19.6 Hazardous materials survey complete?

  • 19.61 Areas of work containing lead identified?

  • 19.62 Lead products abated properly?

  • 19.63 All other hazardous materials identified?

  • 19.64 All other hazardous materials abated properly?

  • 19.65 Asbestos containing materials identified?

  • 19.66 Asbestos containing materials abated properly?

  • 19.7 Other?

20.0 Iterim Life Safety Measures

  • 20.1 Signage?

  • 20.2 Dust control? Barriers? Penetrations blocked?

  • 20.3 Badging?

  • 20.4 Fire extinguishers?

  • 20.5 Clear stairwells/exits?

  • 20.6 Other?

Corrections

  • Section 1. Corrections made? By whom? When?

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.