Title Page

  • Conducted on

  • Prepared by

  • Location
  • Foreman

  • Project Manager

  • Weather

  • Temperature

  • What was the average (dBa)

Flagged Items

  • Were there any flagged items on the walk-through

PPE (Personal Protection Equipment)

  • All employees were wearing the required Safety Gloves.

  • Who was the employee?

  • Action taken?

  • All employees were wearing the required Safety Glasses.

  • Who was the employee?

  • Action taken?

  • All employees were wearing the required Safety Hard Hat.

  • Who was the employee?

  • Action taken?

  • All employees were wearing the required High-Visibility Safety Vest.

  • Who was the employee?

  • Action taken?

  • All employees were wearing hearing protection when required.

  • Who was the employee?

  • Action taken?

  • All employees were wearing the proper mask when required.

  • Were all employees utilizing tool lanyards when required?

  • Who was the employee?

  • Action taken?

  • Were all employees wearing the required Fall Protection when required (Full Body Harness)?

  • Who was the employee?

  • Action taken?

  • Were all employees utilizing the proper lanyard with their harness?

  • Who was the employee?

  • Action taken?

Material handling / Ergonomics

  • Observed safe material handling practices for manual material handling?

  • Material handling aid utilized (forklift, carts, etc.)

Inspections

  • Have MEWP inspections been completed?

  • Have Forklift inspections completed?

  • Have GFCI inspections been completed?

  • Have Telehandler inspections completed?

  • Have harnesses been inspected?

  • Have lanyards been inspected?

  • Have ladders been inspected?

Work Environment

  • Employees are not exposed to energized circuits.

  • Signs are posted to restrict access to locations with exposed live parts.

  • Electrical receptacles/outlets have approved covers/faceplates.

  • Enclosures - Cabinets intact, no knockouts missing or other open holes, panels effectively enclosed.

  • Enclosures - Breakers/Switches legibly marked to indicate purpose.

  • Enclosures - Proper clearances are maintained in front of and around electrical panels.

  • Enclosures - Conductors entering panels and boxes are protected by abrasion.

  • Housekeeping

  • Access/Egress - Pathways are clear and uncluttered. No tripping hazards.

  • Holes are covered. Covers need to support twice the intended load, be marked "Hole" and be secured in place to prevent accidental displacement.

Cord & Cable

  • Cord & Cable - Cords are protected & kept clear of work areas and walkways.

  • Cord & Cable - Ground prong pin attached to electrical cords.

  • Cord & Cable - Flexable cords are not daisy chained.

Temporary Lighting

  • Is there temporary lighting on the project?

  • All temporary light bulbs protected from accidental breakage.

  • All temporary light string sockets have bulbs in them.

  • Temporary light strings are not suspended by the electric cord.

LOTO & Electrical safe work practices

  • Is LOTO being utilized?

  • Ask at least one random employee if they have a lock for performing LOTO.

Ladders

  • Are ladders in use on this project?

  • Extension ladders are secured properly.

  • Extension ladders are at the proper angle.

  • Step ladders are being used safety with spreaders locked.

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.