Title Page
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Member
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Project/Site Name
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Conducted on
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Site Superintendent/Foreman
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Prepared by
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Location
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Document No.
Administration
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State & Federal Postings are in place
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Emergency Telephone #'s and directions to clinics/hospitals are posted
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First Aid Kit is available and stocked
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First Aid & CPR Trained Employees on site
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Drinking water available
Communication
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Pre-Task Planning Meeting conducted prior to the start of work
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Toolbox Talk Conducted for the week
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Heat/Cold exposures addressed
Health and Hazard Communication
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Employees trained on GHS
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SDS available onsite
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Containers properly labeled
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Silica exposures controlled
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Carbon monoxide monitored/exhaust ventilated
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Asbestos risks assessed and addressed
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Lead risks assessed and addressed
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Other hazardous materials identified and risks controlled
PPE
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Head protection
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Eye & Face protection
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Hand protection
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Hearing protection
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Proper work boots
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High visibility clothing
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FR clothing (welding, arc flash)
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Respirator protection
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Other PPE being used properly
Housekeeping & Fire Protection
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Housekeeping maintained regularly
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Aisles, stairwell, passageways clear
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Materials free of protruding nails/screws and other impalement hazards
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Adequate lanes for emergency vehicle access
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Fire extinguisher is available and inspected monthly
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Flammables/combustibles are properly stored and handled safely
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LP cylinders are stored outside
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LP tanks are protected from mobile equipment
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Approved safety gas cans are being used
Electrical
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GFCI and/or Assured Grounding in use
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Cords are not damaged and ground pin is in place
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Good work practices (cords out of pathways, kept out of water, not running through doors/walls, not contacting sharp objects, etc.)
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Temp lighting adequate and in good condition
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Live parts properly guarded (panel/box covers, etc.)
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Lockout/Tagout practices in place
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NFPA 70E work practices in place
Hand/Power Tools
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Tools inspected and maintained
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Guards/safety features working properly
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Damaged equipment tagged/removed from service
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Proper tool for the job being used
Ladders
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Ladders inspected/no defects/stickers in place
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Ladders used properly
Fall Protection
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Proper fall protection at 6' or greater
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Fall protection equipment inspected
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Guardrails are properly installed
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Personnel below are protected from falling objects
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Hole covers in place, secured, and marked
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Roof fall hazards addressed, warning lines in place
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Stairs equipped with handrails
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Slips, trips, fall issues addressed
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Snow, ice, mud addressed
Concrete/Masonry
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Impalement hazards are addressed
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Limited access zones in place
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Wall bracing in place
Aerial Lift / Scissors Lift
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Equipment Inspected
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Safe work practices being followed
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Fall protection utilized
Scaffolding
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Daily inspection conducted by competent person
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Setup & Used properly
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Proper access
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Fall protection in place on all open sides and edges
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Secured/tied/guys in place at 4:1 ratio
Mobile Equipement
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Daily inspections conducted for all mobile equipment
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Proper use of mobile equipment
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Back-up alarms are working
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Operators have been properly trained prior to use
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Proper PPE is being used (fall protection, seat belts, ROPS)
Cranes, Rigging and Signaling
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Daily, monthly, annual inspections conducted
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Swing radius controlled
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Critical lift plan implemented
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Qualified rigger/signal person(s)
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Rigging inspected (tags in place, hook latches in place, damage free, stored properly)
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Crane signals posted in immediate work area
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Proper distance from electrical wires
Excavations
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Competent Person inspection documented daily
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Overhead & Underground utilities located
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Protective system in place
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Proper sloping/benching for soil being excavated
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Access/Egress provided (ladders or ramps within 25 lateral feet)
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Spoil piles, equipment and materials are at least 2' from the edge of the excavation
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Utilities protected/supported
Confined Space
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Competent Person evaluated permit and non-permit spaces
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Air monitor properly calibrated and used
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Atmosphere test results documented
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Permit properly completed and all affected employees signed in
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Multi-employer communication requirements fulfilled
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Energy sources locked out
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Adequate ventilation in place
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Entry Rescue Plan, confirm services availability
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Non-Entry Rescue Plan, proper equipment in use and damage free
Welding, Cutting, & Cylinders
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Compressed gas cylinders stored and secured upright
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Proper separation/5' fire wall between flammable and oxygen cylinders
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Cylinders capped when not in use
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Cylinders, hoses, regulators free from damage
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Welding screen provided
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Welding equipment in good condition (insulators, grounding, welding lead)
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Engineering controls in place (ventilation, fume eaters, fresh air)
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Hot work permits completed
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Fire watch in place
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Flammable/combustible materials safe distance from hot work being performed
Demolition
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Engineering Survey Complete
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All utilities located and disconnected / marked
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Work area and structure adequately guarded and supported
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Airborne particulates controlled / monitored
Notes
Signatures
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Safety Representative
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Supervisor
