Title Page
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Job Number
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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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Superintendent/Foreman
Atmospheric Monitoring
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Is a gas monitor required for work being performed?
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Is the gas monitor calibrated and in good working order?
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Has a bump test been performed?
Cranes/Critical Lifts
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Has a lift plan been completed?
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Is the annual inspection for the crane completed?
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Does the operator have the valid and applicable certification?
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Has a daily inspection been completed?
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Is a spotter/signal person in place?
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Are alarms working and audible?
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Has the lifting capacity and work to be performed been verified?
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Is the proper rigging being utilized and inspected prior to use?
Electrical Hazards
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Are electrical cords and extension cords in good condition?
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Overhead electrical lines and cables clearly identified and safety work distances maintained?
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GFCIs used where required?
Excavation/Trench
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Competent Person
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Has the competent person completed a trench/excavation inspection?
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Properly benched/sloped or shored when exceeding 5 ft. in depth?
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Is there safe access/egress when exceeding 4 ft. in depth?
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Access/Egress within 25ft.?
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Spoil material at least 2 ft. from edge of the excavation?
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Have underground utility installations been identified and safely excavated?
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Are open excavations protected when necessary?
Fire Prevention
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Is the fire extinguisher inspected for the current month?
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Is the fire extinguisher annual inspection current?
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Does the fire extinguisher appear to be in good working order, charged and free of damage?
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Are fire extinguishers properly located and mounted?
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Compressed gas cylinders separated & secured?
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Proper storage of flammable materials? Approved Containers?
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Are fuel tanks properly grounded?
Hand & Power Tools
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Condition of hand tools and power.
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Are all tools being used for their intended use?
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Guards on tools & equipment?
Hoisting/Rigging Equipment
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Is the correct rigging system used?
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Is there a permanently affixed and legible identification to indicate SWL?
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Condition of rigging hardware
Hot Work/Welding
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Is proper PPE being worn for welding, cutting, grinding, etc. activities?
- Yes
- No
- N/A
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Are all employees wearing FR Clothing?
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Condition of welding leads
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Is a Hot Work Permit completed?
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Is a dedicated Fire Watch in Place?
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Area free of combustibles?
Housekeeping
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Good appearance?
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Proper trash disposal?
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Prevention of slips/trips/ falls?
Ladders
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Is the ladder appropriate for the task?
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Is the ladder set at proper angle?
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Is the ladder extending 3' beyond the work surface or leading edge?
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Is the ladder adequately secured to prevent movement?
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Condition of the ladder
Mobile Equipment/Vehicle Safety
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Operation of equipment and vehicles.
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Condition of equipment.
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Seat belts being worn while operating equipment?
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Are vehicles/equipment left running and unattended?
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Is equipment properly secured when not in use? (Attachments grounded, brake engaged, parked in safe location, etc.)
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Proximity to employees. Are spotters in place?
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Has the operator performed a daily inspection?
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Back-up alarms operational?
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Are vehicle wheels chocked when parked on grade?
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Are vehicles in good condition or free from creating additional hazards?
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Are vehicles or equipment being loaded beyond their capacity?
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Load Securement
PPE
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PPE used for task
- Hard hats
- Safety glasses
- Respirators
- Gloves
- Face shields
- Earplugs
- Hi-Viz Reflective Vest
- Safety Toed Work Boots
- Chainsaw Chaps
- FR Clothing
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Are all employees wearing appropriate PPE required for the task and work location?
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Is all PPE in good condition and being worn properly?
Traffic Control
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Is traffic control being performed by a subcontractor?
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Are approach signs in place and adequate for work activities?
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Is proper communication being utilized?
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Is a transition area and work zone delineation properly set up?
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Are appropriate traffic control devices being utilized?
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Are the appropriate measures being taken for night time flagging operations?
Jobsite (General)
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Is the JSA onsite and complete?
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Are other applicable permits completed (Confined Space, Critical Lift, Hot Work, Excavation, Lift Plan, etc.)?
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Were there any incidents reported (Injury, Property Damage, Line Strike, Near Miss, Etc.)?
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Are first aid kits available and stocked?
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Are all employees trained for the tasks being performed (Competent Person, Confined Space, Aerial Lifts, HAZWOPER, Fire Watch, etc.)?
Efficiencies
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Adequate staging of materials.
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Employee emergency access/egress maintained.
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Utilization of equipment.
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Other areas for improvement.
Observations to Initiate Improvement
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Pre-Job Plan/Inspect.
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Proper Tool for the Job.
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Line of Fire.
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Eyes on Path.
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Protective Equipment/PPE.
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Housekeeping.