Information

  • Client / Site

  • Conducted on

  • Prepared by

  • Location

General Work Environment

  • Are all work area clean and dry?

  • Trash removed daily?

  • Are aisles, walkways, doorways, and exit routes kept clear and unobstructed?

  • Are toilets and washing facilities provide, kept clean, and safe?

  • Are all MSDS on site in an area that is readily accessible to all employees?

  • Are measures in place to protect the public from exposure to work activities and equipment?

  • Are required postings readily available to all employees in the workplace?

  • Are monthly and weekly "tool box" safety meetings held and documented with sign in sheets? Was a copy forwarded to the safety department?

  • Was a SWMP audit done? BMP's are adequate and are in place?

  • Is material piled, stacked, or racked in a manner to prevent it from tipping, falling, collapsing, rolling, or spreading?

  • Comments:

First Aid and Emergency Equipment

  • Are emergency telephone numbers and Muster point posted on the job site?

  • Are first aid kits easily accessible, inspected, and stocked at least monthly?

  • Are there any exit doors that open into streets or other high traffic areas? Are adequate warnings provided to alert employees of the hazard?

Fire Protection and Prevention

  • Is there at lease one ABC fire extinguisher for every 3000 sq ft of work area?

  • Are fire extinguishers clearly visible and unobstructed at all times?

  • Are fire extinguishers inspected monthly for proper tags, pins, hoses not cracked or plugged, fully charged, and tags up to date?

Fall Protection

  • Are holes and other floor openings guarded by a grate, cover, guardrail, or equivalent on all sides (except at entrances to stairways or ladders)?

  • Are there stairrails or handrails on all stairways having four or more steps?

  • Are railings provided on ramps?

  • Do all elevated surfaces have guardrails at least 42 inches high?

  • Are all elevated surfaces equipped with a safe means of access?

  • Are fall protection harnesses and lanyards used by every employee working 6 feet or higher above the ground or on steeply pitched roofs, 6/12 or greater?

  • Are fall protection harnesses and lanyards a minimum of 1/2 inch nylon or equivalent, and short enough to prevent employees from falling more than 6 ft?

  • Are lifelines (lanyards) secure above the point of operation to an anchor point that will withstand 5,000 pounds of force for each attached worker?

  • Are harness, lanyards, and other fall protection equipment inspected prior to use?

  • Where a job site has protruding steel rebar below the work level, are the steel rebar protected by covers to prevent impaled injuries?

Portable Ladders

  • Are all ladders maintained in good condition and inspected before each use? Are broken and defective ladders taken out of service immediately?

  • Are ladders being used for their designed purpose only? (Step ladders/Extension ladders)

  • Are ladders being used beyond their maximum intended load?

  • Are ladder rungs/steps slip-resistant and free of dirt, grease, oil, ice, snow, etc?

  • Are employees facing the ladder when climbing up and down?

  • Are employees standing below the top 2 steps when using step ladders?

  • When ladders are used to gain access to elevated platforms, does the ladder always extend at least 3 feet above the elevated surface, and secured properly?

  • Are ladders placed on dry, stable footing, and properly secured?

Materials - Handling, Storage, Use, and Disposal

Scaffolding

  • Are scaffolds set up on level, stable ground with dry footings?

  • Has the scaffold been assembled and inspected by a competent person?

  • Was the scaffold inspected prior to use and scaffold tag properly filled out?

  • Do all scaffolds higher than 4 feet have 42 inch high guardrails and mid rails halfway between the top and platform?

  • Are scaffolds in good working condition with no damage or missing parts?

  • Do all planks on scaffolds fit tightly with no open spaces between boards?

  • Where planks are overlapped are they lapped over the supports?

  • Do all scaffold planks extend 6-18" beyond the end of the scaffold frame?

  • Are all ladders or stairs used to access scaffolds either tied or welded to the scaffolds for safe access? Are ladders positioned to provide direct access?

  • Are materials being stockpiled on scaffold? Are all materials removed from scaffold at the end of the day?

  • Are open sides of scaffold less than 14 inches from the face of the work?

  • Are platforms of 10 feet or less extending over their end supports no more than 12 inches?

  • Are guardrails in place at the open ends of the scaffold?

  • Has the movement of occupied scaffold been prohibited (unless designed by a registered professional engineer)?

  • Have toeboards been installed to prevent falling objects?

  • Is "X" bracing installed on the ends of the scaffold and every third set of post horizontally and every forth runner vertical?

  • Are all pins installed where required and locked?

  • Are castors locked during use?

  • Are castors pinned into the frames or adjustment screws?

Electrical

  • Are all cord-connected, electrically-operated tools and equipment double insulated or effectively grounded?

  • Are ground-fault circuit interrupters provided on all temporary electrical circuits?

  • Are all electrical rooms/panels secured and have proper signage?

  • Do all extension cords have 3-prong plugs and all 3 prongs intact?

  • Are all electrical cords inspected and in good working condition (i.e. no splices, frays, or the ground prong is removed)?

  • Are extension cords a No. 12 or larger gauge and properly marked?

  • Where electrical cords must cross roads, driveways, or walkways, are they protected by solid, weather-resistant bridges to prevent damage to the cords?

  • Are multiple plug adapters (octopus plugs) prohibited?

  • Are electrical circuits and equipment shut off, de-energized, and locked out before equipment installation, repairs, maintenance, or servicing?

  • Are unused switches, receptacles, and junction boxes covered with tight-fitting covers or plates

Power-Actuated Tools / Hand and Power Tools

  • Are employees who operate power actuated tools properly trained and carry a valid operator's card?

  • Are power actuated tools inspected for obstructions or defects before use?

  • Are all tools maintained in safe condition?

  • Are damaged and defected tools removed from service and repaired or replaced as soon as the damage or defect is found?

  • Are grinders, saws, and other tools with moving parts, equipped with appropriate safety guards to prevent physical contact with moving parts?

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.