Title Page
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Contractor:
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Location:
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Team Lead:
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Completed By:
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Conducted on:
General Site Conditions
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Daily engangement reviewed?
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Daily Engagement filled out correctly?
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Number of crew present?
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Number of crew signed off on engangement?
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Worksite organized, clean, and uncluttered?
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Trash kept in bags, containers or bins?
Emergency Response
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Employees aware of how to evacuate building?
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Employees know location of tornado shelter?
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Employees know location of first aid kits?
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Employees know location of fire extinguishers?
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Employees know location of spill kits?
Barricading
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Barricading required?
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Barricading in place?
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Type of barricading? (Red or Yellow)
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Barricading tight and has gate?
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Signs included with correct information?
Personal Protective Equipment (PPE)
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Hard hats worn?
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Gloves worn?
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Type of gloves used?
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Safety glasses/goggles being worn?
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Hearing protection worn?
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Respirators required?
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Type of respirator worn?
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Face shield required?
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Hiviz worn?
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Additional ppe required? (FRs ect)
Equipment
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Pre checks filled out?
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Equipment fuel source? (LP, electric, gas/diesel)
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Equipment chocked when on incline?
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Back up alarm functioning
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Spotters utilized?
Hands and Power Tools
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Tools inspected before use free of defects?
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Defective tools tagged and out of service?
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Guards on grinders and other required tools?
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Cords in good conditon?
Ladders
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Correct ladder being used?
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Ladders being checked before use?
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Ladder in good condition free of defects?
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Ladder 3 feet above walking working surface?
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Ladder being used as correct ratio (4:1)?
Scaffold
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Scaffold erected by qualified persons?
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Scaffold checked by competent person?
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Weight limit known?
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Scaffold planks or platforms in safe condition?
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Guardrails erected correctly?
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Correct access used for climbing?
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Bracing free of defects?
Ariel Lifts
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Checklists completed?
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Type of lift (Electric, LP, Gas/Diesel)
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Groundsperson present?
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Operator trained?
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Every person in lift tied off?
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PFAS inspected before use?
Confined Space
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Confined spaces on site marked?
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Permit entry confined space?
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Rescue procedures in place
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Entry procedures followed?
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Atmosphere montiored?
Rigging
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Weight of lift?
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Is lift a critical lift?
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Lifting capacity of machine being used
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Slings/Staps in good condition free of frays?
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Labels on slings/straps?
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Capacity of slings/straps?
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Hooks, clevises, and other hardware stamped?
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Capacity of hooks and hardware being used?
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Taglines being used?
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Correct hand signals being used?
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Access zone clearly marked?
Electrical
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Electrical work done by qualified person?
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Generator used?
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Type of Generator used (LP, Gas/Diesel)
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GFCI outlets utilized?
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Cords in good condition?
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Cords inspected and correct color code?
Welding/Hotwork
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Type of welder used? (Electric, LP, Gas/Diesel)
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Hotwork Permit filled out?
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Fire watch designated and utilized?
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Atmosphere monitored?
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Welding Screens used?
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Area cleaned of combustibles?
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Tanks stored correctly when not in use?
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Welding leads in good conditon?