Title Page

  • Contractor:

  • Location:

  • Team Lead:

  • Completed By:

  • Conducted on:

General Site Conditions

  • Daily engangement reviewed?

  • Daily Engagement filled out correctly?

  • Number of crew present?

  • Number of crew signed off on engangement?

  • Worksite organized, clean, and uncluttered?

  • Trash kept in bags, containers or bins?

Emergency Response

  • Employees aware of how to evacuate building?

  • Employees know location of tornado shelter?

  • Employees know location of first aid kits?

  • Employees know location of fire extinguishers?

  • Employees know location of spill kits?

Barricading

  • Barricading required?

  • Barricading in place?

  • Type of barricading? (Red or Yellow)

  • Barricading tight and has gate?

  • Signs included with correct information?

Personal Protective Equipment (PPE)

  • Hard hats worn?

  • Gloves worn?

  • Type of gloves used?

  • Safety glasses/goggles being worn?

  • Hearing protection worn?

  • Respirators required?

  • Type of respirator worn?

  • Face shield required?

  • Hiviz worn?

  • Additional ppe required? (FRs ect)

Equipment

  • Pre checks filled out?

  • Equipment fuel source? (LP, electric, gas/diesel)

  • Equipment chocked when on incline?

  • Back up alarm functioning

  • Spotters utilized?

Hands and Power Tools

  • Tools inspected before use free of defects?

  • Defective tools tagged and out of service?

  • Guards on grinders and other required tools?

  • Cords in good conditon?

Ladders

  • Correct ladder being used?

  • Ladders being checked before use?

  • Ladder in good condition free of defects?

  • Ladder 3 feet above walking working surface?

  • Ladder being used as correct ratio (4:1)?

Scaffold

  • Scaffold erected by qualified persons?

  • Scaffold checked by competent person?

  • Weight limit known?

  • Scaffold planks or platforms in safe condition?

  • Guardrails erected correctly?

  • Correct access used for climbing?

  • Bracing free of defects?

Ariel Lifts

  • Checklists completed?

  • Type of lift (Electric, LP, Gas/Diesel)

  • Groundsperson present?

  • Operator trained?

  • Every person in lift tied off?

  • PFAS inspected before use?

Confined Space

  • Confined spaces on site marked?

  • Permit entry confined space?

  • Rescue procedures in place

  • Entry procedures followed?

  • Atmosphere montiored?

Rigging

  • Weight of lift?

  • Is lift a critical lift?

  • Lifting capacity of machine being used

  • Slings/Staps in good condition free of frays?

  • Labels on slings/straps?

  • Capacity of slings/straps?

  • Hooks, clevises, and other hardware stamped?

  • Capacity of hooks and hardware being used?

  • Taglines being used?

  • Correct hand signals being used?

  • Access zone clearly marked?

Electrical

  • Electrical work done by qualified person?

  • Generator used?

  • Type of Generator used (LP, Gas/Diesel)

  • GFCI outlets utilized?

  • Cords in good condition?

  • Cords inspected and correct color code?

Welding/Hotwork

  • Type of welder used? (Electric, LP, Gas/Diesel)

  • Hotwork Permit filled out?

  • Fire watch designated and utilized?

  • Atmosphere monitored?

  • Welding Screens used?

  • Area cleaned of combustibles?

  • Tanks stored correctly when not in use?

  • Welding leads in good conditon?

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.