Information
-
Document No.
-
Project Title - Location
-
Client / Site
-
General Contractor or Hospital Lead
-
Conducted on
-
Prepared by:
-
Inspection Attended By:
Permit Management
-
Workers badged appropriately?
-
ICRA Permit Posted - not expired
-
ILSM Assessment Posted
-
Emergency Contact Listing Posted
-
Hospital Codes/Orientation Information Posted
-
Add media
HOUSEKEEPING
-
ICRA Requirements Maintained
-
Project Secured From Public
-
Work Area Clean & Orderly
-
Construction Debris Under Control
-
Clear Paths of Egress
-
Dumpster Maintained
-
Add media
Personal Protective Equipment
-
Appropriate PPE in use
Fire Prevention & Protection
-
Fire Extinguishers
-
No Smoking Enforced
-
Housekeeping (fire hazard related)
-
Material Storage
-
Fire Sprinkler Systems
-
Compressed Gas Cylinders
-
Add media
Electrical
-
Lockout/Tagout
-
Temporary Wiring & Lighting
-
Extension Cords
-
GFCI
-
Equipment Condition
-
Add media
Hand & Power Tools
-
Correct Tools
-
Equipment Condition (e.g. Frayed cords, lack of guards)
-
Operator Safety Manuals
-
Knowledge of Use
-
Add media
Object Hazards
-
Protrusions & Catch Hazards
-
Unsafe Work Methods
-
Tool/Material Placement
-
Debris Piles
Additional Photos
-
Add photos
-
Photo Comments:
-
Add photos
-
Photo Comments:
Overall Rating
-
Choose an Overall Rating
-
Other Comments
-
ICRA/ILSM/Safety Team Representative Signature
-
Contractor/Project Representative Signature (optional)
