Title Page

  • Name of Job

  • Conducted on

  • Location
  • Supervisor

  • Prepared by

  • Hard hats work by workers on-site?

  • Eye protection worn by workers on-site?

  • Appropriate footwear being worn by workers?

  • Hearing protection needed?

  • Hearing protection adequate for noise exposure?

  • Hearing protection worn correctly?

  • Charge fire extinguishers available on-site?

  • Complete first aid kits in job trailer?

  • Good housekeeping on job site?

  • Proper fall protection being used?

  • Are tools and equipment being use as intended?

  • Are tools serviceable and in good condition?

  • Scaffolding properly assembled and wheels locked?

  • Workers out from under suspended loads?

  • Seat belts being used in all vehicles and equipment?

  • Blanton procedures and guidelines being followed?

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  • Inspector Signature

  • Supervisor Signature

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.