Acts and Conditions

  • Unsafe Acts?

  • Applicable Photos

  • Unsafe acts observed:

  • Were corrective actions taken?

  • Corrective actions carried out:

  • Unsafe Conditions?

  • Applicable Photos

  • Unsafe conditions observed:

  • Were corrective actions taken?

  • Corrective actions carried out:

General Safety Categories

  • Housekeeping

  • Photos

  • Corrective action taken

  • Facilities Available and Maintained

  • Photos

  • Corrective action taken

  • Drinking Water

  • Cups Available

  • Sanitized Containers

  • Corrective action taken

  • Personal Protective Equipment

  • Corrective action taken

General Safety Categories (cont'd)

  • Accident Forms and Instructions

  • Corrective Actions

  • First Aid Kit

  • Corrective Actions

  • Hand Tools and Power Tools

  • Corrective Actions

  • MOT and Equipment Protection

  • Corrective Actions

  • Excavation

  • Protective System

  • Spoil > 2' from Excavation

  • Egress

  • Water Control

  • Utilities Identified/Marked

  • Competent Person

  • Corrective Actions

Equipment

  • Lights/Horns Operating

  • Hoisting Equipment

  • Corrective Actions

Additional Information

  • Additional Comments or Actions Taken

  • Recommendations for Safety Improvement

  • 5-minute Safety Huddle

  • Additional Notes

  • Additional Site Photos

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