Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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Job Number
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Superintendent
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Project Manager
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Pre-Task Plan filled out
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Tool Inspection
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Equipment Inspection
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Tool Box Talk
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Self-Safety Inspection
House Keeping and Sanitation
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Passageways and walkways clear
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Nails and screws removed from material
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Water keg clean, taped, and dated correctly
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Cut rebar cleaned, NO ROLLING STOCK
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Trash Removed
Fire Prevention
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Fire extinguisher not blocked
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Fire extinguisher in close proximity of operation
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Fire extinguisher in good working condition
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Employees know location of fire extinguisher
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Adequate number of fire extinguisher(s) available
Electrical
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No exposed electrical wires
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No broken insulation on cords
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No broken or bent ground prongs on plugs
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Power tools do not have broken or cracked casings
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GFCI used and tested where required
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Correct color code used
Power / Hand Tools
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Tools and accessories inspected for cracks, mushroomed heads, etc.
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Guards in place per manufacture
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Handles installed correctly
Handling and Storage of Material
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General orderliness
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Stability of materials in storage
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Tool Shed / Conex clean
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Office and tool shed / conex secure
Personal Protective Equipment
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Head protection worn by all employees and subcontractors
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Eye protection worn by all employees and subcontractors
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Safety vest worn by all employees and subcontractors
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Hand protection worn
Excavation and Shoring
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Excavation permits executed
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Soil material stored away from edge, minimum 2 feet
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Excavation barricaded
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Is the location of trench marked with contact information
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Equipment kept a safe distance from edge of excavation
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Ladders and/or ramps every 25 feet
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Proper supervision – including competent person designated daily inspection
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Underground piping and electrical lines and identified – adequate support provided
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Are walkways provided when employees are required to cross over excavations
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Authorized employee operating equipment
Ladders
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Ladders inspected & in good condition
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Ladders used properly for type of exposure
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Ladders secured to prevent slipping, sliding, or falling
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Side rails extended 36” above top of landing
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Area around base of ladder clear of material
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Area around top of ladder clear of material
Concrete Construction
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Forms properly installed and braced
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Work area is uncluttered in free of loose material
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Reinforcing steel ends covered
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Walkway has access
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Walkway secure, fully planked, handrail installed
Shoring
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All shoring is inspected DAILY
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Solid rigid footing
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Planking is sound and sturdy
Fall Protection
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Adequate fall protection (harnesses, double retractable lanyard)
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Employee inspected personal fall device
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Horizontal life line inspected
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Any employee in a potential fall situation is tied off
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Employees below are protected from falling objects
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Employee not tied off in a way that will cause pendulum
Overall Notes
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Signature
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