Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • Job Number

  • Superintendent

  • Project Manager

  • Pre-Task Plan filled out

  • Tool Inspection

  • Equipment Inspection

  • Tool Box Talk

  • Self-Safety Inspection

House Keeping and Sanitation

  • Passageways and walkways clear

  • Nails and screws removed from material

  • Water keg clean, taped, and dated correctly

  • Cut rebar cleaned, NO ROLLING STOCK

  • Trash Removed

Fire Prevention

  • Fire extinguisher not blocked

  • Fire extinguisher in close proximity of operation

  • Fire extinguisher in good working condition

  • Employees know location of fire extinguisher

  • Adequate number of fire extinguisher(s) available

Electrical

  • No exposed electrical wires

  • No broken insulation on cords

  • No broken or bent ground prongs on plugs

  • Power tools do not have broken or cracked casings

  • GFCI used and tested where required

  • Correct color code used

Power / Hand Tools

  • Tools and accessories inspected for cracks, mushroomed heads, etc.

  • Guards in place per manufacture

  • Handles installed correctly

Handling and Storage of Material

  • General orderliness

  • Stability of materials in storage

  • Tool Shed / Conex clean

  • Office and tool shed / conex secure

Personal Protective Equipment

  • Head protection worn by all employees and subcontractors

  • Eye protection worn by all employees and subcontractors

  • Safety vest worn by all employees and subcontractors

  • Hand protection worn

Excavation and Shoring

  • Excavation permits executed

  • Soil material stored away from edge, minimum 2 feet

  • Excavation barricaded

  • Is the location of trench marked with contact information

  • Equipment kept a safe distance from edge of excavation

  • Ladders and/or ramps every 25 feet

  • Proper supervision – including competent person designated daily inspection

  • Underground piping and electrical lines and identified – adequate support provided

  • Are walkways provided when employees are required to cross over excavations

  • Authorized employee operating equipment

Ladders

  • Ladders inspected & in good condition

  • Ladders used properly for type of exposure

  • Ladders secured to prevent slipping, sliding, or falling

  • Side rails extended 36” above top of landing

  • Area around base of ladder clear of material

  • Area around top of ladder clear of material

Concrete Construction

  • Forms properly installed and braced

  • Work area is uncluttered in free of loose material

  • Reinforcing steel ends covered

  • Walkway has access

  • Walkway secure, fully planked, handrail installed

Shoring

  • All shoring is inspected DAILY

  • Solid rigid footing

  • Planking is sound and sturdy

Fall Protection

  • Adequate fall protection (harnesses, double retractable lanyard)

  • Employee inspected personal fall device

  • Horizontal life line inspected

  • Any employee in a potential fall situation is tied off

  • Employees below are protected from falling objects

  • Employee not tied off in a way that will cause pendulum

Overall Notes

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Signature

  • Add 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.