Title Page
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Active Job Sites
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Address
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General Contractor
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Project Manager HVAC
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Project Manager Plumbing
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SM Foreman
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PP Foreman
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PL Foreman
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ITech Foreman
Today's Forecasted High Temperature
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Is today's Forecasted Temperature expected to reach or exceed 95 degrees?
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What is todays expected High Temperature?
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Personnel Trained in Heat Illness Prevention?
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Daily High Heat Plan Completed?
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Date
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Prepared by
General Safety:
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CPR/1st Aid Provider on site:
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Adequate First Aid Kits available:
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General cleanliness working/walkways surfaces free of trips/slips hazards:
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PPE: Hardhat/Safety Glasses/Face Shield/Hearing/Gloves (Cut lv 3 min)/Other Worn:
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Training review "Take 5 Personal Protective Equipment"
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Adequate Lighting:
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Adequate Drinking Water:
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Toilets Clean:
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Wash Stations with Soap, Water and Towels:
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Are Impalement Hazards covered:
Dusts, Fumes, Mists, Vapors, and Gases:
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Are there known Asbestos Containing Materials (ACMs) on this project:
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Are ACMs contained/encapsulated?
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Are Personnel Asbestos Awareness Trained
Silica Dust Exposure:
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Are Employees engaged in activities that create or are exposed to silica dust created by other trades:
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HEPA Filtered Tools. Vacuums Used , Frequently Cleaned:
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Employees Trained in Silica Dust Exposure:
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Filter Face Piece Available for Voluntary use:
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Other Trades complying with Silica Dust Standard:
Carbon Monoxide Exposure:
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Are Internal Combustion Engines being operated inside the building:
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Is there adequate ventilation:
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Is Carbon Monoxide Monitoring in Place:
Excavation & Trenching:
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Are Employees engaged in Excavation or Trenching Activities:
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Inspected By A Competent Person:
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All Personnel Inside Trench/Excavation Trained:
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Ramp present or Ladder installed, 4ft or deeper, and extended 3ft above landing and within 25ft from all workers:
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Bench, Sloped or Shored 5ft in depth or greater:
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Trenches less than 5ft safe guarded against falls
Traffic Control:
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Are Employees Engage in Traffic Control Activities:
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Employees wearing High visibility Clothing:
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Personnel Trained:
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Stop signs/Signaling Devices Used:
Cranes Operations:
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Are employees engaged in Crane Activities:
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Qualified Signalman:
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Qualified Riggers:
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Rigging Equipment inspected:
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Pre-lift Safety Brief Conducted (all personnel must be present):
Standard Railings:
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Are there Guarding, Rails, Nets, Toeboards to be Inspected:
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Are fall exposures 6ft or greater properly guarded (leading edges, shafts, etc.):
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Are fall exposures less than 6ft made safe
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Railings, Cables, extended 39-42in above the working surface no more than 3in of deflection in any direction:
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Are toe-boards, netting or equivalent installed to prevent items from falling to the lower level:
Ramps, Runways, Stairwells, and Stairs:
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Are there Ramps, Stairwells, and Stairs to be inspected:
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Personnel Ramps sturdy no deflection/spring, secured from displacement:
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Stairwell Handrails Installed, Steps and Landings Filled in:
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Stairs clear to provide clear access and egress? (if more than 1 at least one continuously cleared):
Floor and Wall Openings:
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Floor openings/wall openings guarded to prevent personnel/items from falling to lower levels:
Roof Openings and Skylights:
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Roof Openings/Skylights Guarded:
Scaffolding:
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Are Personnel working on Scaffolding:
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Personnel Trained: Scaffold User Training:
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Scaffolding Inspected by Competent Person:
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Working Surface at least 20in wide:
Fall Protection:
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Personnel Wearing Personal Fall Arrest or Restraint Systems:
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Appropriate Fall Protection System Used?
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Appropriate Anchor point utilized (i.e. Rated 5klb, no pipe, no conduit, no Unistrut):
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Personnel Trained in the proper use, selection and inspection:
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Personal Fall Protection Gear Inspected:
Ladders:
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Ladders Inspected, Appropriate for Task and Used/Set up correctly
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Training Review "Take 5 Ladders"
Hand Tools:
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Tools Inspected and in good condition:
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Guards, Handles Installed:
Powder Actuated Tools:
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Powder Actuated Tools Used in safe manner/Secured
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Training Review "Take 5 Powder Actuated Tools"
Cords, GFCI:
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Cords/GFCI Inspected:
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Cords free from trip hazards, not ran through/over sharp edges.
Multi Elevated Work Platforms (Scissor and Boom Lifts):
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Multi Elevated Work Platforms Operated Safely: (i.e. Mid-rail chain, Inspected, not standing on rails, etc.)
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Training Review "Take 5 MEPWs" (if previously trained)
Powered Industrial Truck:
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Fork Lifts Operated Safely: (i.e. seatbelt worn, Inspected, load carried properly, etc.)
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Training Review "Take 5 Forklifts" (if previously trained)
Confined Space:
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Are Personnel engaged in Confined Space Activities:
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Are all personnel working in Confined Spaces Trained:
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has a Confined Space permit been completed and signed by the Supervisor:
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Air monitoring and ventilation present/Adequate:
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Rescue Retrieval System Setup:
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Lock Out Tag Out in Place:
HAZCOM:
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Are Hazardous Materials Being Used:
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Containers Labeled? (Primary and Secondary):
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Stored/Disposed Properly:
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SDS Available:
Welding/Hot Work:
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Are there current hot work activities? Any flame or spark producing tasks:
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Hot Work Permit Completed:
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Combustibles Moved 25ft away:
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Welding blankets used to prevent slag/sparks from falling to lower levels:
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Fire Extinguisher Present and Inspected (tag signed/dated)
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Fire Watch Present (note: if slag/sparks are falling to lower levels a separate FW is required at each level to the lowest level where slag/sparks could land):
Ventilation
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Is ventilation adequate for work space
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is Installed Ventilation, smoke eaters or fans being used
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Are other trades complying
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Regulator, Hoses, Torch Inspected, Flashback Arrestors Installed
Compressed Gas Cylinder Storage:
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Bottles Stored Properly: Secured from tipping, incompatible gases separated
Tools, Ladders, Equipment Secured/locked up
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Are tools, ladders and equipment properly secured?
Other Trades Using Company Tools, Equipment?
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Are Non-Company personnel, including Company Subcontractors, are using Company Tools or Equipment:
Safe Behavior Observation:
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Do you have a Safe Behavior Observation Report for this project:
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Who was Observed, Name and Trade:
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Who is the Supervisor:
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What Was The Safe Observation:
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Was a Gift card Issued for this event: Gift Cards are issued for those actions up and beyond normal compliance
Company Vehicle 1:
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Are there company vehicles on site to be inspected:
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Vehicle Number:
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Assigned Driver:
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Vehicle Exterior Clean:
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Truck Bed Neat and Organized:
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Vehicle free of damage other than minor scratches and/or dents:
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Glass free of cracks, chips:
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Lights/lens free of cracks:
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Driver Compartment Neat and Organized:
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Tires in good condition: