Title Page

  • Active Job Sites

  • Address
  • General Contractor

  • Project Manager HVAC

  • Project Manager Plumbing

  • SM Foreman

  • PP Foreman

  • PL Foreman

  • ITech Foreman

Today's Forecasted High Temperature

  • Is today's Forecasted Temperature expected to reach or exceed 95 degrees?

  • What is todays expected High Temperature?

  • Personnel Trained in Heat Illness Prevention?

  • Daily High Heat Plan Completed?

  • Date

  • Prepared by

General Safety:

  • CPR/1st Aid Provider on site:

  • Adequate First Aid Kits available:

  • General cleanliness working/walkways surfaces free of trips/slips hazards:

  • PPE: Hardhat/Safety Glasses/Face Shield/Hearing/Gloves (Cut lv 3 min)/Other Worn:

  • Training review "Take 5 Personal Protective Equipment"

  • Adequate Lighting:

  • Adequate Drinking Water:

  • Toilets Clean:

  • Wash Stations with Soap, Water and Towels:

  • Are Impalement Hazards covered:

Dusts, Fumes, Mists, Vapors, and Gases:

  • Are there known Asbestos Containing Materials (ACMs) on this project:

  • Are ACMs contained/encapsulated?

  • Are Personnel Asbestos Awareness Trained

Silica Dust Exposure:

  • Are Employees engaged in activities that create or are exposed to silica dust created by other trades:

  • HEPA Filtered Tools. Vacuums Used , Frequently Cleaned:

  • Employees Trained in Silica Dust Exposure:

  • Filter Face Piece Available for Voluntary use:

  • Other Trades complying with Silica Dust Standard:

Carbon Monoxide Exposure:

  • Are Internal Combustion Engines being operated inside the building:

  • Is there adequate ventilation:

  • Is Carbon Monoxide Monitoring in Place:

Excavation & Trenching:

  • Are Employees engaged in Excavation or Trenching Activities:

  • Inspected By A Competent Person:

  • All Personnel Inside Trench/Excavation Trained:

  • Ramp present or Ladder installed, 4ft or deeper, and extended 3ft above landing and within 25ft from all workers:

  • Bench, Sloped or Shored 5ft in depth or greater:

  • Trenches less than 5ft safe guarded against falls

Traffic Control:

  • Are Employees Engage in Traffic Control Activities:

  • Employees wearing High visibility Clothing:

  • Personnel Trained:

  • Stop signs/Signaling Devices Used:

Cranes Operations:

  • Are employees engaged in Crane Activities:

  • Qualified Signalman:

  • Qualified Riggers:

  • Rigging Equipment inspected:

  • Pre-lift Safety Brief Conducted (all personnel must be present):

Standard Railings:

  • Are there Guarding, Rails, Nets, Toeboards to be Inspected:

  • Are fall exposures 6ft or greater properly guarded (leading edges, shafts, etc.):

  • Are fall exposures less than 6ft made safe

  • Railings, Cables, extended 39-42in above the working surface no more than 3in of deflection in any direction:

  • Are toe-boards, netting or equivalent installed to prevent items from falling to the lower level:

Ramps, Runways, Stairwells, and Stairs:

  • Are there Ramps, Stairwells, and Stairs to be inspected:

  • Personnel Ramps sturdy no deflection/spring, secured from displacement:

  • Stairwell Handrails Installed, Steps and Landings Filled in:

  • Stairs clear to provide clear access and egress? (if more than 1 at least one continuously cleared):

Floor and Wall Openings:

  • Floor openings/wall openings guarded to prevent personnel/items from falling to lower levels:

Roof Openings and Skylights:

  • Roof Openings/Skylights Guarded:

Scaffolding:

  • Are Personnel working on Scaffolding:

  • Personnel Trained: Scaffold User Training:

  • Scaffolding Inspected by Competent Person:

  • Working Surface at least 20in wide:

Fall Protection:

  • Personnel Wearing Personal Fall Arrest or Restraint Systems:

  • Appropriate Fall Protection System Used?

  • Appropriate Anchor point utilized (i.e. Rated 5klb, no pipe, no conduit, no Unistrut):

  • Personnel Trained in the proper use, selection and inspection:

  • Personal Fall Protection Gear Inspected:

Ladders:

  • Ladders Inspected, Appropriate for Task and Used/Set up correctly

  • Training Review "Take 5 Ladders"

Hand Tools:

  • Tools Inspected and in good condition:

  • Guards, Handles Installed:

Powder Actuated Tools:

  • Powder Actuated Tools Used in safe manner/Secured

  • Training Review "Take 5 Powder Actuated Tools"

Cords, GFCI:

  • Cords/GFCI Inspected:

  • Cords free from trip hazards, not ran through/over sharp edges.

Multi Elevated Work Platforms (Scissor and Boom Lifts):

  • Multi Elevated Work Platforms Operated Safely: (i.e. Mid-rail chain, Inspected, not standing on rails, etc.)

  • Training Review "Take 5 MEPWs" (if previously trained)

Powered Industrial Truck:

  • Fork Lifts Operated Safely: (i.e. seatbelt worn, Inspected, load carried properly, etc.)

  • Training Review "Take 5 Forklifts" (if previously trained)

Confined Space:

  • Are Personnel engaged in Confined Space Activities:

  • Are all personnel working in Confined Spaces Trained:

  • has a Confined Space permit been completed and signed by the Supervisor:

  • Air monitoring and ventilation present/Adequate:

  • Rescue Retrieval System Setup:

  • Lock Out Tag Out in Place:

HAZCOM:

  • Are Hazardous Materials Being Used:

  • Containers Labeled? (Primary and Secondary):

  • Stored/Disposed Properly:

  • SDS Available:

Welding/Hot Work:

  • Are there current hot work activities? Any flame or spark producing tasks:

  • Hot Work Permit Completed:

  • Combustibles Moved 25ft away:

  • Welding blankets used to prevent slag/sparks from falling to lower levels:

  • Fire Extinguisher Present and Inspected (tag signed/dated)

  • 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

  • Is ventilation adequate for work space

  • is Installed Ventilation, smoke eaters or fans being used

  • Are other trades complying

  • Regulator, Hoses, Torch Inspected, Flashback Arrestors Installed

Compressed Gas Cylinder Storage:

  • Bottles Stored Properly: Secured from tipping, incompatible gases separated

Tools, Ladders, Equipment Secured/locked up

  • Are tools, ladders and equipment properly secured?

Other Trades Using Company Tools, Equipment?

  • Are Non-Company personnel, including Company Subcontractors, are using Company Tools or Equipment:

Safe Behavior Observation:

  • Do you have a Safe Behavior Observation Report for this project:

  • Who was Observed, Name and Trade:

  • Who is the Supervisor:

  • What Was The Safe Observation:

  • Was a Gift card Issued for this event: Gift Cards are issued for those actions up and beyond normal compliance

Company Vehicle 1:

  • Are there company vehicles on site to be inspected:

  • Vehicle Number:

  • Assigned Driver:

  • Vehicle Exterior Clean:

  • Truck Bed Neat and Organized:

  • Vehicle free of damage other than minor scratches and/or dents:

  • Glass free of cracks, chips:

  • Lights/lens free of cracks:

  • Driver Compartment Neat and Organized:

  • Tires in good condition:

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.