Information
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Document No.
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General Contractor
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Job Name
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Prepared by
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Type of Work Being Performed
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Approximate Number of Employees on Site
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Conducted on
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Location
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Personnel
Personal Protective Equipment
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Standard PPE (hard hat, safety glasses, vest, boots, gloves)
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Job specific PPE required
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Hearing Protection
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Foot Protection
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Proper clothing
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First Aid Kit on Site
Hand and power tools
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Tool condition
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Proper guards and handles
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GFCIs are in place on all temporary power supplies
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Use of proper tool for the task being performed
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Layout of cords, hoses, lines, cables
Aerial Lifts
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Are aerial lifts on site
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Are they currently in use
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Is employee wearing proper fall protection and tied off
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Ground clear of obstructions
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Over head hazards removed or accounted for
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Pre shift inspection completed
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Equipment manual is with the equipment
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Weight limitations are posted
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Fire extinguisher on equipment
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Is fire extinguisher inspection up to date
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Stability
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Are there wind concerns
Fall Protection
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Is personal fall protection currently in use
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Is employee tied off to an approved anchor point
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Is the correct type of lanyard being used
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Is employee properly tied off to prevent contact with ground if a fall was to occur
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Is harness properly worn and fitted
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Was harness inspected prior to use
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Have individuals been trained on personal fall protection systems and proper implementation
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Is fall protection currently in use
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Warning Line System Set No Less Than 6 Feet From The Roofs Edge
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Safety Monitoring System
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100% Tie Off
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Guard Rail system
Hot work / Fire prevention
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Is there hot work taking place
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Hot Asphalt
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Condition of kettle
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Has kettle operator been trained
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Kettle operators name
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Fuel Tanks stored properly/securely
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Is a portable fire extinguisher immediately available at the work area where the hot work is taking place
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Stored fuel is at least 20' from kettle
Crane
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Is our crane on site? If so, which one?
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Has the operator been identified?
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Is operator certified
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Certification reviewed
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Is lift plan required for load being lifted
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Has the person rigging for the crane been identified?
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Has the crane, as well as the path of travel been flagged off?
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Has lift plan been completed, approved and available for review
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Signal man/women has been identified
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Communication method has been stablished and is acceptable
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Hand signals
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Radio communication
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Other
Motorized equipment
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Do we have any motorized equipment on site? If so, what types?
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Has the operator been trained
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Is the machine being used for it's intended purpose
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Is there a fire extinguisher near by
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Are guards in place
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Is the warning line system set up to reflect the use of rooftop motorized equipment (10' from roofs edge in the direction of travel, 6 feet on all other sides)
Forklift
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Do we have a Forklift on site?
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Is operator certified
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Has the operator been identified?
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Has annual inspection been completed and inspection decal visible
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Load chart is in equipment and available for review
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Is there a fire extinguisher on the equipment
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Fire extinguisher has been inspected and is in good conditiono
Electrical
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Is electrical power being used
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Has power source been identified
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Permanent source
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Temporary source
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Are power cords in use
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Have power cords been inspected and in good condition
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Are they of the correct gauge and type
Scaffolds
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Is scaffolding on site
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Is scaffolding currently in use
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Is daily inspection sheet complete and available for review
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Was daily inspection sheet reviewed
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Railings / guardrails on scaffolding are in place and in good condition
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Cross members / supports are in place and in good condition
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Stability of scaffolding
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Climbing rungs
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Wheels are locked and secured
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Scaffolding is secured (top and bottom)
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General condition of equipment
Ladders
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Are ladders on site
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Are they currently in use
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Is ladder secured
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Ladder is set up at 4:1 angle
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Top of ladder extends 3' above landing
Type of Work Being Done
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Roofing
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Single Ply
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Built-Up
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Metal
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Shingles
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Detail work
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Tear Off
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Lay-Up
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ACM Panels
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Metal
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Audit Completed By
Additional comments and photos
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