Title Page

  • Project Name

  • Brief Summary of Tasks and Crew (number of carpenters, finishers, etc)

  • Construction Management/General Contractor/Owner Representative

  • Circle B Subcontractors on-site

  • Report Date

  • Prepared by

  • Assisted by

Safety Documentation, Emergency Action Plan, First Aid Kits

  • Weekly TBT, Daily JHA/PTP, Equipment Inspections, & Other Reports/Documents

  • First Aid Kits: Location, Adequately Stocked, Trained Provider

  • Emergency Action Plan is Posted: Nearest Approved Medical Facility, Emergency Signals, Evacuation or Shelter Map/Locations

Housekeeping/Organization (related to Circle B tasks, except item for 'other')

  • General Site Conditions (clear walkways, work areas, and access to entry/exits)

  • Material Storage: Stable, Organized, Accessible

  • Trash/Waste Removal (dump/trash carts available, accessible dumpsters, trash removal schedule)

  • Hazard Communication (containers labeled, stored correctly, used properly, chemical list available, SDS available)

  • Other Site Hazard Awareness (other trade & owner activities, site conditions, site visitors/public access)

Fire Prevention and Protection

  • Site Provided Fire Extinguishers: Location & Condition of Extinguishers

  • Task Specific Area: (dedicated fire extinguisher, protected & clear of combustible/flammable materials, hot work permits when required)

  • Flammable Fuels/Chemicals (proper container, storage, labels, use)

Personal Protective Equipment

  • General: Hard Hat, Safety Glasses (with side shields), Sturdy Work Boots (safety toe per task/project requirement)

  • Gloves: Cut Resistant, Task Specific, Project/Site Required

  • Face Shield: Use with Chop Saws, Grinders, Circular Saws, as required by tool manufacturer, other tasks that create similar flying object potential.

  • Respiratory Protection: Task Specific Dust Mask, N95, or other type

  • Hearing Protection: Ear Plugs or Ear Muffs as required by Noise Level of Task or Equipment

  • Hi-Visibility Clothing: Site/Task Required

Fall Prevention and Protection

  • Guardrails: Wood or Cable (toprail, midrail, and toeboard, properly secured)

  • Barricades/Warning Lines: Red/Yellow Tape with Signs (restricted access, overhead hazards, leading/open edges, limited access areas)

  • Personal Fall Arrest Systems (Full Body Harness, Lanyard/SRL, Anchor Point): Inspected, Proper Installation and Use of Equipment

Electrical, Temporary Lighting, Hand/Power Tools

  • Temporary Electrical Power: Outlets Provided, GFCI's, Protected from Damage

  • Extension Cords, Battery Chargers, Tool Cords: Condition, GFCI or Double Insulated, Protected from Damage

  • Hand & Power Tools: correct selected, inspected, in good condition, used as designed, stored/protected from damage

  • Temporary Lighting: Provided, Adequate, Protected, Portable Lights available as needed

Elevated Work Tasks: Ladders, Benches, Stilts, Scaffolds, MEWPs

  • Ladders: Step/Extension (correct type, inspected, proper set-up & use)

  • Carts (finishers), Drywall Benches, Stilts (inspected, proper set-up, & use)

  • Scaffolds (correct type, proper assembly, height/base ratio stable, inspection)

  • Mobile Scaffolds (proper assembly, locked wheels)

  • Scaffolds: Fall Protection (guardrails when platform at/above 4 feet, personal fall protection systems)

  • MEWP: Boom/Scissor Lifts (correct type & use, inspected, fall protection as required)

  • Suspended Scaffold System (inspected pre-use/post-break/post-lunch, proper set-up, competent person, personal fall protection system)

Material Handling / Heavy Equipment

  • Manual Material Handling (proper lifting form, team lifts, lift plan and clear path)

  • Lifting/Rigging Equipment (competent person, inspection, condition, proper selection, rigging plan)

  • Forklift/Lull/Telehandler (trained operator, inspection, proper selection, correct use)

  • Cranes: Certified Operator, Stable Set-Up, Inspected

  • Trained/Qualified Signal Person, Standard Signal Chart Posted

General Notes/Comments

  • Note / Comments

  • Foreman 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.