Information
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Protective Equipment
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Head protection (brim to front)
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Eye Protection (proper type)
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Hearing Protection
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Minimum 6 inch Leather Work Shoes
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Fall Protection, On/From/To/6ft
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Material Handling Gloves
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Reflective Vests
General Workplace
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General Housekeeping
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Spill Kit / Pads at Site
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Secondary Containments
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Bulk Fuel Storage
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Barricades/Fencing/Bales
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Sanitation
Excavations
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Shoring/Sloping
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Access/Egress Provided
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Access/Egress Provided
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Barricades as Required
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Daily Inspections Foreman
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Spoils / Rocks Min 2 ft back
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Encumbrances Supported
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Personnel Clear of Equipment
Electrical / Hand Tools
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Cords Inspect/Safe Condition
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GFCI's Inspected and In Use
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Grinders, Guarding, Covers
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Hammer Handles
Rigging
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Chokers / Slings / Chains
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Proper Technique Used
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Chain Falls / Com-a-longs
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Hooks and Safety Latches
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Inspections / Proper Lifting
Ladders / Stairs and Rails
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Proper Used and Secured
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General Condition
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Proper Angle and 3 ft above
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Inspections Completed
Materials
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Stacking / Storage of Materials
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Proper Signage
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Lifting / Hauling
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Equipment / Tool Storage
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Fuels / Propane / Storage
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Proper Handling / Carrying
Equipment / Vehicle
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Inspections Completed
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Safe Operation
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Seat Belts in use
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Fire Extinguishers
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Load Secured
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Spotters When Required
Miscellaneous / Training
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Orientations
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Confined Space
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Excavation
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Safety Meetings
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Rock Truck
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Flaggers Controlling Traffic
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MSHA / Respirators
Hazard Controls
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Welding / Cutting / Guages
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Compressed Gases
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SDS Books / Labels
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Traffic Signs Barricades
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Chemical Exposure Control
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Environmental Issues
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Fire Extinguisher Available
Corrections
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Corrections
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Item Description
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Person Responsible
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Time And Date
Comments
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Comments
Signatures
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Person Performing Inspection
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Signature
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Date and Time
