Information

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Protective Equipment

  • Gas Monitors Being Worn When Required

  • Head protection (brim to front)

  • Eye Protection (proper type)

  • Hearing Protection

  • Minimum 6 inch Leather Work Shoes

  • Fall Protection, On/From/To/6ft

  • Material Handling Gloves

  • Reflective Vests

General Workplace

  • General Housekeeping

  • Spill Kit / Pads at Site

  • Secondary Containments

  • Bulk Fuel Storage

  • Barricades/Fencing/Bales

  • Sanitation

Excavations

  • Shoring/Sloping

  • Access/Egress Provided

  • Access/Egress Provided

  • Barricades as Required

  • Daily Inspections Foreman

  • Spoils / Rocks Min 2 ft back

  • Encumbrances Supported

  • Personnel Clear of Equipment

Electrical Hazards, Power Tools and Hand Tools

  • Cords Inspect/Safe Condition

  • GFCI's Inspected and In Use

  • Grinders, Guarding, Covers

  • Hammer Handles

  • Junction boxes are secure and closed off.

  • No exposed wires

  • Stationary Mechanical Units are properly grounded

Rigging

  • Chokers / Slings / Chains

  • Proper Technique Used

  • Chain Falls / Com-a-longs

  • Hooks and Safety Latches

  • Inspections / Proper Lifting

Ladders / Stairs and Rails

  • Proper Used and Secured

  • General Condition

  • Proper Angle and 3 ft above

  • Inspections Completed

Materials

  • Stacking / Storage of Materials

  • Proper Signage

  • Lifting / Hauling

  • Equipment / Tool Storage

  • Fuels / Propane / Storage

  • Proper Handling / Carrying

Equipment / Vehicle

  • PreShift Inspections Completed

  • Safe Operation

  • Seat Belts in use

  • Fire Extinguishers

  • Load Secured

  • Spotters When Required

Miscellaneous / Training

  • Employees have customer required training

  • JSA being completed before each shift

  • Orientations

  • Confined Space

  • Excavation

  • Safety Meetings

  • Rock Truck

  • Flaggers Controlling Traffic

  • MSHA / Respirators

  • Are employees aware of the location of the muster point

Hazard Controls

  • Welding / Cutting / Guages

  • Compressed Gases

  • SDS Books / Labels

  • Traffic Signs Barricades

  • Chemical Exposure Control

  • Environmental Issues

  • Fire Extinguisher Available

First Aid Boxes

  • Boxes are properly supplied

  • Are supplies expired

  • Are employees aware of the First Aid Kit location

  • Is the box easily accessible and the box location identified

Corrections

    Corrections
  • Item Description

  • Person Responsible

  • Time And Date

Comments

  • Comments

Signatures

  • Person Performing Inspection

  • Signature

  • Date and Time

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.