Title Page

  • Conducted on

  • Inspection by

  • Project name

  • Project number

  • Person in charge

  • Location of project

Project Information

  • Describe the work activity

  • How many crew members are on site

  • How many company vehicles and equipment are on site

1. Job Hazard Analysis

  • JSA available and enforced at the work site

  • JSA presented in a timely manner

  • Does JSA include all tasks being performed

  • High-risk hazards recorded on the JSA

  • Required information properly filled in on the JSA

  • Person in charge has signed the JSA

  • Employees and visitors briefed of hazards and signed in

2. First Aid & Medical / Emergency Preparedness

  • First aid kit, blood bourne pathogen kit, and eye wash bottle

  • Supply expiration dates checked

  • AED on-site, inspected, and documented on JSA

  • Emergency action plan available

  • All personnel briefed on the site emergency exit routes

  • Fire extinguisher condition and inspections checked

3. Housekeeping

  • Clear ingress / egress to the site

  • Good housekeeping is practiced in all locations

  • Trash contained and removed from site properly

  • Sanitary facilities clean and secured

  • Vehicles are clean and organized

4. Electrical

  • Extension cords clear from pathways or guarded

  • GFCI’s installed and maintained

  • Cords in good condition

  • Proper use of temporary power

  • Proper grounding in place

5. Storm water pollution prevention (SWPP)

  • Environmental training for workers

  • BMP’s installed and maintained

  • Adequate spill kits available

  • Nuisance dust controled

  • Hazardous material stored properly

  • Adequate secondary containment or wash out location

6. Rigging and slinging

  • Rigging and slings inspected and tags present

  • Rigging stored properly

  • Lift plan available as needed

  • Proper use of rigging observed

  • Tag lines identified and inspected

  • Workers aware of proper Inspection methods

7. Signs and barricades

  • Appropriate signs to warn against hazards

  • Traffic control plan established and utilized correctly

  • Barricades installed and appropriate for the hazard

  • Overhead lines identified and clearance verified

Personal protective equipment

  • All personnel wearing hard hat while working

  • All personnel wearing gloves while working

  • All personnel wearing safety glasses / side shields

  • All personnel wearing safety toe footwear while working

  • All personnel wearing high visibility gear class 2 / 3

  • Hearing protection sufficient for the tasks

  • Face shields available and utilized

  • Crew leader ensuring crew uses proper PPE

  • Is PPE in good condition

  • H2S monitor available / stored properly

  • Dust masks / respirators available

9. Fall protection

  • Workers are able to demonstrate a proper inspection

  • Workers maintain proper storage of fall protection gear

  • Fall protection utilized in appropriate situations

  • Fall protection used has compatible connections

  • Workers attach to proper anchor points

  • Fall protection labels are legible

  • Fall protection documented in the pre-job briefing

10. Trenching, excavations, and barricades

  • Competent person present

  • Sloped, benched, or shored per soil conditions

  • Daily inspections complete

  • Perimeter trench protection / barricade in place

  • Proper clearance of soils from edge

  • Ingress / egress of trench adequate

  • Proper ladder use, clearance, and condition

  • Site hazards marked (811 notified and utilities verified)

  • Public is protected from hazards

  • Employees are aware and trained on hazard mitigation

11. Equipment and vehicles

  • Review of equipment inspection reports

  • Equipment swing radius barricaded as needed

  • Equipment / lines properly grounded

  • Proper use of seat belt

  • Operated in a safe manner

  • Operator properly trained / competent

  • Spotters identified and utilized

  • Training docs available

12. Hand and power tools

  • Tools in good condition and stored properly

  • Personnel properly trained

  • Proper tool utilized for the job

  • Guards / attachments in place and functional

  • Tools and storage areas near and organized

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.