Title Page
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State conducted
- Indiana
- Louisiana
- Minnesota
- Mississippi
- Ohio
- Texas
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Client Name
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Job Description
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Inspection Date/Time
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Region
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Office Location
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Worksite Address or Location Description
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Client Supervisor
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Is an Inspector on site?
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Name of the Inspector on site?
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Inspection Performed By
Jobsite Protection & Work Zone Safety
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Was a pre-job briefing performed prior to starting? (1910.269)(D) (CS B1.100) Leadership safety program -Pre-job Inspection)
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General Housekeeping is neat and orderly? (1926.25)(SWPHB 4.1)
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General work area is protected? (1926.25)
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TCDs in good condition/properly placed, number, and spacing/proper taper length? [1926 Subpart G]
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Are Vehicle(s) parked correctly according to CNP Safe Work Practices, Laws, and Regulations? (i.e. parked with the flow of traffic, backed in or pull-through, or with-in barricades, cones, or traffic control devices) RS 32:144(La), (SWPHB 7.2.18 - 23)
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Traffic control signs are in good condition, properly positioned, in clear view, and has appropriate message. [1926.200 (g) & Part 6 of MUTCD]
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Flaggers are visible, utilizing proper flagging techniques, and advanced warning signs are in place? [1926.201 (a) & Part 6 of MUTCD]
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Additional comments for this section?
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Describe other unsafe findings and flag response.
Personal Protective Equipment (General)
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Appropriate eye protection available & being worn including users who require prescriptive glasses? [1926.102] (SWPHB 2.3)(LSP - PPE Pg 7)
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Appropriate hand protection available & worn as required? [1926.951](SWPHB 2.5)(LSP - PPE Pg 6)<br>
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Foot protection worn as required? [1926.96](SWPHB 2.6)(LSP - PPE Pg 5)
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Hearing protection worn when required? [1926.101](SWPHB 2.8)(LSP - PPE Pg 4)
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Hard hats worn on construction site as required? [1926.100](SWPHB 2.7)(LSP - PPE Pg 3)
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High visibility safety vests available & worn when necessary (reflective for night time use)? [1926.28] (MUTCD)
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Flaggers wearing appropriate ANSI Class II apparel if required? [1926.201] (MUTCD)
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Fire Resistant clothing (including hood) is: clean, sized correctly, has no tears, Velcro/zippers in good condition? (LSP - PPE Pg 5)(CNP)
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When a potential for a gaseous exposure exists, workers are wearing appropriate cotton clothing & layered correctly? [1910.132(a) &(d)] (SWPHB 2.1 & 2.2) (LSP - PPE Pg 5) (NFPA 2112 & 2113)
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Oxygen monitors, gas detectors, etc. being used as required & properly placed when monitoring? (1926.55)(a) & (CNP Resp. Program)
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First Aid Kit is on site, fully stocked, and material is not expired?
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Fire extinguisher fully charged, inspected monthly, annual inspection tags present, and pin & seal is in place? (1926.150(a) & (CNP SWPHB 4.2.3)
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Fire extinguisher properly placed at work site (upwind of the fire hazard)? (CNP C&S Manual) 1926.352(d)<br>
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Additional comments for this section?
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Describe other unsafe findings and flag response.
Trenching & Excavation
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Spoil placed 2 ft. away from edge of excavation? [1926.651(j) (2)](LSP - Excavation & trenching)
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Is unattended excavations secured and barricaded? (CNP Leadership manual (excavation) Pg.11)
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Ladder or means of access and egress being used in excavations > 4 ft.? (1926.651(c)(2)(LSP - Excavation & trenching)
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Is water accumulating in excavation?
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Is water removal equipment being utilized or is the excavation protected to prevent cave-in? (1926.651(h)(1)) (LSP - Excavation & trenching)
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Is the excavation =/> 5' in depth
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Is the excavation shored, sloped, benched, or is a trench box/shield being used to protect the workers inside? [1926.652(a)(1)(ii)]
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Is hazardous atmosphere monitoring equipment being utilized where potentially oxygen deficient or gaseous atmospheres are present while workers are inside of the excavation? (1926.651(g) (LSP - Excavation & trenching)<br>
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Additional comments for this section?
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Describe other unsafe findings and flag response.
Hand & Power Tools
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Hand tools are free of defects and have not been modified? (1910.242(a) (CNP SWPHB)
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Tool handles are free of damages? (1910.242(a) (CNP SWPHB)
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Hand tools are being used for their intended purpose? (CNP SWPHB 3.0)
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Tools with spinning parts such as grinders, circular saws, etc. have protective guards in place? [1926.304(d)] (CNP SWPHB)<br>
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Impact tools, hammers kept free of splinters/mushrooms? [1926.301(c)](CNP SWPHB)
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Air hose in good condition? [1910.242 (a)] (CNP SWPHB)
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Safety clips / retainers are installed on Pneumatic (air) connectors? [1926.302(b)(2) &(b)(1)]<br>
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Air hose is properly coupled to connection fitting? 1910.243(b) (CNP SWPHB)
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Gas tapping & stopping equipment in good working condition (should not be leaking gas through the O-rings or valves)?(CS B 3.160)
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Tapping / Stopping equipment and valves are properly tightened with a wrench? (CS B 3.160)
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Welding leads in good condition (No damaged insulation or exposed wires)?1926.351(b)(4)
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Compressed gas cylinders are secured & upright? [1926.350(a)](1926.350(a)(4) <br>
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Torch hose, regulators, and gauges in good condition?1926.350(f)(3) <br>
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Oxygen/acetylene torch units have flash back arrestors installed? [1926.350(f)(4)]<br>
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Additional comments for this section?
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Describe other unsafe findings and flag response.
Ladder Safety
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Is a ladder present on the work site?
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Are the appropriate warning labels present & legible?
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Ladder is safe for use? [Periodically 1926.1053(b)(15)] & (Before each use 1910.23(b)
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Is the ladder set up for use or being used at this time?
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Extension & straight ladders extend 3’ beyond landing? [1926.1053(b)(1)]
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Additional comments for this section?
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Describe other unsafe findings and flag response.
Electrical Safety (Competent person training required 1926.404(b1)(ii)(B))
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Electrical cord insulation is intact and in good condition? [1926.404(b)(1)(iii(C)]
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Electrical cords inspected & have all prongs intact? [1926.404 (f)]
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GFCI’s used for all portable electrical hand tools? [1926.404] (Competent person training required 1926.404(b1)(ii)(B))
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Electrical power tools are double insulated or grounded? [1926.302(a)]
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Light bulbs for illumination Class I Div. I per NEC requirements? [1926.407(b)]
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Additional comments for this section?
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Describe other unsafe findings and flag response.
Vehicles, Trailers, & Equipment
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Housekeeping inside the cab of vehicle is adequate? (FMCSR 392.9) (SWPHB 4.1.2)
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Housekeeping in bed of vehicle is adequate? (FMCSR 392.9) (SWPHB 4.1.2)
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Vehicle & trailer lights in good condition & working properly? (FMCSR 392.7)
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Vehicle & trailer tires in good condition? (1926.601(b)(14) (FMCSR 392.7)
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Vehicle bumper / Trailer tongue in good shape and free of stress fractures? (FMCSR 392.7)
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Are the trailer brake cable and safety chains properly secured to the vehicle? (1926.601(b)(14) (FMCSR 392.7)<br>
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Trailer boards, fenders, etc. in good condition?
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Spoil, rocks, debris, tools, etc. secured on vehicle / trailer? (FMCSR 392.9 & 393.102)(SWPHB 4.1.2)
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Equipment is properly tied down during transport? (1926.601(b)(14) (FMCSR 393.102)<br>
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Equipment boom is secured while being transported? (FMCSR 393.130(b)
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Generic containers on vehicle and trailer labeled properly with substance inside? CFR 49 173.6(C)(1)
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Approved Safety cans for gasoline / Diesel? - (5 gallon or less Metal or Plastic CFR 49 173.6(b)(4), 1910.106 (d)(2), 1926.152(a)(1), (SWPHB 4.2.2) (SWPHB 4.2.5))
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Pressurized cylinders are secured during transport? (FMCSR 392.9)
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Is excavation equipment on site
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Is equipment in good working condition? (1926.601(b)(14)
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Housekeeping inside the cab of the equipment is adequate? (1926.601(b)(7)
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Is equipment free of oil leaks? (1926.601(b)(14)
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Equipment lights in good condition & working properly? (1926.601(b)(2)(ii) & (1926.601(b)(14)?
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Boom, loader, attachments, etc. lowered to ground when not in use?(1926.600(a)(3)(i)
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Suspended loads free of workers underneath? (1926.651(e)
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If equipment is being operated, is driver wearing seatbelt? 1926.602(a)(2)(i) & 1926.602(b)(1)
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Additional comments for this section?
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Describe other unsafe findings and flag response.
Gaseous/Hazardous Atmosphere
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Is a potentially gaseous or hazardous atmosphere present on this job site?
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Is atmosphere monitoring equipment (CGI & Oxygen Monitor) being used ?1926.651(g) [Per Company Policies]
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Is a fire watch & extinguisher present near the work area? 1926.352(d) [Per Company Policies]
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Are workers properly wearing the appropriate flash gear (including hood & gloves)? (1910.132(d)(1)(i) [Per Company Policies]
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When working in a gaseous or oxygen deficient atmosphere, is non-entry rescue equipment (harness & Lanyard) being worn while working? (1910.132(d)(1)(i) [CS D-2.140]
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Respiratory equipment is used when a hazardous atmosphere requires? 1926.651(g)(2)(i) [Per Company Policies]
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Have all the potential ignition sources including power operated equipment, vehicles, motors, etc. been shut down or removed in or near a gaseous atmosphere? [1910.178(c)(2)(I)]<br>
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Additional comments for this section?
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Describe other unsafe findings and flag response.