Title Page

  • Conducted on

  • Prepared by

  • Location

General Safety

  • Are personnel active on the project?

  • All personnel are wearing hard hats

  • All personnel are wearing safety glasses

  • All personnel are wearing high visibility clothing

  • All personnel are wearing work boots

  • All personnel onsite have successfully completed orientation

  • All personnel are conducting daily planning activities (THA, JHA, JSA)

  • Work area is clean and material organized

  • Lighting in all work areas is adequate to allow for clear view of all activities

  • Emergency Action Plan and escape routes are complete and readily available

  • Ventilation in work area is effective

  • Potable water is available to personnel

  • 1 restroom per 40 personnel is available and clean (1 restroom minimum)

  • First aid services are stocked and available

  • Medical care is available within 3-4 minutes of the site

Trenching and Excavation

  • Are there trenches or excavations on site?

  • 811 locates are done

  • Daily inspection has been done

  • Access/egress is within 25’ of travel

  • Trench/excavation is free of standing or seeping water

  • Spoil piles are located a minimum of 2’ back from edge of trench/excavation

  • Trench/excavation edge is identified and/or protected

  • Does trench/excavation have sloping, benching or shoring?

  • Trench/excavation is sloped or benched in accordance with type of soil

  • Shoring is in place and braced according to manufacturer specifications

Crane, Rigging, Hoisting

  • Are Cranes being utilized?

  • Operator has training certification on person and available

  • Operator appears to be competent in running crane

  • Crane has annual and daily inspection

  • Barriers around crane are established to protect for swing radius

  • Outriggers and cribbing is effectively utilized

  • If necessary, a critical lift plan is completed and approved

  • Are suspended loads present?

  • The personnel rigging and signaling are trained

  • Rigging equipment has been inspected and is in good working condition

  • Loads are balanced and rigged correctly

  • Suspended loads are away from personnel

  • Tag lines are used on all suspended loads

  • Entire swing of load is protected from personnel being beneath the load

  • Is Rigging or Hoists being used?

  • Hoist has been inspected

  • Rigging is tagged to identify load capabilities

  • Rigging is inspected and in good working condition

  • Hoist, chain fall, or come-along is secured to material capable of handling load

Mobile Equipment

  • Is mobile equipment (i.e. earth moving, lull, fork truck, aerial lift, pallet jack, duct lift) being utilized on the project?

  • Mobile equipment has been inspected

  • All mobile equipment is shut down for refueling

  • Operator is using equipment as trained

  • Spotter(s) is/are being utilized to assist in backing up and protecting operator’s blind spots

  • Backup alarm and horn are operational

  • Operator is wearing safety belt

  • Pedestrians are aware and are separated from mobile equipment operation

  • Operator has training for equipment being operated

  • Mobile equipment is in original from manufacturer condition (no modifications, no missing parts)

  • Pallet jacks are being used as intended by manufacturer

  • Duct lifts are being used as intended by manufacturer

  • Is equipment being used with additional attachments? (lifting, rigging, platforms)

  • Equipment manufacturer approved attachment is being used

  • Attachment is being used in a manner intended for use

  • Attachment is securely fastened to the equipment

  • Are scissor lifts being used?

  • Scissor lift has been inspected

  • Scissor lift is being operated on level surface

  • Personnel have feet on deck of scissor lift

  • Chain on scissor lift is attached

  • Are boom or articulating lifts being used?

  • Lift has been inspected

  • Ground is suitable for safe operation

  • Personnel in basket are utilizing fall protection (i.e. harness and lanyard) and are tied off to the basket

  • Personnel in basket are only working off basket platform (i.e. not standing on rails)

  • Operator of lift is doing so in a safe manner

  • Personnel are clear below working area of elevated lift

  • Operator has training for equipment being operated

  • Is equipment used in the building?

  • Floor is capable of supporting weight (point load, total per sqft)

Scaffold

  • Are scaffolds used on the jobsite?

  • Daily inspection by competent person has been completed

  • Guardrails or fall protection is in place for decks over 10’

  • Access to platforms is sufficiently provided

  • Bracing is installed and sufficient per manufacturer

  • Mudsills, plates or wheels are in place

  • Scaffold is not overloaded

  • Scaffold has tie in or outriggers at 4:1 base to height ratio

Fall Protection

  • Are personnel working with their feet at/or above 6 feet?

  • Are guardrails present?

  • Top rail, mid-rail, and toe board present in all areas

  • Top rail, mid-rail, and toe board at proper heights (42” +/-3”, 21” +/-3”, within an inch of deck)

  • Top rail, mid-rail and toe board sturdy (200lbs of force and 50lbs of force) and in good condition

  • Guardrail is surfaced as to prevent injury to an employee from punctures or lacerations, and to prevent snagging of clothing

  • Is a harness, lanyard, and anchor point being used?

  • Harness, lanyard, and anchor points have been inspected

  • Anchor point is secure and can withstand 5,000lbs

  • Lanyard is securely affixed to anchor point and harness

  • Lanyard is in good condition and the correct type of lanyard is utilized for working environment

  • Harness fits well and is in good condition

  • Are covers being utilized to protect floor penetrations greater than 2 inches in diameter?

  • Covers are secured and labeled as “HOLE”

  • Material used for floor penetration protection has sufficient load capacity for activity in work area

  • Are stairways present?

  • There is at least one handrail and one system per unprotected side

  • The handrail is 37”-30” off the face of the tread

  • The handrail is surfaced as to prevent injury to an employee from punctures or lacerations, and to prevent snagging of clothing

  • Stairways are free and clear of slippery materials

  • An effective system (Mid-rails, screens, mesh, intermediate vertical members, or equivalent intermediate structural members) is in place between the handrail and the tread

  • Handrails provide adequate handhold to prevent personnel from falling

  • Pan stairs are filled with material prior to concrete

  • Is warning line being used to warn of potential fall hazards on roof?

  • Warning line is set up 6’ (for roofers) or 15’ (non-roofing trades) from roof edge

  • Warning line has flagging at 6’ minimum intervals

  • Warning line is between 34”-39” from walking/working surface

  • Warning line is connected to each stanchion so as to not pull slack from adjacent stanchions

Electrical

  • Is electrical power for tools, equipment, lighting, etc. being used?

  • Electrical panels and/or cabinets are identified and secured

  • Electrical cords, plugs, and/or outlets are in good working condition

  • Ground Fault Circuit Interrupter (GFCI) is used with all electrical tools and equipment

  • Electrical cords are out of walkways

  • Electrical cords do not run through doors or wall openings without being protected from damage

  • Temporary lighting has cages and bulbs intact

  • Is there lockout/tagout being used?

  • The LOTO plan is being followed

  • All energy sources have been determined and rendered inoperative

  • Tags or locks are in place at all points of possible energy release

Ladders

  • Are ladders being used?

  • Ladders are free of damage and defects

  • Ladders are set up and secured

  • Personnel using ladder is maintaining three points of contact

  • Ladders are made of fiberglass

  • Ladders used as access extend 3’ above landing

  • A 4:1 height to base ratio is used for all extension ladders

  • Are Job made wood ladders on site?

  • Ladder is surfaced to prevent injury from punctures or lacerations

  • 2x4 side rails are used for ladders up to 14’ in length

  • Ladder is between 16”-20” wide

  • Each cleat is continuous across the ladder

  • Cleats are level and spaced 12” from top of cleat to top of next

  • Filler blocks are same thickness as cleat and beneath each cleat

  • Ladder is secured at both top and bottom

Tools

  • Are tools being utilized on the job site?

  • Guards are in place

  • Handles are in place

  • Hand tools are in good working order

  • Proper tool is being used for the job

  • Are powder actuated tools being used?

  • Personnel have been trained in proper use of tool

  • Loaded tools are not left unattended

  • Material being penetrated is of sufficient thickness

  • Tool is treated as if it is loaded at all times

Fire Protection

  • Are Flammable and/or combustible materials being stored on the project?

  • All flammable and combustible materials are stored in a safe location

  • Metal cans designed for gasoline storage are being used

  • All flammable and combustible materials are labeled

  • Location of stored flammable and combustible materials are identified with signage and secure

  • Compressed gas cylinders are secured, upright, and are capped

  • Bulk(over 25 gallons) fuel storage is minimum of 20’ from any building

  • Secondary containment of above ground fuel storage is sealed and can contain 1.5x the fuel stored

  • Are grinding, cutting, welding or any other spark producing activities being conducted?

  • If required, Hot Work Permits are completed, reviewed, and approved

  • A fire extinguisher is available for the activity being conducted

  • All flames, sparks and/or slag is contained from spreading (i.e. floor penetrations, stairways, etc.)

  • Gauges, hoses, cables, and welding leads in good working condition

  • Flash arrest protection is present with torches

  • When welding, flash protection is used (hoods, screens)

  • Are Fire extinguishers present on the site?

  • Fire extinguishers have had an annual inspection and have been inspected for the current month

  • Fire extinguishers are located at each floor level of the stairwell

  • There are sufficient extinguishers (100’ of travel and/or 1 per 3,000sqft) for the job

  • Fire extinguishers are available at all access and egress points

  • Are Fire Hydrants accessible to the site?

  • The areas around the hydrant(s) are accessible to fire department

  • There are clear paths to the building from the hydrant(s)

  • No smoking policy is enforced

  • Equipment is shut down during refueling

Material Storage

  • Is material stored on site?

  • Construction material to be used on site is stored out of walkways and traffic

  • Is material stored outside?

  • Material is protected and secured from elements (wind, rain, snow)

  • Clear access to material is maintained

  • Is material stored inside?

  • Material is secured from movement (rolling, scooting, falling, tipping)

  • Is trash and debris stored on site?

  • Proper trash receptacles are used

  • Nails or impalement hazards are removed from all material

Emergency Action

  • Exit signs are in place and visible at all egress points

  • A minimum of two means of access and egress are available per floor

Public Safety

  • Does the work potentially interact with public and/or staff?

  • The perimeter of the work area is identified and protected

  • Signage is present identifying work areas as “Construction Zone”

  • Mobile and vehicle equipment is coordinated with a spotter/flagger

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.