Title Page
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Client
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Project
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Conducted on
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Prepared by
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Location
General Safety
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Are personnel active on the project?
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All personnel are wearing hard hats
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All personnel are wearing safety glasses
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All personnel are wearing high visibility clothing
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All personnel onsite have successfully completed orientation
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All personnel are conducting daily planning activities (Task Hazard Analysis)
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Workarea is clean and materials organized
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Lighting in all work areas is adequate to allow for clear view of all activities
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Emergency Action Plan and escape routes are complete and readily available
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Ventilation in work area is effective
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Potable water is available to personnel
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1 restroom per 20 personnel is available and clean
Mobile Equipment
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Is mobile equipment (i.e. earth moving equipment, lulls, fork trucks) being utilized on the project?
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Mobile equipment has been inspected
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Operator is functioning in a competent manner
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Spotter are being utilized to assist in backing up and protecting operator's blind spots
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Backup alarm and horn are operational
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Operator is wearing safety belt
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Pedestrians are aware and are staying clear of mobile equipment operation
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Operator has training for equipment being operated
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Is mobile equipment used in the building?
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Floor is capable of supporting weight (point load, total per sqft)
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Are Scissor lifts being used?
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Scissor lift has been inspected
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Scissor lift is being operated on level surface
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Personnel have feet on deck of scissor lift
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Chain on scissor lift is attached
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Are aerial lifts being used?
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Aerial lift has been inspected
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Ground is suitable for safe operation
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Personnel in basket are utilizing fall protection (i.e. harness and lanyard) and are tied off to the basket
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Personnel in basket are only working off of basket platform (i.e. not standing on rails)
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Operator of aerial lift is doing so in a safe manner
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Personnel are clear below working area of elevated aerial lift
Cranes, Rigging, Hoisting, Suspended Loads
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Are cranes being utilized?
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Operator has training certification on person and available
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Operator appears to be competent in running crane
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Crane has annual and daily inspection
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Barriers around crane are established to protect for swing radius
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Outriggers and cribbing is effectively utilized
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If necessary, a critical lift plan is completed and approved
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Are suspended loads present?
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Personnel rigging and signaling are trained
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Rigging equipment has been inspected and is in good working condition
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Loads are balanced and rigged correctly
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Suspended loads are away from personnel
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Tag lines are used on all suspended loads
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Entire swing of load is protected from personnel being beneath the load
Ladders
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Are ladders being used?
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Ladders are free of damage and defects
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Ladders are set up and secured
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Personnel using ladder is maintaining three points of contact
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Ladders are made of fiberglass
Public Protection
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Does the work potentially interact with public and/or staff?
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The perimeter of the work area identified and protected
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Signage is present identifying work areas as "Construction Zone"
Fall Protection
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Are personnel working with their feet at/or above 6 feet?
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Are guardrails present
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Top rail, mid-rail, and toe board present in all areas
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Toprail, mid-rail, and toe board sturdy (200 pounds of force) and in good condition
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Top rail, mid-rail, and toe board at proper heights (42” +/-3”, 21” +/-3”, within an inch of deck)
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Guardrail is surfaced as to prevent injury to an employee from punctures or lacerations, and to prevent snagging of clothing
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Is a harness, lanyard, and anchor point being used?
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Anchor point is secure and can withstand 5,000 pounds
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Lanyard is securely affixed to anchor point and harness
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Lanyard is in good condition and the correct type of lanyard is utilized for working environment
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Harness fits well and is in good condition
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Are covers being utilized to protect floor penetrations greater than 2 inches in diameter?
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Covers are secured and labeled as "HOLE
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Material used for floor penetration protection has sufficient load capacity for activity in work area
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Are stairways present?
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There is at least one handrail and one system per unprotected side
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The handrail 37”-30” off the face of the tread
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The handrail is surfaced as to prevent injury to an employee from punctures or lacerations, and to prevent snagging of clothing
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Stairways are free and clear of slippery materials
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An effective system(Mid-rails, screens, mesh, intermediate vertical members, or equivalent intermediate structural members) is in place between the handrail and the tread
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Handrails provide adequate handhold to prevent personnel from falling
Electrical
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Is electrical power for tools, equipment, lighting, etc. being used?
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Electrical panels and/or cabinets are identified and secured
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Electrical cords, pugs, and/or outlets are in good working condition
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Ground Fault Circuit Interrupter (GFCI) are used with all electrical tools and equipment
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Electrical cords are out of walkways
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Electrical cords do not run through doors or wall openings without being protected from damage
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Temporary lighting has cages and bulbs intact
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Is there lockout/tagout being used?
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The LOTO plan is being followed
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All energy sources have been determined and rendered inoperative
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Tags or locks are in place at all points of possible energizing
Fire Protection
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Are fire extinguishers present on the site?
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Fire extinguishers have an annual inspection and have been inspected for the current month
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Fire extinguishers are located at each floor level of the stairwell
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There are sufficient extinguishers(100’ of travel and/or 1 per 3,000sqft) for the job
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Fire extinguishers are available at all access and egress points
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Are flammable and/or combustible materials being stored on the project?
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All flammable and combustible materials are stored in a safe location
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Location of stored flammable and combustible materials are identified with signage and secure
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Compressed gas cylinders are secured, upright, and are capped
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Are grinding, cutting, welding or any other spark producing activities being conducted?
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If required, are Hot Work Permits completed, reviewed, and approved?
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A fire extinguisher available for the activity being conducted
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All flames, sparks and/or slag is contained from spreading (i.e. floor penetrations, stairways, etc.)
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Gauges, hoses, cables, and welding leads in good working condition
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Flash arrest protection is present with torches
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When welding, flash protection is used
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Are Fire Hydrants accessible to the site?
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The areas around the hydrant(s) are accessible to fire department
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There are clear paths to the building from the hydrant(s)
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The No Smoking Policy is enforced
Material Storage
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Is construction material to be used at a future date stored on site?
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Walkways are free of stored material
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Is material stored outside?
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Material is protected from the elements (wind, rain, snow)
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Clear access to material is maintained
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Is material stored inside?
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The floor is rated to withstand weight of material (point loading, total per sq/ft)
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Material is secured from movement (rolling, scooting, falling, tipping)
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Is trash and debris stored on site?
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Proper trash receptacles are used
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Nails or impalement hazards are removed from all material
Tools
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Are tools being utilized on the job site?
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Guards are in place
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Handles are in place
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Hand tools are in good working order
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Proper tool is being used for the job
Trench and Excavations
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Are there trenches or excavations on site?
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811 locates are done
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Daily inspection has been done
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Access/egress is within 25' of travel
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Sloping, benching or shoring is in accordance with Trench Form
Scaffold
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Are scaffolds used on the jobsite?
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Daily inspection by competent person has been completed
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Guardrails or fall protection is in place for decks over 10’
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Access to platforms is sufficiently provided
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Bracing is installed and sufficient
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Mudsills, plates or wheels are in place
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Scaffold is not overloaded
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Scaffold has tie in or outriggers at 20'