Title Page

  • Client

  • Project

  • 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 onsite have successfully completed orientation

  • All personnel are conducting daily planning activities (Task Hazard Analysis)

  • Workarea is clean and materials 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 20 personnel is available and clean

Mobile Equipment

  • Is mobile equipment (i.e. earth moving equipment, lulls, fork trucks) being utilized on the project?

  • Mobile equipment has been inspected

  • Operator is functioning in a competent manner

  • Spotter 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 staying clear of mobile equipment operation

  • Operator has training for equipment being operated

  • Is mobile equipment used in the building?

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

  • 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 aerial lifts being used?

  • Aerial 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 of basket platform (i.e. not standing on rails)

  • Operator of aerial lift is doing so in a safe manner

  • Personnel are clear below working area of elevated aerial lift

Cranes, Rigging, Hoisting, Suspended Loads

  • 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?

  • 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

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

Public Protection

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

  • The perimeter of the work area identified and protected

  • Signage is present identifying work areas as "Construction Zone"

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

  • Toprail, mid-rail, and toe board sturdy (200 pounds of force) and in good condition

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

  • 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?

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

  • 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 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

Electrical

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

  • Electrical panels and/or cabinets are identified and secured

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

  • Ground Fault Circuit Interrupter (GFCI) are 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 energizing

Fire Protection

  • Are fire extinguishers present on the site?

  • Fire extinguishers have 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 flammable and/or combustible materials being stored on the project?

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

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

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

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

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

  • A fire extinguisher 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

  • 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)

  • The No Smoking Policy is enforced

Material Storage

  • Is construction material to be used at a future date stored on site?

  • Walkways are free of stored material

  • Is material stored outside?

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

  • Clear access to material is maintained

  • Is material stored inside?

  • The floor is rated to withstand weight of material (point loading, total per sq/ft)

  • 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

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

Trench and Excavations

  • Are there trenches or excavations on site?

  • 811 locates are done

  • Daily inspection has been done

  • Access/egress is within 25' of travel

  • Sloping, benching or shoring is in accordance with Trench Form

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

  • Mudsills, plates or wheels are in place

  • Scaffold is not overloaded

  • Scaffold has tie in or outriggers at 20'

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.