Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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Weather Conditions
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Project Schedule
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Public/Private
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OCIP/CCIP
Choose "Safe", "At Risk", or "N/A" for each question. If choosing "At-Risk", add notes below the question, add any pictures, and note any corrections made or needed.
1.0 ENVIRONMENTAL
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1.1 Fugitive dust control
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1.2 Track-out devices
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1.3 SWPPP is current as of...
2.0 HAND and POWER TOOLS
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2.1 Guards on machines/equipment
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2.2 Hand/Power tools condition
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2.3 Laser and powder actuated tool warning placards
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2.4 Tool cords/plugs condition
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2.5 Correct tool being used for job at-hand
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2.6 Operators of gas/powdered actuated tools licensed
3.0 HEALTH, HYGIENE & HOUSEKEEPING
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3.1 Toilet facilities
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3.2 Drinking water/cups
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3.3 Hand washing capabilities
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3.4 Work area/housekeeping
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3.5 Waste containers
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3.6 Potential impalement hazards from protruding rebar, form stakes, pipe stubs, and nails,<br>capped, or covered
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3.7 Adequate lighting present
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3.8 Electrical cords
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3.9 Materials properly stored, cleared of stairways, walkways and exit routes
4.0 WARNING/BARRICADES
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4.1 Hazard communication program and SDS
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4.2 All chemicals stored in approved containers with proper labels
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4.3 Safety and OSHA signage
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4.4 Emergency Action Plan
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4.5 Work area signs and barricades
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4.6 Traffic control/flaggers
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4.7 Confined space(s)
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4.8 Emergency access/exits
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4.9 Fencing for public protection
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4.10 Covered walkways/signage/lighting for public protection
5.0 LADDERS and STAIRWAYS
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5.1 Ladders/duty rating/task
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5.2 Extension ladders extend min. 36" above landing and secured
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5.3 Ladders with split or missing rungs taken out of service
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5.4 Stepladders used in fully open position
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5.5 No stepping on top two rungs of stepladder
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5.6 Stairway railings are complete
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5.7 Stair pans are filled
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5.8 Appropriate use of a ladder
6.0 FALL PROTECTION
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6.1 Safety perimeter cables/guardrails are secured properly
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6.2 Employees exposed to fall hazards are tied off or guardrails/barricades are utilized
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6.3 Fall protection equipment is appropriate for working height
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6.4 Employees below are protected from falling objects
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6.5 Floor penetrations are covered, secured and marked "Hole" or "Do Not Remove"
7.0 EXCAVATIONS
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7.1 Excavations protected by fencing or barricades
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7.2 Excavation inspected daily by a competent person before workers enter
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7.3 Materials and spoil piles are stored min. 2' away from excavation
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7.4 Equipment is a safe distance from edge of excavation
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7.5 Ladders provided every 25' in excavation
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7.6 Proper access/egress
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7.7 Trench box, hydraulic shoring and/or sloping used greater than 5' deep
8.0 HEAVY MOBILE EQUIPMENT
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8.1 Aerial lift/scissor lift chain or door closed
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8.2 Fall protection used in aerial lift
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8.3 Reverse signal alarms working (audible) above surrounding noise levels
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8.4 Seat belt usage
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8.5 Tag lines are used to guide loads
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8.6 Pre-shift crane inspection completed by a competent person
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8.7 Outriggers are fully extended with proper ground conditions
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8.8 Employees kept from under suspended loads
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8.9 Slings/rigging are inspected/tagged
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8.10 Maximum crane radius at least 20' from overhead power lines
9.0 PERSONAL PROTECTIVE EQUIPMENT
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9.1 Hard hats are being worn
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9.2 Safety glasses are being worn and meet ANSI Z87 requirements
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9.3 Face protection is being worn when needed
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9.4 High-visibility vests are being worn when needed
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9.5 Gloves are being worn when needed
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9.6 Proper footwear is being worn
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9.7 Respirators are worn when required
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9.8 Hearing protection is being worn when required
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9.9 Proper fall protection equipment is worn
10.0 ELECTRICAL
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10.1 Electrical cords being used are proper size of wire
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10.2 Defective extension cords are taken out of service
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10.3 Ground fault circuit interrupters (GFCI) being used
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10.4 Lockout/tagout devices are used
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10.5 Light bulbs covered with protective cages
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10.6 Energized panels/devices are secured and labeled
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10.7 Electrician(s) present during electrical demolition activities
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10.8 Electrical circuits properly marked (red/green tagged) during electrical demolition
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10.9 Affected parties testing (voltage detector) all electrical circuits before touching them
11.0 SCAFFOLDING
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11.1 Erected on sound, rigid footing
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11.2 Proper mudsills in place where necessary
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11.3 Tied to structure as required
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11.4 Scaffold is plumb, square and level
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11.5 Cross braces are complete
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11.6 Complete guardrail system around working platform
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11.7 All working-level platforms fully planked/decked
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11.8 Proper access/egress provided and adequate
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11.9 All scaffolding inspected daily by a competent person
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11.10 Mobile scaffold equipped with locking casters
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11.11 Proper pins (no wire, nails, etc.) used in all connections
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11.12 Employees below protected from falling objects
12.0 FIRE PROTECTION
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12.1 Adequate number of fire extinguishers on site
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12.2 Fire extinguishers have current inspection (check tag)
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12.3 Travel distance between fire extinguishers does not exceed 75 feet
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12.4 Flammable/combustible liquids stored in approved containers and labeled
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12.5 Fire extinguisher located near flammable/combustible liquid storage
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12.6 Unobstructed access to fire extinguishers/hydrants
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12.7 Gas cylinders stored upright and secured
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12.8 Proper separation between welding fuels and oxygen (30 min.-rated fire wall or a min.<br>distance of 20 feet)
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12.9 Fire extinguisher/fire watch nearby with hot work activities
Photos and Documents
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