Information
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Document No.
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Conducted on
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Prepared by
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Location
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Personnel
PROGRAM ADMINISTRATION
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1.1 Are OSHA guidelines in clear view and have been communicated well?
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1.2 Are emrgency numbers and contacts posted?
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1.3 Have toolbox talks been conducted?
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1.4 Are emergency action plans posted and up to date?
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1.5 Are all emergency life-saving equipment in place?
HOUSEKEEPING
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2.1 Work areas orderly and clean
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2.2 Adequate lighting
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2.3 Job site free of slips, trips and fall hazards
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2.4 Break areas orderly
ELECTRICAL / UTILITY
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3.1 Insulation intact on cords and wiring
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3.2 Temporary lighting guarded
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3.3 Electrical panels labeled and covered accordingly
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3.4 Ground-Fault Circuit Interrupter (GFCI) protection utilized
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3.5 Underground electrical lines marked
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3.6 Underground gas lines marked
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3.7 Lockout procedures utilized
HAND AND POWER EQUIPMENT
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4.1 Hand tools in good working order
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4.2 Electrical cords in good working order
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4.3 All mechanical safeguards in use
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4.4 Handles not broken and are splinter free
EQUIPMENT
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5.1 Breaks, lights, signals and alarms operative
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5.2 Daily log book filled out
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5.3 Seat belts worn
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5.4 Aerial lift - PPE being used
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5.5 Cranes- swing radius protected - level
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5.6 Rigging equipment inspected - tag showing
BARRICADES AND FENCING
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6.1 Roadways and sidewalks protected
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6.2 Floor openings planked or barricaded
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6.3 Wall, roof openings covered or barricaded
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6.4 Leading edges guarded
EXCAVATION
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7.1 Necessary ladders provided
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7.2 Spoil set back at least 2 feet
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7.3 Rebar impalement protection
LADDERS
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8.1 Ladders in good condition
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8.2 Side rails extend well above landing
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8.3 Proper for job and secure
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8.4 Step ladders fully open when in use
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8.5 Placement of ladder safe
INFECTION CONTROL
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9.1 Daily inspection checklist completed
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9.2 Interim Life Safety Measures (ILSM) updated
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9.3 Debris covered
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9.4 Walk off mats in place and in use
SCAFFOLDING
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10.1 All scaffolds plumbed and leveled as erection proceeds
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10.2 Are adequate sills and base plates being used
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10.3 If electrical power lines are near the scaffold, are necessary precautions being taken
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10.4 Do scaffold planks extend past their end supports not less than 6 inches and no more than 12 inches
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10.5 Are guardrails and end rails in place
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10.6 To protect from falling objects, are toe boards or area barricaded below
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10.7 Are frames and panels braced by cross, horizontal or diagonal braces
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10.9 Is fall protection being used in areas where required
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10.10 Are scaffolds securely anchored at lease every 30 feet of length and 25 feet in height
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10.11 Is their an assess ladder, steps or equivalent safe access to scaffold
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10.12 Is the scaffold within its weight capacity
ENVIRONMENTAL CONTROLS
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11.1 Silt fence installed and maintained
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11.2 Hazardous materials properly stored
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11.3 Spill containment kit adequate / on site
FIRE PREVENTION
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12.1 Are safety cans being used and properly labeled
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12.2 Propane tanks - barricade installed - labeled - (flammable,no smoking, fuel type)
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12.3 Compressed gas cylinders secured- upright- protected from damage
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12.4 Fire extinguishers immediately available and inspection current
PPE
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13.1 Hard hats worn
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13.2 Gloves available - cut resistant for demo
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13.3 Face shields being used - mason saw or other operations
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13.4 Eye protection
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13.5 Hearing protection
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13.6 Safety harness and lanyards utilized with adequate anchorage points
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13.7 Respirators and masks utilized
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13.8 High visible clothing in use
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Any violations?
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What are the violations?
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Sign off
