Title Page

  • Conducted on

  • Prepared by

Fall Protection

  • Are holes or windows that are 6 feet or more in height above the lower level properly protected by a guardrail system, safety net system, or personal fall arrest systems?

  • Are there any open holes that are 6 feet or more in height unprotected?

  • Are workers protected from falling objects?

Scaffolding

  • Is each platform on the scaffold completely decked?

  • Is each scaffold platform and walkway at least 18 inches wide?

  • Does the scaffold have a top rail, mid rail and toe board?

Ladders

  • Are ladders being set up properly?

  • Are the ladders being used properly?

  • Is the ladder damaged in any way?

Electrical

  • Is all energized switching and control parts protected and effectively grounded?

  • Are people using protective devices when messing with energized wires?

  • Are the fuses in a metal box and only where qualified personnel can get to them?

Hazard Communication

  • Does the employer have a way to inform the employees of non-routine tasks and the hazards that are associated with it?

  • Is there a hazard communication program?

  • Is there a way for other employees to access safety data sheets on site?

Respiratory Protection

  • Are the respirators tight fitting?

  • Are employees provided respirators?

  • Do workers have the appropriate respirator on?

Lock out/tag out

  • Are the electric lines deenergized?

  • Is the fuse box tagged out?

  • Are you able to plainly see the tags and what circuit or equipment that it is tagging out?

General requirements-Hand and power tools

  • Do all the power tools have the appropriate guards?

  • Are all power tools in safe condition?

  • Are workers using proper PPE when operating these tools?

Fall Protection-Training Requirements

  • Have all the employees been trained in fall protection prior to working on the job site?

  • Are all fall protection systems being used properly?

  • Are the fall protection systems in good condition?

Material Handling Equipment

  • Does the operator of a piece of equipment have his seat belt on?

  • Do the brakes on this piece of equipment work properly?

  • Is there an audible alarm on this piece of equipment?

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.