Title Page
-
Conducted on
-
Prepared by
-
Location
-
Customer:
-
Brief Scope of Work:
-
Inspection performed by: Date:
-
SITE AREAS INSPECTED:
-
INSPECTION SUMMARY AND IMPORTANT NOTES:
SAFETY ITEM CHECKLIST
Safety Item
-
1. Site Entry
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
2. Transport
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
3. Fire Precautions
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
4. First Aid & Welfare
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
5. Site Conditions
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
6. Hazardous Materials
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
7. Safety Signs and Barriers
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
8. Personal Protective Equipment
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
9. Scaffolding & Workplace Access
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
10. Lifting Equipment
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
11. Asbestos Handling
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
12. Porttable Appliance in date
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
13. Electrical Apparatus fit for use
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
14. Machine Guarding
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
15. Abrasive Wheels & Discs
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
16. Compressed Gas Cylinders
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
17. Highly Flammable Liquids & Gases
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
18. Welding & Flame Cutting
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
19. Cartridge Tools
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
20. Confined Spaces
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
21. Permits to Work
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
-
22. Site Documentation
- A - Not Applicable
- B - Inspected OK
- C - Inspected with corrective action
- D - Not inspected
-
Corrective action taken
-
Details
23 other
-
Discription
-
Corrective Action
Sign off
-
Inspectors Signature:
-
Time completed: