Title Page

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Do workers have safe access to the site?

  • Do workers have adequate access to drinking water, toilets, and other sanitary facilities?

  • Are workers wearing proper PPE for the task they are performing?

  • Are workers protected from live electrical work?

  • Are extension cords and tool cords in good shape (no damage to cord, ground prongs intact)?

  • Are workers using GFCI protection?

  • Are there any scaffolds on site?

  • Is the scaffold type/weight rating appropriate for its current use?

  • Is the competent person on site?

  • Has the scaffold been inspected before use?

  • Is the base/bearing adequate?

  • Do workers have adequate access to the scaffold?

  • Is scaffold braced, guyed, or tied to building adequately?

  • Are decks 100% planked?

  • Are planks adequately lapped or secured?

  • Are planks rated for use as scaffold planks?

  • Are workers who are working over 10' high protected from falls?

  • Any other scaffold issues?

  • There any trenches more than 4 feet deep on site?

  • Is the Competent Person on site?

  • Are workers in the trench protected from cave-in or collapse via shoring/shielding, benching, or sloping?

  • Is there a ladder or other means of egress within 25 feet of travel of workers?

  • Any other trench issues?

  • Are door and wall openings guarded to protect workers from falls of more than 6 feet with top rail at 42" high and midrail at 21" high?

  • Are floor openings greater than 2" guarded or covered properly?

  • Are workers using PFAS properly and as needed?

  • Any other fall protection issues?

  • Are there forklifts being used on site?

  • Is the operator qualified as defined by OSHA?

  • Has the forklift been inspected before use?

  • Is the forklift being used to lift workers with an aerial work platform?

  • Has the platform been inspected before use?

  • Are all workers on the platform wearing full body harnesses connected to an approved anchorage point?

  • Describe any other safety issues (worker safety or public safety) on site?

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