Title Page

  • Conducted on

  • Prepared by

  • Location
  • Contractor

  • Subcontractor

  • Job name

JOB INFORMATION, Permits / Clearances

  • 1. OSHA 300A form posted between February 1 and April 30

  • 2. Confined Space

  • 3. Hot work (fire watch, fire extinguisher) / Fire impairment

  • 4. Work at Heights Permit

  • 5. General Work Permit

  • 6. Process Safety Management

  • 7. Critical Lift Permit (proper rigging, signal person)

  • 8. Toolbox talks up to date

  • 9. Work areas properly signed and barricaded

  • 10. Emergency Exits

  • 11. Ingress and egress (ladders, stairs, etc)

  • Safe Work Behavior

  • Safe Work Conditions

HOUSEKEEPING

  • 1. Work area neat, debris picked up and free of trip hazards

  • 2. Projecting nails removed or bent over

  • 3. Waste containers provided and used

  • 4. Passageways and walkways clear

  • 5. Cords and leads off the floor

FIRE PREVENTION

  • 1. Adequate fire extinguishers, inspected and accessible

  • 2. Phone number of fire department posted

  • Adequate Fire Watch

ELECTRICAL

  • 1. Extension cords with bare wires or missing ground prongs taken out of service

  • 2. Ground fault circuit interrupters being used

  • 3. Terminal boxes accessible and equipped with required covers

  • 4. Live equipment or machines are not left unattended

HAND, POWER & POWDER-ACTUATED TOOLS

  • 1. Hand tools inspected regularly

  • 2. Guards in place on machines

  • 3. Operators of powder-actuated tools are authorized

FALL PROTECTION

  • 1. Safety rails and cables are secured properly

  • 2. Employees exposed to fall hazards are protected from falls

  • 3. Employees below protected from falling objects

LADDERS

  • All Ladders inspected by a competent person

  • 1. Ladders extend at least 36 inches above the landing if accessing upper level

  • 2. Ladders are secured to prevent slipping, sliding or falling

  • 3. Ladders with split or missing rungs taken out of service

  • 4. Stepladders used in fully open position

  • 5. Ladders are correctly used (3 points of contact)

SCAFFOLDING

  • 1. All scaffolding inspected daily by a competent person

  • 2. Erected on sound rigid footing

  • 3. Tied to structure as required

  • 4. Guardrails, intermediate rails, toe boards and screens in place

  • 5. Working platform is fully decked

  • 6. Cross braces are complete

  • 7. Baseplates and mudsills in place

  • 8. Proper access provided

  • 9. Employees below protected from falling objects

FLOOR & WALL OPENINGS

  • 1. All floor or deck openings are planked over or barricaded and coded/marked

  • 2. Perimeter protection is in place

  • 3. Deck planks are secured

  • 4. Materials stored away from edge

  • 5. Work surface conditions safe (slippery, uneven, unstable)

MATERIAL HANDLING

  • 1. Materials are properly stored or stacked

  • 2. If mechanical equipment is being used, is equipment in good condition

  • 3. If equipment is being used properly

WELDING & BURNING

  • 1. Gas cylinders stored upright, securely, and in good condition

  • 2. Proper separation between fuels and oxygen (1/2-hr-rated fire wall or a minimum of 20 feet)

  • 3. Burning/welding/cutting goggles or shields are used

  • 4. Fire extinguishers are nearby

  • 5. Hoses are in good condition

CRANES

  • 1. Outriggers extended and swing radius barricade in place

  • 2. Load charts are available on site

  • 3. Hand signal charts are on crane

  • 4. Crane operators’ logs are up to date

  • 5. Employees kept from under suspended loads

  • 6. Tag lines are used to guide loads

  • 7. Nylon lifting slings or wire rope slings are inspected and tagged as required

PERSONAL PROTECTIVE EQUIPMENT

  • 1. Hard hats are being worn

  • 2. Arm/hand protection (gloves, guards, etc.)

  • 3. Leg/Footwear Protection (boots, metatarsals, chaps)

  • 4. Face Protection (Safety glasses, face shields, etc.)

  • 5. Respirators are used when required

  • 6. Hearing protection is being worn when required

  • 7. High-visibility vests are being worn

  • 8. All PPE kept in sanitary and reliable condition

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.