Title Page
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Conducted on
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Prepared by
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Location
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Contractor
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Subcontractor
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Job name
JOB INFORMATION, Permits / Clearances
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1. OSHA 300A form posted between February 1 and April 30
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2. Confined Space
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3. Hot work (fire watch, fire extinguisher) / Fire impairment
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4. Work at Heights Permit
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5. General Work Permit
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6. Process Safety Management
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7. Critical Lift Permit (proper rigging, signal person)
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8. Toolbox talks up to date
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9. Work areas properly signed and barricaded
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10. Emergency Exits
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11. Ingress and egress (ladders, stairs, etc)
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Safe Work Behavior
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Safe Work Conditions
HOUSEKEEPING
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1. Work area neat, debris picked up and free of trip hazards
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2. Projecting nails removed or bent over
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3. Waste containers provided and used
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4. Passageways and walkways clear
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5. Cords and leads off the floor
FIRE PREVENTION
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1. Adequate fire extinguishers, inspected and accessible
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2. Phone number of fire department posted
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Adequate Fire Watch
ELECTRICAL
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1. Extension cords with bare wires or missing ground prongs taken out of service
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2. Ground fault circuit interrupters being used
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3. Terminal boxes accessible and equipped with required covers
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4. Live equipment or machines are not left unattended
HAND, POWER & POWDER-ACTUATED TOOLS
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1. Hand tools inspected regularly
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2. Guards in place on machines
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3. Operators of powder-actuated tools are authorized
FALL PROTECTION
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1. Safety rails and cables are secured properly
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2. Employees exposed to fall hazards are protected from falls
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3. Employees below protected from falling objects
LADDERS
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All Ladders inspected by a competent person
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1. Ladders extend at least 36 inches above the landing if accessing upper level
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2. Ladders are secured to prevent slipping, sliding or falling
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3. Ladders with split or missing rungs taken out of service
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4. Stepladders used in fully open position
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5. Ladders are correctly used (3 points of contact)
SCAFFOLDING
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1. All scaffolding inspected daily by a competent person
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2. Erected on sound rigid footing
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3. Tied to structure as required
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4. Guardrails, intermediate rails, toe boards and screens in place
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5. Working platform is fully decked
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6. Cross braces are complete
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7. Baseplates and mudsills in place
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8. Proper access provided
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9. Employees below protected from falling objects
FLOOR & WALL OPENINGS
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1. All floor or deck openings are planked over or barricaded and coded/marked
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2. Perimeter protection is in place
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3. Deck planks are secured
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4. Materials stored away from edge
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5. Work surface conditions safe (slippery, uneven, unstable)
MATERIAL HANDLING
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1. Materials are properly stored or stacked
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2. If mechanical equipment is being used, is equipment in good condition
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3. If equipment is being used properly
WELDING & BURNING
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1. Gas cylinders stored upright, securely, and in good condition
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2. Proper separation between fuels and oxygen (1/2-hr-rated fire wall or a minimum of 20 feet)
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3. Burning/welding/cutting goggles or shields are used
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4. Fire extinguishers are nearby
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5. Hoses are in good condition
CRANES
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1. Outriggers extended and swing radius barricade in place
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2. Load charts are available on site
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3. Hand signal charts are on crane
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4. Crane operators’ logs are up to date
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5. Employees kept from under suspended loads
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6. Tag lines are used to guide loads
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7. Nylon lifting slings or wire rope slings are inspected and tagged as required
PERSONAL PROTECTIVE EQUIPMENT
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1. Hard hats are being worn
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2. Arm/hand protection (gloves, guards, etc.)
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3. Leg/Footwear Protection (boots, metatarsals, chaps)
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4. Face Protection (Safety glasses, face shields, etc.)
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5. Respirators are used when required
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6. Hearing protection is being worn when required
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7. High-visibility vests are being worn
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8. All PPE kept in sanitary and reliable condition