Title Page

  • Corning-Pharma Vineland
  • Conducted on :

  • Prepared by :

  • Location :
  • Contractor :


  • Does the contractor have a Health & Safety Program on site?

  • Is the SDS readily available to all workers?

  • Are emergency numbers posted for all workers?

  • Have they performed and documented toolbox talks according to Corning standard?

  • Have work areas been barricaded and proper signage placed?

  • Was the Safe Work Permit Completed?

  • Does the Master JSA cover all listed tasks on the Safe Work Permit?

  • Do workers know security's number?

  • Are there any additional permits being filled out?

  • Were the additional permits filled out accurately and completely?


  • Are hardhats being worn?

  • Have they expired?

  • Are they the right type of hardhat?

  • Are they being worn properly?

  • Are safety glasses being worn?

  • Are they ANSI Z87.1 rated?

  • Is Hi-Vis vests/shirts being worn?

  • If motorized equipment is being used, are there retro-reflective stripes on the Hi-Vis gear?

  • Are all workers wearing steel/composite toe boots?

  • Are gloves, armguards, aprons, leg guards, etc. in use when required?

  • Is hearing protection being worn when necessary?


  • Is the work area neat?

  • Waste containers used?

  • Are they properly labeled?

  • Are passageways/walkways kept clear?

  • Are materials properly stored and/or stacked?


  • Are ladders being used?

  • Do extension ladders extend 36 inches past the landing?

  • Are ladders secured to prevent slipping, sliding, or falling?

  • Are stepladders used in fully open position?

  • Are the ladders being used in a safe manner? (3-points of contact, belt buckle rule, not on top 2 rungs)

Trenches & Excavations

  • Is digging beyond 2 inches occurring on site?

  • Is there a valid 811 ticket?

  • Has an excavation permit been filled out?

  • Are spoil piles kept 2 feet away from excavation?

  • Access/Egress provided every 25 feet when below 4 feet?

  • Is cave-in protective system being used beyond 5 feet?

  • Is the protective system of sloping/shoring adequate? (No benching, all soil is class C)

Fall Protection

  • Is there any work being done from heights?

  • Is a PFAS required?

  • Has the PFAS equipment been inspected?

  • Is the anchorage point in good condition and designed for the work?

  • Is the body harness in good condition?

  • Are the connectors in good condition and designed for the work?

  • Are workers 100% tied off when in lifts, including scissor lifts?

  • Are guardrails installed?

  • Is the top of guardrail 42 inches +/- 3 inches?

  • Can the guardrail resist at any point 200 pounds of downward or outward force?

  • Is toe-board 3.5 inches with no more than a 1/4 inch gap?

  • Can the toe-board withstand 50 pounds of force?


  • Is there any scaffolding being used?

  • Is there proper access to the scaffold?

  • Has the scaffold been inspected by competent person?

  • Is there a green scaffolding tag indicating competent person and inspection date?

  • Are employees below protected from falling hazards?

  • Is there any scaffolding being built?

  • Is there proper access to the scaffold?

  • Is the scaffold erected on sound rigid footings?

  • Are planks sound and sturdy?

  • Are guardrails, intermediate rails, toe-boards, and screens in place?

  • Are employees below protected from falling objects?

Fire Prevention

  • Are workers equipped with adequate fire extinguishers?

  • Are the extinguishers monthly and annual inspections maintained?

  • Are the extinguishers readily available?


  • Are GFCIs in use?

  • Are the cords in good working condition? (grounding prong, no frayed wiring)

  • Is electrical work being performed?

  • Was additional electrical permit filled out?

  • Has the additional PPE been tested and/or kept in good working condition?

  • Have Is the proper PPE being worn for the task?

  • Has an electrical permit been completed?

  • Was LOTO performed?

  • Why not?

  • Is additional PPE for electrical work being worn?

  • Do high-voltage PPE have valid test dates and remain in good working condition?

Welding and Burning

  • Is there any welding, burning, or sparking work being performed?

  • Do they have a hot work permit filled out?

  • Is additional PPE being worn for the work?

  • Is a face shield in addition to eye protection being used for work operations resulting in sparks?

  • Are the proper shades being used for the welding operation?

  • Are the welding gloves in good condition?

  • Are gas cylinders stored upright and secured?

  • Are fire blankets being used to protect flammable material near hot work?

  • Are screens being used to protect eyes of those near the hot work operation?


  • Is a crane being used?

  • Was a pick plan created, reviewed, and approved by Corning?

  • Was the crane the properly set up?

  • Were barricades set up?

  • Was the restricted access zone enforced?

  • Was the pick plan followed? (operator, rigger, signalman, swing radius, rigging components, proper crane, etc.)

Floor and Wall Penetrations

  • Will the floor or wall be penetrated?

  • Was a floor and wall penetration permit filled out?

  • Have the proper individuals been notified of the opening?

  • Is perimeter protection in place for opening?

  • Are floor or deck openings planked over or barricaded?

Confine Space

  • Is there work being done in a confined space?

  • Has the survey been completed to determine if it is permit required?

  • If it is a permit required confined space, has a permit been completed?

  • Have the workers been trained in confined space entry?

  • Has the air monitor been bump tested?

  • Is the calibration date good on the air monitor?

  • Has a rescue plan been established?

  • Has adequate ventilation been provided?

  • Is there proper signage and barriers for the confined space?

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.