Information

  • Document No.

  • Job Site

  • Foreman

  • Conducted on

  • Prepared by

  • Location

SHED

  • ILLNESS & INJURY PREVENTION PROGRAM (IIPP)

  • SAFETY DATA SHEETS (SDS)

  • WATER & CUPS PROVIDED

  • FIRST AID KIT - FULLY STOCKED

  • FIRE EXTINGUISHER AVAILABLE

  • SAFETY OSTERS VISIBLE

  • THERMOMITER

  • TRASH RECEPTICLE

  • SHADE AREA (CANOPY OR GARAGE)

JOB SITE

  • HARD HATS ON

  • EYE PROTECTION ON

  • PROPER SHOES ON

  • SAW GUARDS IN PLACE

  • POWER TOOLS IN GOOD CONDITION

  • NAIL GUN SPRINGS ARE IN PLACE

  • EXTENTION CORDS IN GOOD CONDITION

  • POWDER ACUATED TOOLS IN GOOD CONDITION

  • UNUSED/USED SHOTS UNATTENDED

  • EXTENTSION LADDERS ARE SECURE

  • "A" FRAME LADDERS ARE USED PROPERLY

  • HANDRAILS INSTALLED ON STAIRWAYS AND SECOND FLOOR OPENINGS

  • FALL PROTECTION/SCAFFOLDING SYSTEM PROPERLY INSTALLED

  • HARNESSES ON AND OR ATTACHED WHEN NEEDED

  • SECOND STORY WINDOW/BALCONY SAFETY GUARDS INSTALLED

  • HAZARD TAPE AROUND OPEN TRENCH(ES)

  • DEBRIS SAFE DISTANCE FROM HOUSES

  • NAILS BENT OVER UNATTENDED LUMBER

  • REMIND FORKIFT DRIVER TO WEAR SEATBELT

Corrective Actions

  • Enter any corrective actions that will be undertaken

  • Add signature

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