Daily JSA

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Permits

• Confined Spaces

  Yes

  No

  N/A

• Hot Work

  Yes

  No

  N/A

• Hot Work #

• Clearance Required

  Yes

  No

  N/A

• Clearance Accepted

  Yes

  No

  N/A

• Grading Removal

  Yes

  No

  N/A

• Excavation

  Yes

  No

  N/A

• Other

Fall Protection

• Safety Harness Inspections

  Yes

  No

  N/A

• Proper Anchorage Point

  Yes

  No

  N/A

• Personnel Platform (Man Basket) Daily Inspections

  Yes

  No

  N/A

• Lifeline

  Yes

  No

  N/A

• Other

General

• Flammable/Gaseous Liquids

  Yes

  No

  N/A

• Combustibles

  Yes

  No

  N/A

• Lead-Painted Coatings/Metal Tested

  Yes

  No

  N/A

• Arsenic

  Yes

  No

  N/A

• Hexavalent Chromium

  Yes

  No

  N/A

• Chemical Explosives

  Yes

  No

  N/A

• Struck By Pinch Points

  Yes

  No

  N/A

• Ergonomics

  Yes

  No

  N/A

• Signs

  Yes

  No

  N/A

• Slip/Trip Hazards

  Yes

  No

  N/A

• Hole Covers

  Yes

  No

  N/A

• Visibility

  Yes

  No

  N/A

• Heat Stress

  Yes

  No

  N/A

• Radiation/Nuclear Source

  Yes

  No

  N/A

• Snagging

  Yes

  No

  N/A

• Asbestos (Gaskets, Roofing, Insulation, Expansion Joints, Floor Tile, etc.)

  Yes

  No

  N/A

• Line of Fire

  Yes

  No

  N/A

• Lifting Heavy or Awkward Objects (Assess for Team or Mechanical Lift)

  Yes

  No

  N/A

Scaffolding/Ladder

• Ladder Tied Off

  Yes

  No

  N/A

• Inspected by Competent Person

  Yes

  No

  N/A

• Tagged

  Yes

  No

  N/A

• Special Provisions

  Yes

  No

  N/A

• Proper Ladder Inspected Daily

  Yes

  No

  N/A

• Railing/Toeboards

  Yes

  No

  N/A

• Access

  Yes

  No

  N/A

Personal Protective Equipment

• Normal PPE

  Yes

  No

  N/A

• Hard Hat

  Yes

  No

  N/A

• Safety Glasses

  Yes

  No

  N/A

• Safety Toed Boots

  Yes

  No

  N/A

• Fire Retardant Clothing

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Type

• Additional Foot Protection

  Yes

  No

  N/A

• Type

• Monogoggles

  Yes

  No

  N/A

• Welding Sleeves

  Yes

  No

  N/A

• Welding Shield

  Yes

  No

  N/A

• Burning Goggles

  Yes

  No

  N/A

• Seat Belts

  Yes

  No

  N/A

• Fall Protection

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Respirator (No Facial Hair in Seal Area)

  Yes

  No

  N/A

• Mechanical Vibration

  Yes

  No

  N/A

• Face Shield

  Yes

  No

  N/A

Excavations

• Inspected by Competent Person

  Yes

  No

  N/A

• Proper Access

  Yes

  No

  N/A

• Shoring/Sloping/Benching Required

  Yes

  No

  N/A

• Properly Barricaded

  Yes

  No

  N/A

Human Hazards

• Nearby Work Activities

  Yes

  No

  N/A

• Work After Long Break

  Yes

  No

  N/A

• Lack of Experience/Apprentice

  Yes

  No

  N/A

• Distractions

  Yes

  No

  N/A

• First Time Evaluation

  Yes

  No

  N/A

• Confusion/Mix-Up Potentials (Labeling, Look-Alike Equipment, etc.)

  Yes

  No

  N/A

Tools

• Proper Cutting Tool for the Job (Non-Retracting Blade-Type Knives Require Cut Resistant Gloves)

  Yes

  No

  N/A

• Proper Tools for the Job

  Yes

  No

  N/A

• Daily Inspection

  Yes

  No

  N/A

Welding

• Welding Screens

  Yes

  No

  N/A

• Combustibles

  Yes

  No

  N/A

• Condition of Welding Leads

  Yes

  No

  N/A

• Fire Blanket

  Yes

  No

  N/A

• Fire Extinguisher

  Yes

  No

  N/A

• Inspected

  Yes

  No

  N/A

• Grounding

  Yes

  No

  N/A

• Fire Watch

  Yes

  No

  N/A

• Sleeves/Jackets

  Yes

  No

  N/A

• Welding Gloves/Sleeves/Jackets

  Yes

  No

  N/A

• Welding Hood

  Yes

  No

  N/A

• Proper Clothing

  Yes

  No

  N/A

Emergency Info/Equipment Locator

• Emergency Phone Location

  Yes

  No

  N/A

• MSDS Review

  Yes

  No

  N/A

• Portable Radio Required

  Yes

  No

  N/A

• Reporting Area

  Yes

  No

  N/A

• Evacuation Route

  Yes

  No

  N/A

• Safety Showers/Eye Wash Station

  Yes

  No

  N/A

• Fire Extinguishers

  Yes

  No

  N/A

• Fire Hose

  Yes

  No

  N/A

Electrical

• GFCI Test

  Yes

  No

  N/A

• Lighting Inspected

  Yes

  No

  N/A

• Electrical Tool Inspected

  Yes

  No

  N/A

• Extension Cord Inspections

  Yes

  No

  N/A

Plants and Animals

• Snakes, Animals, Birds, Insects

  Yes

  No

  N/A

• Poison Ivy/Poison Oak

  Yes

  No

  N/A

Environmental

• Clean Up Materials

  Yes

  No

  N/A

• Storm Drains/Discharge Inspected

  Yes

  No

  N/A

• Spill Prevention Measures

  Yes

  No

  N/A

• Waste Generation- Storage, Labeling, Disposal

  Yes

  No

  N/A

• Air Emission- Dust, Toxic, etc.

  Yes

  No

  N/A

Crane/Lifting Equipment

• Proper Maintenance

  Yes

  No

  N/A

• Hydraulic Cranes

  Yes

  No

  N/A

• Inspected

  Yes

  No

  N/A

• Crawler Crane

  Yes

  No

  N/A

• Inspected

  Yes

  No

  N/A

• Manual Lifting Equipment

  Yes

  No

  N/A

• Proper Rigging Practice

  Yes

  No

  N/A

• Personnel Platform Prelift Form

  Yes

  No

  N/A

• 10 Tons or Greater (Critical Lift Plan Required)

  Yes

  No

  N/A

• Voltage

  Yes

  No

  N/A

• Amount

• Safe Working Distance

• Voltage Chart

  

• Proper Barricades

  Yes

  No

  N/A

• Overhead Hazards

  Yes

  No

  N/A

• JLG

  Yes

  No

  N/A

• Outriggers Extended

  Yes

  No

  N/A

• Communications

  Yes

  No

  N/A

• Oper/Oiler in Place

  Yes

  No

  N/A

Equipment

• Skid Steer

  Safe

  At Risk

  N/A

• Plate Tamp/Jumping Jack

  Safe

  At Risk

  N/A

• Wacker Packer

  Safe

  At Risk

  N/A

• Ride Compactor

  Safe

  At Risk

  N/A

• Trench Roller

  Safe

  At Risk

  N/A

• Mini Excavator

  Safe

  At Risk

  N/A

• Excavator

  Safe

  At Risk

  N/A

• Dozer

  Yes

  No

  N/A