Information
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Document No.
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Project Name
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Project Number
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Conducted on
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Superintendent Name
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Location
CONDITIONS:
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Temperature:
- 0-32F
- 33-40F
- 41-50F
- 51-60F
- 61-70F
- 71-80F
- 81-90F
- 91-100F
- 101F +
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Weather Condition:
- Sunny
- Windy
- Partially Cloudy
- Mostly Cloudy
- Raining
- Snowing
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Jobsite Condition:
ADMINISTRATION
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Are the Safety Data Sheets (SDS) available to every employee onsite?
MEDICAL/EMERGENCY
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Is a first aid kit readily available to every employee onsite?
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Did you perform any First Aid?
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Notes:
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Add media
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Did you have any "Near Miss" incidents?
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Notes:
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Add media
GENERAL
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Is the work area clean and free of trip hazards?
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Notes:
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Add media
PERSONAL PROTECTIVE EQUIPMENT
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Are all hard hats being properly worn?
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Notes:
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Add media
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Are all safety glasses/face shields being properly worn?
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Notes:
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Add media
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Are all work boots and appropriate clothing being worn?
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Notes:
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Add media
FIRE PROTECTION
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Are the fire extinguishers readily available wherever work is being performed?
Location
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Notes:
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Add media
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Are all of the fire extinguishers charged and recently inspected?
Location
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Notes:
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Add media
LADDERS
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Are you using ladders?
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Are all ladders in good condition?
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Notes:
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Add media
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Are all ladders tied-off properly?
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Notes:
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Add media
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Is there 3' extending beyond the landing?
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Notes:
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Add media
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Is the ladder at a safe working angle and away from electrical hazards?
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Notes:
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Add media
FALL PROTECTION
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What fall protection system is being used?
- Guardrails
- SRL's & Harnesses
- Controlled Access Zone/Safety Monitor
- N/A
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Are the top/mid rails in-place, properly secured and at the correct height?
Location
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Notes:
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Add media
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Are all harnesses in good condition and being wore properly?
Person/Equipment
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Notes:
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Add media
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Are all anchor points in good condition and installed properly?
Person/Equipment
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Notes:
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Add media
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Are all SRL's in good condition and working properly?
Person/Equipment
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Notes:
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Add media
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Are all the stanchions in good condition and working properly?
Location
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Notes:
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Add media
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Is the warning line at the proper height?
Location
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Notes:
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Add media
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Are there flags at every 6' and are they in good condition?
Location
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Notes:
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Add media
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Are all the openings covered, secured, and properly marked?
Location
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Notes:
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Add media
ELECTRICAL
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Are you using extension cords and/or power tools?
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Are GFCI's being properly used?
Location
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Notes:
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Add media
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Are extension and power tool cords in good condition?
Location
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Notes:
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Add media
CHEMICALS/FUEL
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Is fuel being stored away from flames/sparks/heat?
Location
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Notes:
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Add media
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Are fuels and other liquids stored capped in the proper containers?
Location
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Notes:
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Add media
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Are fuels and other liquids stored in properly marked containers?
Location
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Notes:
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Add media
SCISSOR/AERIAL LIFTS
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Are you using scissor/aerial lifts?
- Scissor Lift
- Boom Lift
- N/A
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Is the gate/chain secured on the scissor lift?
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Notes:
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Add media
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Is the scissor lift being operated on a flat surface?
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Notes:
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Add media
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Are the boom lift operators properly tied-off?
Location
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Notes:
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Add media
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Have the employees been properly trained to operate the lift?
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Notes:
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Add media
EQUIPMENT
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Are you using any WFP equipment?
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Is the equipment securely set with wheels chocked and outriggers out?
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Notes:
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Add media
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Is the equipment a safe distance from overhead power lines?
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Notes:
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Add media
OTHER
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Were there any other safety observations made?
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Notes
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Add media
APPROVAL SIGNATURE:
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Superintendent Signature
