Information

  • Document No.

  • Project Name

  • Project Number

  • Conducted on

  • Superintendent Name

  • Location

CONDITIONS:

  • Temperature:

  • Weather Condition:

  • Jobsite Condition:

ADMINISTRATION

  • Are the Safety Data Sheets (SDS) available to every employee onsite?

MEDICAL/EMERGENCY

  • Is a first aid kit readily available to every employee onsite?

  • Did you perform any First Aid?

  • Notes:

  • Add media

  • Did you have any "Near Miss" incidents?

  • Notes:

  • Add media

GENERAL

  • Is the work area clean and free of trip hazards?

  • Notes:

  • Add media

PERSONAL PROTECTIVE EQUIPMENT

  • Are all hard hats being properly worn?

  • Notes:

  • Add media

  • Are all safety glasses/face shields being properly worn?

  • Notes:

  • Add media

  • Are all work boots and appropriate clothing being worn?

  • Notes:

  • Add media

FIRE PROTECTION

  • Are the fire extinguishers readily available wherever work is being performed?

  • Location
  • Notes:

  • Add media

  • Are all of the fire extinguishers charged and recently inspected?

  • Location
  • Notes:

  • Add media

LADDERS

  • Are you using ladders?

  • Are all ladders in good condition?

  • Notes:

  • Add media

  • Are all ladders tied-off properly?

  • Notes:

  • Add media

  • Is there 3' extending beyond the landing?

  • Notes:

  • Add media

  • Is the ladder at a safe working angle and away from electrical hazards?

  • Notes:

  • Add media

FALL PROTECTION

  • What fall protection system is being used?

  • Are the top/mid rails in-place, properly secured and at the correct height?

  • Location
  • Notes:

  • Add media

  • Are all harnesses in good condition and being wore properly?

  • Person/Equipment
  • Notes:

  • Add media

  • Are all anchor points in good condition and installed properly?

  • Person/Equipment
  • Notes:

  • Add media

  • Are all SRL's in good condition and working properly?

  • Person/Equipment
  • Notes:

  • Add media

  • Are all the stanchions in good condition and working properly?

  • Location
  • Notes:

  • Add media

  • Is the warning line at the proper height?

  • Location
  • Notes:

  • Add media

  • Are there flags at every 6' and are they in good condition?

  • Location
  • Notes:

  • Add media

  • Are all the openings covered, secured, and properly marked?

  • Location
  • Notes:

  • Add media

ELECTRICAL

  • Are you using extension cords and/or power tools?

  • Are GFCI's being properly used?

  • Location
  • Notes:

  • Add media

  • Are extension and power tool cords in good condition?

  • Location
  • Notes:

  • Add media

CHEMICALS/FUEL

  • Is fuel being stored away from flames/sparks/heat?

  • Location
  • Notes:

  • Add media

  • Are fuels and other liquids stored capped in the proper containers?

  • Location
  • Notes:

  • Add media

  • Are fuels and other liquids stored in properly marked containers?

  • Location
  • Notes:

  • Add media

SCISSOR/AERIAL LIFTS

  • Are you using scissor/aerial lifts?

  • Is the gate/chain secured on the scissor lift?

  • Notes:

  • Add media

  • Is the scissor lift being operated on a flat surface?

  • Notes:

  • Add media

  • Are the boom lift operators properly tied-off?

  • Location
  • Notes:

  • Add media

  • Have the employees been properly trained to operate the lift?

  • Notes:

  • Add media

EQUIPMENT

  • Are you using any WFP equipment?

  • Is the equipment securely set with wheels chocked and outriggers out?

  • Notes:

  • Add media

  • Is the equipment a safe distance from overhead power lines?

  • Notes:

  • Add media

OTHER

  • Were there any other safety observations made?

  • Notes

  • Add media

APPROVAL SIGNATURE:

  • Superintendent Signature

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.