Information

  • Conducted on

  • Prepared by

  • Location
  • Project Name:

  • Project Manager:

  • Technicians On Site:

Part 1 - General Safety/Housekeeping

  • Housekeeping, trash removal, work area clear of debris?

  • Temporary illumination adequate. (10 f.c. in work areas 5 f.c. in walking areas - minimum)

  • Adequate trash containers/being emptied?

  • Exits and non-exits clearly marked and free from obstructions?

  • Adequate ventilation?

Part 2 - Ergonomics

  • Anti-vibration gloves in use?

  • Adequate work surface provided to reduce bending and stooping?

  • Ladders of adequate height available to eliminate over-reaching?

  • Proper lifting equipment available?

  • Gang box contents arranged so heavy items are in strike zone?

Part 3 - Personal Protective Equipment (PPE)

  • Hard hats being worn at all times?

  • Approved goggles, safety glasses, face shields are being worn?

  • Proper footwear is being worn? (Steel or hard-toed shoes)

  • Hearing protection is in use when required? (>85 db over 8 hrs)

  • Dust masks and/or approved respirators in use?

  • Fall protection equipment in serviceable condition?

Part 4 - Welding and Cutting

  • Hot work permit issued for task?

  • Combustibles stored at minimum safe distance? (30ft)

  • Oxygen/acetylene tanks are secure and upright?

  • Oxygen/fuel gas storage meets minimum requirements? (20ft apart / 5ft high / 1 hour rated fire wall)

  • Leads/hoses inspected and protective clothing is being worn?

  • Fire watch is posted with fire extinguisher available?

Part 5 - Handling & Storage of Material

  • Storage areas and gang boxes are clean and well organized?

  • Palletized material is stacked evenly, placed on firm base?

  • Banding material and pallets have been removed?

  • Six foot from edge rule for material storage at heights is adhered to?

Part 6 - Excavation, Trenching, & Shoring

  • Competent person for excavation identified?

  • Excavation permits are signed and posted?

  • Trenches are shielded/shored properly

  • Proper sloping of banks?

  • Ladders available for access/egress every 25 feet?

  • Underground utilities identified?

  • Materials/equipment 2 feet from edge?

  • Trenches are barricaded and signs posted?

Part 7 - Lifting & Digging Equipment

  • Signal person identified?

  • Swing radius protected?

  • Accessible fire extinguisher?

  • Pre-lift meeting conducted?

  • Rigging hooks equipped with safety latches?

  • Slings/Chokers etc. fee of damage?

Part 8 - Fixed & Portable Ladders

  • Job-made ladders are constructed properly?

  • Ladders extend three feet (3') above top landing?

  • Ladders in good condition and free of oil/dirt/cracks?

  • Extension ladders tied off?

  • Extension ladders properly footed?

Part 9 - Scaffolds

  • Handrails and toe boards are installed properly?

  • Scaffolding is erected properly and inspections documented?

  • There is a competent person on site for scaffolding?

  • Guardrails on scaffolding meet requirements?

  • Use of base plates and mud sills?

  • Appropriate access and egress?

  • Not overloaded?

  • Mobile scaffolding properly erected? (Not more than 4 times the minimum base dimension & Diagonal bracing used)

  • Mobile scaffolding wheels locked out when person on scaffold?

Part 10 - Mobile Equipment

  • Operable backup alarms?

  • Parking break/wheels chocked?

  • Adequate clearance between equipment?

Part 11 - Electrical Installations

  • Cords are in good condition and are properly hung?

  • Temporary light bulbs are covered and hung properly?

  • Temporary power installed safely and cords hung properly?

  • Covers are in place on electrical panels?

Part 12 - Fire Protection & Prevention

  • No build-up of flammable debris or trash?

  • Flammable liquid cabinets & safety containers in use?

  • Flammable material is stored with HMIS lables?

  • LPG - use, equipment & storage?

  • Temporary heating properly protected?

Part 13 - Tools

  • Defective tools tagged and removed from service?

  • Safety guards operable and in place, cords inspected?

  • All electrical hand tools double insulated or equipped with three-wire ground plugs?

  • Workers have permits for powder actuated tools?

  • Proper disposal of powder loads?

  • Proper use of tools?

Part 14 - Guarding of Walking & Working Surfaces

  • Handrails are installed and secured properly?

  • Temporary filler material installed in metal pan stairways and landings? Risers are of equal height?

  • Ladder access at upper floors corralled?

Part 15 - Signals, Signs, Tags & Barricades

  • Danger signs are posted in hazardous areas?

  • Traffic control cones, barriers, signs and vests in use?

Part 16 - Aerial Work Platforms

  • Applicable permits are available?

  • Fall protection utilized when required?

  • Safety chains and gates are latched or closed?

  • Equipment properly maintained?

Part 17 - Right to Know/Hazard Communication

  • MSDS folder accessible and current?

  • Hazardous chemical inventory list kept current?

  • Chemical containers labeled - including gas cans?

Part 18 - Fall Protection

  • Anyone working over six feet (6') is protected by guardrails, safetynet, or personal fall arrest system?

  • All sides or edges are properly protected?

  • Appropriate guardrail system in place?

  • Lanyards secured properly?

  • Floor holes greater than 2 inches (2") are covered?

  • Hole covers secured and clearly marked?

  • Guardrails/mid-rails/toe boards adequately installed?

  • Perimeter cable adequately installed?

Part 19 - Lock Out/Tag Out

  • Lock out Tag Out kit on site?

  • Potential hazardous energy sources locked out and tagged as necessary?

Part 20 - Confined Space Entry

  • Confined space procedures documented?

  • Competent person identified and spotter onsite?

Checklist Corrections

  • Item #1:

  • Corrective Action Taken?

  • Name of Employee?

  • Name of Supervisor?

  • Date Corrected?

  • Add media

  • Item #2:

  • Name of Employee?

  • Name of Supervisor?

  • Add media

  • Date Corrected?

  • Corrective Action Taken?

  • Item #3:

  • Corrective Action Taken?

  • Name of Employee?

  • Name of Supervisor?

  • Date Corrected?

  • Add media

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.