Information
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Conducted on
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Prepared by
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Location
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Project Name:
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Project Manager:
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Technicians On Site:
Part 1 - General Safety/Housekeeping
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Housekeeping, trash removal, work area clear of debris?
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Temporary illumination adequate. (10 f.c. in work areas 5 f.c. in walking areas - minimum)
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Adequate trash containers/being emptied?
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Exits and non-exits clearly marked and free from obstructions?
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Adequate ventilation?
Part 2 - Ergonomics
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Anti-vibration gloves in use?
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Adequate work surface provided to reduce bending and stooping?
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Ladders of adequate height available to eliminate over-reaching?
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Proper lifting equipment available?
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Gang box contents arranged so heavy items are in strike zone?
Part 3 - Personal Protective Equipment (PPE)
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Hard hats being worn at all times?
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Approved goggles, safety glasses, face shields are being worn?
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Proper footwear is being worn? (Steel or hard-toed shoes)
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Hearing protection is in use when required? (>85 db over 8 hrs)
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Dust masks and/or approved respirators in use?
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Fall protection equipment in serviceable condition?
Part 4 - Welding and Cutting
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Hot work permit issued for task?
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Combustibles stored at minimum safe distance? (30ft)
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Oxygen/acetylene tanks are secure and upright?
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Oxygen/fuel gas storage meets minimum requirements? (20ft apart / 5ft high / 1 hour rated fire wall)
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Leads/hoses inspected and protective clothing is being worn?
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Fire watch is posted with fire extinguisher available?
Part 5 - Handling & Storage of Material
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Storage areas and gang boxes are clean and well organized?
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Palletized material is stacked evenly, placed on firm base?
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Banding material and pallets have been removed?
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Six foot from edge rule for material storage at heights is adhered to?
Part 6 - Excavation, Trenching, & Shoring
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Competent person for excavation identified?
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Excavation permits are signed and posted?
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Trenches are shielded/shored properly
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Proper sloping of banks?
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Ladders available for access/egress every 25 feet?
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Underground utilities identified?
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Materials/equipment 2 feet from edge?
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Trenches are barricaded and signs posted?
Part 7 - Lifting & Digging Equipment
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Signal person identified?
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Swing radius protected?
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Accessible fire extinguisher?
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Pre-lift meeting conducted?
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Rigging hooks equipped with safety latches?
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Slings/Chokers etc. fee of damage?
Part 8 - Fixed & Portable Ladders
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Job-made ladders are constructed properly?
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Ladders extend three feet (3') above top landing?
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Ladders in good condition and free of oil/dirt/cracks?
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Extension ladders tied off?
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Extension ladders properly footed?
Part 9 - Scaffolds
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Handrails and toe boards are installed properly?
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Scaffolding is erected properly and inspections documented?
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There is a competent person on site for scaffolding?
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Guardrails on scaffolding meet requirements?
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Use of base plates and mud sills?
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Appropriate access and egress?
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Not overloaded?
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Mobile scaffolding properly erected? (Not more than 4 times the minimum base dimension & Diagonal bracing used)
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Mobile scaffolding wheels locked out when person on scaffold?
Part 10 - Mobile Equipment
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Operable backup alarms?
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Parking break/wheels chocked?
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Adequate clearance between equipment?
Part 11 - Electrical Installations
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Cords are in good condition and are properly hung?
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Temporary light bulbs are covered and hung properly?
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Temporary power installed safely and cords hung properly?
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Covers are in place on electrical panels?
Part 12 - Fire Protection & Prevention
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No build-up of flammable debris or trash?
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Flammable liquid cabinets & safety containers in use?
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Flammable material is stored with HMIS lables?
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LPG - use, equipment & storage?
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Temporary heating properly protected?
Part 13 - Tools
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Defective tools tagged and removed from service?
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Safety guards operable and in place, cords inspected?
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All electrical hand tools double insulated or equipped with three-wire ground plugs?
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Workers have permits for powder actuated tools?
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Proper disposal of powder loads?
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Proper use of tools?
Part 14 - Guarding of Walking & Working Surfaces
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Handrails are installed and secured properly?
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Temporary filler material installed in metal pan stairways and landings? Risers are of equal height?
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Ladder access at upper floors corralled?
Part 15 - Signals, Signs, Tags & Barricades
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Danger signs are posted in hazardous areas?
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Traffic control cones, barriers, signs and vests in use?
Part 16 - Aerial Work Platforms
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Applicable permits are available?
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Fall protection utilized when required?
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Safety chains and gates are latched or closed?
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Equipment properly maintained?
Part 17 - Right to Know/Hazard Communication
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MSDS folder accessible and current?
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Hazardous chemical inventory list kept current?
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Chemical containers labeled - including gas cans?
Part 18 - Fall Protection
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Anyone working over six feet (6') is protected by guardrails, safetynet, or personal fall arrest system?
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All sides or edges are properly protected?
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Appropriate guardrail system in place?
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Lanyards secured properly?
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Floor holes greater than 2 inches (2") are covered?
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Hole covers secured and clearly marked?
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Guardrails/mid-rails/toe boards adequately installed?
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Perimeter cable adequately installed?
Part 19 - Lock Out/Tag Out
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Lock out Tag Out kit on site?
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Potential hazardous energy sources locked out and tagged as necessary?
Part 20 - Confined Space Entry
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Confined space procedures documented?
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Competent person identified and spotter onsite?
Checklist Corrections
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Item #1:
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Corrective Action Taken?
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Name of Employee?
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Name of Supervisor?
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Date Corrected?
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Item #2:
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Name of Employee?
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Name of Supervisor?
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Add media
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Date Corrected?
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Corrective Action Taken?
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Item #3:
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Corrective Action Taken?
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Name of Employee?
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Name of Supervisor?
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Date Corrected?
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