Derrick Companies Safety Inspection & Equipment Rental Checklist - 2016

• Client / Site / Job Number:

• Prepared by

• Location
  Address

• For the Week Ending:

  Date

• All Sub-Contractors have an AWAIR Program if this site is in Minnesota

  Yes

  No

  N/A

• Right To Know / GHS / SDS

  Safe

  At Risk

  N/A

• Lead, Asbestos, Silica Exposures

  Safe

  At Risk

  N/A

• Respiratory Protection (Voluntary & Required Use)

  Safe

  At Risk

  N/A

• Fall Protection (6' Trigger Height)

  Safe

  At Risk

  N/A

• Steel Erection (15' & 30' Trigger Heights, Controlled Decking Area, Controlled Access Below)

  Safe

  At Risk

  N/A

• Ladders (Proper Use)

  Safe

  At Risk

  N/A

• Stairways (Handrails, Steps, etc.)

  Safe

  At Risk

  N/A

• Scaffolding (10' Trigger Height for Fall Protection, fully planked, mud sills, safe access, secured)

  Safe

  At Risk

  N/A

• Cranes (Operator License, Inspections, Lifting Calculations, Critical Lifts)

  Safe

  At Risk

  N/A

• Hoisting & Rigging, Signalers (Must be Trained/Certified)

  Safe

  At Risk

  N/A

• Electrical Wiring & Equipment (Cords, Panels, Covers, Protect from Damage, Overhead Power Lines)

  Safe

  At Risk

  N/A

• Forklift Operators trained & certified 3 years, inspections, seatbelts

  Safe

  At Risk

  N/A

• Aerial Work Platforms (PFAS, Guardrails, Secured)

  Safe

  At Risk

  N/A

• Excavations (2,4,5 Rules - A,B,C Soil Types)

  Safe

  At Risk

  N/A

• First Aid & CPR (EMS Response within 4 Minutes)

  Safe

  At Risk

  N/A

• Woodworking Machines (Guards in Place, Push Sticks

  Safe

  At Risk

  N/A

• Power Tools (Cords, Guards/Shields, Proper Use

  Safe

  At Risk

  N/A

• Fire Extinguishers

  Safe

  At Risk

  N/A

• Demolition (Stability Dust Control, Safe Access/Egress, Holes)

  Yes

  No

  N/A

• Personal Protective Equipment - Proper Use

  Safe

  At Risk

  N/A

• To the Best of Your Knowledge All Other Jobsite Hazards are Controlled

  Yes

  No

  N/A

• Please Sign Here When Your Safety Inspection is Complete

  Sign

Equipment In Use:

• Bobcat Days/Hours Used

• Bobcat Asset #BB-

• Bobcat Task Code

• Forklift Days/Hours Used

• Forklift Asset #FL-

• Forklift Task Code

• Generators Days/Hours Used

• Generators Asset #GN-

• Geneators Task Code

• Heaters Days/Hours Used

• Heaters Asset #H-

• Heaters Task Code

• Jobsite Trailer Days/Hours Used

• Jobsite Trailer Asset#TR-

• Jobsite Trailer Task Code

• Scaffold (Per End) Days/Hours Used

• Scaffold Task Code

• Concrete Blankets Days/Hours Used

• Concrete Blanket Task Code

• Plate Compactor Days/Hours Used

• Plate Compactor Asset #PC-

• Plate Compactor Task Code

• Other Equipment Days/Hours Used:

• Other Equipment Task Code:

Superintendent Weekly Job Update:

• Project Status:

• Equipment on Site: