Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
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Job Number
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Weather Condition
Administrative and Procedures
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Confined space emergency action plan and rescue plan
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Emergency contact list / site specific plan / Emergency action plan
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Federal and State posters in place and posted?
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Company and project banners visible?
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First Aid kit stocked and available?
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Hand Washing facilities
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OSHA required permits
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Operation
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JHA / PTP completed and signed off
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Open holes in floor / ground
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Proper checklist / permits in place and posted
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Signs barricades and safety tags available
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Work platforms and scaffolds
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Ladder / stairs / guardrails
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Roadways Accessible and clear
Materials Handling / Storage
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Materials: stacked, seat, separate, within 25' of work area
Emergency Action Plan
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Assembly area's location and egress routes known
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Supervisor in charge known to all employees
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Safety shower and eye wash locations known
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Employees know to report job related injury, illness, near miss to supervisor or management immediately?
Ergonomics and Body Positioning
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Posture for work activity
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Eyes on work
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Lifting, pulling, pushing, and carrying techniques
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Line of fire
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Overhead fall hazards
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Pinch points and caught between hazards
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Struck by, or against hazards
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Climbing Hazards
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Walking Hazards
House Keeping
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Tripping Hazards
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Passageways kept clear
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Safety and warning signs posted
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Slipping Hazards
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Spill containment
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Trash receptacles and lids available
PPE
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Hard Hats
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Safety Glasses
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Hand Protection
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Foot Protection
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Hi-Vis or long sleeves
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Fall protection
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Hearing protection
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Overhead fall protection
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Respiratory Protection
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Other
Tools and Equipment
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Clean and stored properly
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Guards and handles in place
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Inspected and color coated
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Portable ladders
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Pressure hoses pinned and secured
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Tools being used properly
Electrical
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GFCI used
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Hoses, cords out of walk areas
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Tripping hazards created by cords
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Hoses cords and welding leads inspected and color coded
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hoses and cords more than 10' from doors
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Lock out and tag out procedures
Fire Protection
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Fire extinguishers
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Combustibles
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Fire exits are not obstructed
Mobile Equipment
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Checklist inspected
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Fire extinguishers
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Leaks and spill containment
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Required safety signage and decals
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Rigging tagged and inspected
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Safety equipment working
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Seatbelt present and used
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Spotter used where required
Excavation and Trench
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Trench box and protection
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Proper slopes for soil type
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Confined spaces permit required
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Other
Employee Interview
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Emergency action plan understood
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Employee job responsibilities understood
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Work in progress follows JHA or PTP
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House keeping acceptable
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Overall of job looks safe and tidy
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PPE requirements in use
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Required lock and tags in place and ID
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Safety rules and procedures complied with
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Work allowed to continue
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Employee Interviewed
Chemicals
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SDSs available
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Labeled properly
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Stored properly
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No Leaks
