Dome Construction Safety Inspection / Weekly Tailgate Meeting

• Conducted on

  Date

• Project No.

• Project Name

• Location
  Address

• Weather

• Job Supervisor

• Project Manager

Personal Protective Equipment

• Hard Hats

  Safe

  At Risk

  N/A

• Eye Protection

  Safe

  At Risk

  N/A

• Ear Protection

  Safe

  At Risk

  N/A

• Respirators

  Safe

  At Risk

  N/A

• Proper Clothing

  Safe

  At Risk

  N/A

• Footwear

  Safe

  At Risk

  N/A

• Fall Protection Equipment

  Safe

  At Risk

  N/A

Housekeeping

• Exits & Stairs Clear

  Safe

  At Risk

  N/A

• Piling & Stacking

  Safe

  At Risk

  N/A

• Debris Removal

  Safe

  At Risk

  N/A

• Nails Bent or Removed

  Safe

  At Risk

  N/A

• Power Cords

  Safe

  At Risk

  N/A

Ladders & Stairs

• Ladder Condition

  Safe

  At Risk

  N/A

• Ladders Tied Off

  Safe

  At Risk

  N/A

• Ladder 3' Above Landings

  Safe

  At Risk

  N/A

• Stairs

  Safe

  At Risk

  N/A

Railings / Flooring Openings

• Floor Openings / Shafts

  Safe

  At Risk

  N/A

• Stairs / Ramps

  Safe

  At Risk

  N/A

• Walkways

  Safe

  At Risk

  N/A

• Elevator Door Openings

  Safe

  At Risk

  N/A

• Perimeter

  Safe

  At Risk

  N/A

Electrical

• Lighting

  Safe

  At Risk

  N/A

• Grounding

  Safe

  At Risk

  N/A

• Cords, Plugs & Receptacles

  Safe

  At Risk

  N/A

Fire Protection

• Extinguishers

  Safe

  At Risk

  N/A

• Flammable Materials

  Safe

  At Risk

  N/A

• Required Permits

  Safe

  At Risk

  N/A

• Welding / Cutting Equipment

  Safe

  At Risk

  N/A

Tools

• Condition

  Safe

  At Risk

  N/A

• Guarded

  Safe

  At Risk

  N/A

• Power Cords

  Safe

  At Risk

  N/A

• Temp. Power Boxes

  Safe

  At Risk

  N/A

Site & Public Protection

• Excavation / Trenches

  Safe

  At Risk

  N/A

• Earth Moving Equipment

  Safe

  At Risk

  N/A

• Forklift / Cranes

  Safe

  At Risk

  N/A

• Fences

  Safe

  At Risk

  N/A

• Lighting

  Safe

  At Risk

  N/A

• Barricades

  Safe

  At Risk

  N/A

• Signage

  Safe

  At Risk

  N/A

• Rebar Caps

  Safe

  At Risk

  N/A

First Aid

• Trained Personnel

  Safe

  At Risk

  N/A

• Emergency Evacuation Plan

  Safe

  At Risk

  N/A

• Eye Wash Station

  Safe

  At Risk

  N/A

• Kits / Supplies

  Safe

  At Risk

  N/A

• Sanitation / Water

  Safe

  At Risk

  N/A

Program / Information

• Daily Inspections

  Safe

  At Risk

  N/A

• Orientation: New Emp / Haz Sub

  Safe

  At Risk

  N/A

• Safety Meetings

  Safe

  At Risk

  N/A

• Required Signs Posted

  Safe

  At Risk

  N/A

• Job Safety Board

  Safe

  At Risk

  N/A

Other (Lists)

• Safety Manual

  Safe

  At Risk

  N/A

• Safety Data Sheets (SDS)

  Safe

  At Risk

  N/A

• Cal / OSHA 300 Log

  Safe

  At Risk

  N/A

• Pre Task Plan

  Safe

  At Risk

  N/A

• Heat Illness Prevent Program

  Safe

  At Risk

  N/A

Additional Information

• Comments

• Add signature

  Sign

• Add signature

  Sign

• Safety Meeting

  Off

  On

Information

• Date of Meeting

  Date

• Project Number

• Project Name

• Meeting Leader

  Sign

Topics Discussed

• Identify all Documents Discussed

• Results of Inspection

Personnel In Attendance

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Additional Signers

  Off

  On

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Additional Signers

  Off

  On

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Additional Signers

  Off

  On

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Additional Signers

  Off

  On

• ** If additional signers are required, attach photo of a sign in sheet below.**

• Sign in sheet

  Media

• Sign in sheet

  Media

• Sign in sheet

  Media

• Sign in sheet

  Media

• Was a safety reward decal sticker issued?

  Yes

  No

• How many Stickers were issued

  1

  2

  3

  4

• Employee Name

• Employee's Company

• Sticker Number

• Description of Safe Behavior

• Employee Name

• Employee's Company

• Sticker Number

• Description of Safe Behavior

• Employee Name

• Employee's Company

• Sticker Number

• Description of Safe Behavior

• Employee Name

• Employee's Company

• Sticker Number

• Description of Safe Behavior

• Employee Name

• Employee's Company

• Sticker Number

• Description of Safe Behavior

• Employee Name

• Employee's Company

• Sticker Number

• Description of Safe Behavior

• Employee Name

• Employee's Company

• Sticker Number

• Description of Safe Behavior

• Employee Name

• Employee's Company

• Sticker Number

• Description of Safe Behavior

• Employee Name

• Employee's Company

• Sticker Number

• Description of Safe Behavior

• Employee Name

• Employee's Company

• Sticker Number

• Description Of Safe Behavior