Information
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Project Name
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Project Number
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Date Completed
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Prepared by
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Location
SUPERINTENDENTS NAME
PERSONAL PROTECTIVE EQUIPMENT
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Hard Hats
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Safety Glasses Appropriate for Conditions ( tinted or clear )
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Reflective Vests and/or High Visibility Shirts
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Hard Toed Work Boots
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Gloves (if required)
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Hearing Protection (if required)
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Face Shields (if required)
HOUSEKEEPING
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General Site Housekeeping
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Trash Cans in Work Area
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Storage / Conex
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Safe Walkways or Passages
TEMPORARY BARRICADES
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All sides of work area barricaded and labeled (if required)
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Proper tape used, Red for Danger and Yellow for Caution (if required)
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Road/Sidewalk Closed signs in place (if required)
LADDERS AND ELEVATED WORK
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Extension ladders tied off and secured
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Extension ladders extended 3' above upper landing
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Step ladders fully open and locked
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Damaged ladders tagged Out-of-Service
FALL PROTECTION
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Employees 100% tied off when working over 6'
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Fall protection in place (i.e. handrails and warning lines)
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Harness and lanyards inspected prior to use
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Harness and lanyards used correctly
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Employees anchored off correctly
MOBILE EQUIPMENT
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Operating at a safe speed (both travel and swing)
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Operating at a safe distance from ground personnel
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Inspected and documented prior to each shift
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Seatbelts used
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Operators trained
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Backup and movement alarms working
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Spotters used when needed
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Equipment maintained without leaks
HOISTING AND RIGGING EQUIPMENT
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Annual crane inspection placard and/or hard copy in place
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Daily crane inspection performed and documented
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Operators manual in cab
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Swing radius protection in place
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Workers staying clear of suspended loads
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Rigging inspected prior to each use
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Proper rigging and techniques used
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Rigging properly stored
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Qualified rigger/signal person being used
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Knowledge of crane signals
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Proper use of tag lines
EXCAVATION
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Excavations inspected and documented by a competent person
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Means of entering/exiting for excavations deeper than 4'
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Daily air quality checked for excavations deeper than 4’
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Cave-In protection for excavations deeper that 5'
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Excavation protected from unauthorized personnel (i.e. handrails/barricades)
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Equipment staged at a safe distance from the edge
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Spoils and materials at least 2' from leading edge
COMPRESSES GAS CYLINDERS
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Stored upright and succored
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Oxygen and acetylene stored at least 20' apart when not in use
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Hard caps in place when not in use and/or in transport
CONCRETE OPERATIONS
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Concrete pump and hoses in good condition and used properly
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Slick lines and hoses properly clamped with safety wire and whip checks
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Concrete washed from skin in a timely manner
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Employees involved where concrete dust is present, have been trained in Silica Awareness
CONFINED SPACE
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Confined spaces identified and posted
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Permit required spaces controlled by permit and attendant
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All confined spaces inspected and documented
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All confined spaces air quality checked and documented
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Open spaces, such as manholes are protected from pedestrians and vehicular traffic
PREWORK
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Weekly Toolbox Talks are performed and documented
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Daily JHA's communicated to all employees and documented
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SDS for all chemicals on the project are available upon request
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Supervisors are aware of local Urgent Care and Emergency Room locations
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All required jobsite work permits (i.e. hot work permits and excavation permits) obtained
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Underground locates are in place and current
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Employee training records are available for work being performed
REPRIMANDS OR WARNINGS
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We're any safety violations issued?
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We're any verbals warnings or directives given?
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Was any Stop Work order issued?
COMMENTS
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