Title Page
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Job # & Job Name
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Location
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Task
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Foreman
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Conducted on
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Prepared by
PERSONAL PROTECTIVE EQUIPMENT
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Safety glasses with side shields or goggles available & being used.
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Proper tinted lens for welding, cutting.
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Face shield being used?
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Foot protection worn as required?
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Hearing protection worn when required?
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Hard hats proper and worn correctly?
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Harness/Lanyard/D ring extender
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High viz and reflective clothing worn?
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Arc-rated FR clothing worn when required?
ELECTRICAL SAFETY
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MAD maintained with overhead lines?
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Overhead lines de-energized and grounds visible?
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GFCI's used properly for portable hand tools?
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Portable generators/welders equipped with GFCI's?
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Electrical cords inspected and have all prongs in tact?
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Electrical hand tools are grounded or double insulated?
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Ground rods available and used when required?
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Ground cables available, used when required, absent of damage?
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Ground cable tested within two (2) years?
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Ground cable test dates:
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Ground cable test dates:
COMPRESSED GAS
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Compressed gas cylinders stored secured & upright?
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Oxygen/acetylene torch units have flashback arrestors?
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Compressed gas cylinders not in use have caps in place?
FALL PROTECTION
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Are Barricades set up per policy?
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Why are they set up different than policy?
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Barricades minimum six feet from excavation?
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Why are they set up different than policy?
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Proper fall protection while working at or above six feet?
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Anchor points available and used? Minimum four feet from excavation?
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Are Anchor Points placed properly to eliminate exposure to drill swinging?
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Are Poles and braces assembled correct?
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Self Retracting Lanyard used
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Self Retracting Lanyard inspected?
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Full Body Harness used?
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Full body Harness Inspected?
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Open holes securely covered and labeled?
HAZARD COMMUNICATION
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SDS available on site?
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Flammable liquids in approved safety cans?
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All hazardous chemicals labeled appropriately?
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Spill kits available?
CRANES AND DERRICKS
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Daily inspection documented?
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Annual inspection documented?
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Equipment capacity adequate for the load?
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Operator demonstrating safe work practices?
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Outrigger pads being used?
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Swing radius protected?
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Rigger and signal person trained and using proper signals?
MATERIAL HANDLING
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Lift/Loader operator demonstrating safe work practices?
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Rigging inspected for damage and used properly?
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Lifting hooks and/or safety latch absent of deformation?
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Fork lift hoisting load using hook attachment with retention cable?
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Workers demonstrating safe work practices? (Tag lines, spotting equipment, not standing under load, etc.)
HAND TOOLS / POWER TOOLS
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Grinders have guards in place?
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Portable circular/table saws equipped with protective guards?
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Unsafe hand tools removed from service?
ADMINISTRATIVE
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Company safety policy available?
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Hazard Right Of Way review completed?
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Daily Job Briefing completed?
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JHA/JSA/THA available and reviewed with personnel and visitors?
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Emergency plan / PSSP completed and reviewed with personnel?
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Training documented: safety orientation, OSHA 10 & 30, first aid/CPR?
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Equipment operator training documented? (Ex. CCO, forklift)
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Critical set-up plan completed when working near energized lines?
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New hires drug tested within last 12 months?
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Toolbox talks conducted and documented?
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Competent person on site?
EMERGENCY / FIRST AID
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Emergency contacts and maps posted in known location?
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Eye wash accessible?
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First aid kits available and location marked?
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Blood Born pathogens kit accessible?
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Fire extinguishers readily available during hot work?
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Fire extinguishers inspected and storage location marked?
GENERAL SAFETY
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Personnel demonstrate safe work practices?
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Good housekeeping in storage and work areas?
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Rebar caps used on impalement hazards?
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Monitoring of weather conditions as required?
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Task lighting adequate?
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Back-up alarms operational on vehicles?
OTHER SAFETY OBSERVATION
OTHER SAFETY OBSERVATION
360-DEGREE JOB SITE PHOTOS
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Photograph job set-up, work in progress, site conditions and equipment.
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