Title Page

  • Job # & Job Name

  • Location
  • Task

  • Foreman

  • Conducted on

  • Prepared by

Adminstrative

ADMINISTRATIVE

  • Site hazard assessment completed?

  • JHA/JSA/THA available and reviewed with personnel and visitors?

  • Emergency plan / PSSP completed and reviewed with personnel?

  • Equipment operator training documented? (Ex. CCO, forklift)

  • Company safety policy available?

  • Critical set-up plan completed when working near energized lines?

  • Training documented: safety orientation, OSHA 10 & 30, first aid/CPR?

  • New hires drug tested within last 12 months?

  • Toolbox talks conducted and documented?

  • Competent person on site?

Emergency/First Aid

EMERGENCY / FIRST AID

  • Fire extinguishers inspected and storage location marked?

  • Fire extinguishers readily available during hot work?

  • First aid kits available and location marked?

  • Eye wash accessible?

  • Emergency contacts and maps posted in known location?

General Safety

GENERAL SAFETY

  • Back-up alarms operational on vehicles?

  • Task lighting adequate?

  • Monitoring of weather conditions as required?

  • Rebar caps used on impalement hazards?

  • Good housekeeping in storage and work areas?

  • Personnel demonstrate safe work practices?

Personal Protective Equipment

PERSONAL PROTECTIVE EQUIPMENT

  • Safety glasses with side shields or goggles available & being used.

  • Proper tinted lens for welding, cutting.

  • Face shield being used?

  • Foot protection worn as required?

  • Hearing protection worn when required?

  • Hard hats proper and worn correctly?

  • Harness/Lanyard/D ring extender

  • High viz and reflective clothing worn?

  • Arc-rated FR clothing worn when required?

Hand Tools / Power Tools

HAND TOOLS / POWER TOOLS

  • Unsafe hand tools removed from service?

  • Pneumatic power tools have hoses secured?

  • Portable circular/table saws equipped with protective guards?

  • Impact tools/hammers kept free from splinters/mushrooming?

  • Impact style air tools have safety clips/retainers installed?

  • Grinders have guards in place?

  • Spill kits available?

Hazard Communication

HAZARD COMMUNICATION

  • All hazardous chemicals labeled appropriately?

  • Flammable liquids in approved safety cans?

  • SDS available on site?

Electrical Safety

ELECTRICAL SAFETY

  • Ground cable tested within two (2) years?

  • Ground cables available, used when required, absent of damage?

  • Ground rods available and used when required?

  • Electrical hand tools are grounded or double insulated?

  • Electrical cords inspected and have all prongs in tact?

  • Portable generators/welders equipped with GFCI's?

  • GFCI's used properly for portable hand tools?

  • Overhead lines de-energized and grounds visible?

  • MAD maintained with overhead lines?

  • Ground cable test dates:

Cranes and Derricks

CRANES AND DERRICKS

  • Rigger and signal person trained and using proper signals?

  • Outrigger pads being used?

  • Swing radius protected?

  • Operator demonstrating safe work practices?

  • Equipment capacity adequate for the load?

  • Annual inspection documented?

  • Daily inspection documented?

Fall Protection

FALL PROTECTION

  • Proper fall protection while working at or above six feet?

  • Open holes securely covered and labeled?

  • Barricades minimum six feet from excavation?

  • Anchor points available and used? Minimum four feet from excavation?

Material Handling

MATERIAL HANDLING

  • Workers demonstrating safe work practices? (Tag lines, spotting equipment, not standing under load, etc.)

  • Fork lift hoisting load using hook attachment with retention cable?

  • Lifting hooks and/or safety latch absent of deformation?

  • Rigging inspected for damage and used properly?

  • Lift/Loader operator demonstrating safe work practices?

Compressed Gas

COMPRESSED GAS

  • Compressed gas cylinders not in use have caps in place?

  • Oxygen/acetylene torch units have flashback arrestors?

  • Compressed gas cylinders stored secured & upright?

Ladders

LADDERS

  • "A"-frame ladders only used in the open position?

  • Ladder extends three (3) feet above landing?

  • Ladders in safe working order and labels legible?

Other Safety Observations

OTHER SAFETY OBSERVATION

OTHER SAFETY OBSERVATION

360-DEGREE JOB SITE PHOTOS

  • Photograph job set-up, work in progress, site conditions and equipment.

Signature

  • Add signature

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