Information
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Site
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Conducted on
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Prepared by
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Location
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Personnel
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Add media
DESCRIPTION OF FACILITY AND SCOPE OF WORK
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Line Item Rating Information:
2 - Meets Requirements
1 - Needs Improvement
0 - Totally Unacceptable
NA - Not Acceptible
HEALTH AND WELFARE
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Location of nearest Emergency Room and Urgent Care Center
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First Aid supplies available
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Hand washing materials or facilities available
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Safety Data Sheets and Safe Work Practices Manual Available
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Emergency Preparedness: Evacuation route
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Safety Bulletin Board current and orderly
HOUSEKEEPING
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Good site layout of materials
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Site Housekeeping/Controls
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Material Stacked and stable
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Flammable - combustible stored/access clear
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Passageways/walkways clear at all times
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Cords/cables routed properly out of walkway
PERSONAL PROTECTIVE EQUIPMENT
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Head protection worn at all times
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Eye protection appropriate for hazards
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Foot protection - hard soled rubber boots
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Hearing Protection appropriate for hazards
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Hand protection appropriate for hazards
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Respiratory protection as required for tasks
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Chemical Protection appropriate for hazards
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Fall protection and anchor points adequate
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Proper work clothing
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NFPA 70E PPE available/used
EMPLOYEE WORK OBSERVATIONS
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Employees working on scissor lifts properly
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Employee's were handling materials properly
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Lifting and moving devices were available
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Employees observed using ladders properly
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Employees are trained on operating equipment being used
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Employees using fall protection properly
SAFETY PROCEDURES
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Pre-Task planning form used before starting project
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Electrical Hazards identified
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Hazardous Energy Control Program - Lock Out/Tag Out
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NFPA 70E Arc Flash Procedures involved,
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Confined Space Entry controls in place
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Hazard Communication labeling in use
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Machine guarding hazards identified
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Correct tools and use for task being observed
HAND AND POWERED HAND TOOLS
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Defective tool program in use
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Properly grounded or double insulated
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GFCI in use
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Properly guarded at all times
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Inspections of electrical cords and connectors
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Inspection and maintenance - daily/monthly
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Correct disc/speed/size/type
LADDERS, RAMPS, AND STAIRS
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Ladders inspected before use
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Ladder design and use correct for task
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Secure at top and/or base
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Side rails extend 3' above top platform
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Ramps cleated
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Stairways completed for use
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Elevation changes of 19" - ramp or steps provided
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Handrails provided as required
ENVIRONMENTAL
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Universal wastes labeled, separated and stored properly
FIRE PREVENTION/PROTECTION
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Adequate fire extinguishers for hazards
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Proper type and location
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Fire watches trained and posted where required
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No smoking signs posted
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Fire extinguisher use reported
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Flammable materials in approved containers
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Flammable distribution systems are grounded
SAFETY PERMITS
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Obtained as required/monitored, hot work, etc.
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Smoking control in areas of flammable material
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Fie extinguishers present as required by permit
WELDING/CUTTING
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Cylinders secured and upright
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Gauges removed during relocation (individual)
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Condition of hoses inspected daily
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Fire extinguishers present - 10lb ABC minimum within 50' of hot work operations
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PPE
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Welding shields in use
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Grounding - close to work station
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Cable condition inspected/rolled up not in use
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Hot work permit issued
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Equipment off when not in use.
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Machine Frame grounded
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Flash back arrestors installed
SCAFFOLDING
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Erected/Dismantled, supervised by a competent person
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Platforms, full width - 2"x10" planks secured
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Scaffold tied to structure every 20 ft
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Platform free of debris
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Base pads/casters used, scaffolds are plumb and braced
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Gaurdrails 42" highly/stable
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Materials are in good condition
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Mobil scaffolds are stationary - no ride
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Scaffold properly inspected
CRANES/LIFTING
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Operator qualified/certification
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Qualified rigger/signal person when required.
ADDITIONAL INFORMATION
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Inspector's Comments: (Document any critical observations, serious safety violations observed, employee(s) counseling required deficeincy training and/or disciplinary actions.
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Employee/Supervisor/Foreman Comments:
SGNATURES
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Inspector
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Supervisor/Foreman
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Employee