Information

  • Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Add media

DESCRIPTION OF FACILITY AND SCOPE OF WORK

  • Line Item Rating Information:
    2 - Meets Requirements
    1 - Needs Improvement
    0 - Totally Unacceptable
    NA - Not Acceptible

HEALTH AND WELFARE

  • Location of nearest Emergency Room and Urgent Care Center

  • First Aid supplies available

  • Hand washing materials or facilities available

  • Safety Data Sheets and Safe Work Practices Manual Available

  • Emergency Preparedness: Evacuation route

  • Safety Bulletin Board current and orderly

HOUSEKEEPING

  • Good site layout of materials

  • Site Housekeeping/Controls

  • Material Stacked and stable

  • Flammable - combustible stored/access clear

  • Passageways/walkways clear at all times

  • Cords/cables routed properly out of walkway

PERSONAL PROTECTIVE EQUIPMENT

  • Head protection worn at all times

  • Eye protection appropriate for hazards

  • Foot protection - hard soled rubber boots

  • Hearing Protection appropriate for hazards

  • Hand protection appropriate for hazards

  • Respiratory protection as required for tasks

  • Chemical Protection appropriate for hazards

  • Fall protection and anchor points adequate

  • Proper work clothing

  • NFPA 70E PPE available/used

EMPLOYEE WORK OBSERVATIONS

  • Employees working on scissor lifts properly

  • Employee's were handling materials properly

  • Lifting and moving devices were available

  • Employees observed using ladders properly

  • Employees are trained on operating equipment being used

  • Employees using fall protection properly

SAFETY PROCEDURES

  • Pre-Task planning form used before starting project

  • Electrical Hazards identified

  • Hazardous Energy Control Program - Lock Out/Tag Out

  • NFPA 70E Arc Flash Procedures involved,

  • Confined Space Entry controls in place

  • Hazard Communication labeling in use

  • Machine guarding hazards identified

  • Correct tools and use for task being observed

HAND AND POWERED HAND TOOLS

  • Defective tool program in use

  • Properly grounded or double insulated

  • GFCI in use

  • Properly guarded at all times

  • Inspections of electrical cords and connectors

  • Inspection and maintenance - daily/monthly

  • Correct disc/speed/size/type

LADDERS, RAMPS, AND STAIRS

  • Ladders inspected before use

  • Ladder design and use correct for task

  • Secure at top and/or base

  • Side rails extend 3' above top platform

  • Ramps cleated

  • Stairways completed for use

  • Elevation changes of 19" - ramp or steps provided

  • Handrails provided as required

ENVIRONMENTAL

  • Universal wastes labeled, separated and stored properly

FIRE PREVENTION/PROTECTION

  • Adequate fire extinguishers for hazards

  • Proper type and location

  • Fire watches trained and posted where required

  • No smoking signs posted

  • Fire extinguisher use reported

  • Flammable materials in approved containers

  • Flammable distribution systems are grounded

SAFETY PERMITS

  • Obtained as required/monitored, hot work, etc.

  • Smoking control in areas of flammable material

  • Fie extinguishers present as required by permit

WELDING/CUTTING

  • Cylinders secured and upright

  • Gauges removed during relocation (individual)

  • Condition of hoses inspected daily

  • Fire extinguishers present - 10lb ABC minimum within 50' of hot work operations

  • PPE

  • Welding shields in use

  • Grounding - close to work station

  • Cable condition inspected/rolled up not in use

  • Hot work permit issued

  • Equipment off when not in use.

  • Machine Frame grounded

  • Flash back arrestors installed

SCAFFOLDING

  • Erected/Dismantled, supervised by a competent person

  • Platforms, full width - 2"x10" planks secured

  • Scaffold tied to structure every 20 ft

  • Platform free of debris

  • Base pads/casters used, scaffolds are plumb and braced

  • Gaurdrails 42" highly/stable

  • Materials are in good condition

  • Mobil scaffolds are stationary - no ride

  • Scaffold properly inspected

CRANES/LIFTING

  • Operator qualified/certification

  • Qualified rigger/signal person when required.

ADDITIONAL INFORMATION

  • Inspector's Comments: (Document any critical observations, serious safety violations observed, employee(s) counseling required deficeincy training and/or disciplinary actions.

  • Employee/Supervisor/Foreman Comments:

SGNATURES

  • Inspector

  • Supervisor/Foreman

  • Employee

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.