• Site/Account:

  • Assessment Date

  • Inspected/Prepared by

  • Location
  • Participating Personnel


  • Review - Account Operations Plan Overview, Scope of Services,
    Identify High Risk Tasks
    - Review Job Plans
    Site Walk Through and Gap Analysis

  • Site description (general scope and comments)

  • Number of Full Time Employees (FTE's) 1 - thru 75

  • Scoring Criteria NA = Not Applicable 0 = Totally Unacceptable (RED) 1 = Needs Improvement (YELLOW) 2 = Meets Requirements (GREEN)

  • Review the section questions with all members of site supervision and summarize findings in this text area.:

  • Management Team Comments

Resource Awareness

  • Employees aware of our mandatory rules?

  • Employees are able to describe the elements or intent of the Be There For Life Policy

  • BTFL Policy Posted?

  • Employees demonstrate where / how to find the BTFL policy

  • Employees aware of SWP's and how to access?

  • Employees aware of GWP's, how to access or evidence of use?

  • Employees are aware and seeing Safety Alerts from the safety department?

  • Are EMCOR Pretask Planning guides or another form of Job Hazard Analysis JHA or safe work plan being utilized on site?

  • Employees meet at the start of each shift to review daily tasks, open work orders, and appropriate safety procedures.

  • Supervisor or representative regularly conduct and document Field Safety Observations?

  • Corrective actions related to field observations are documented and reviewed with the team regularly?

  • Monthly and annual Fleet Vehicle Inspections are being completed?

  • Fleet Vehicle Related Comments

  • Supervision is aware of proper accident investigation forms?

  • Demonstrated knowledge and methodology surrounding incident investigation/root cause finding, and corrective actions?

  • Accident Investigation Comments:

  • Employees are aware of the EFS Reporting Line and reporting requirements?

  • Appropriate toolbox talks and/or Good Work Practices are distributed weekly?

  • Toolbox talks available for review signed and dated?

  • Toolbox Talk Comments:

  • Employees evidence knowledge Hazard Communication labeling related to the new GHS revision and Safety Data Sheets

  • Employees have knowledge of Safety Data Sheets (SDS) and how to access?

  • The EM & FS/Viox number for accessing SDS' is posted in conspicuous area / bulletin board?

  • SDS managed through client supply and control?

  • SDS related Comments:

  • Are training records / matrix available for the site?

  • Are there any client or contract specific training requirements?

  • Evidence that local or vendor supplied training is communicated to HQ for data tracking?

  • Training records are up to date and shared with HQ for data tracking?

  • Training related Comments:

  • Ask what we get requested to do that might be out of scope?

  • Are any employees using respirators at the site?

  • Fit Test / Training records are up to date and shared with HQ for data tracking?

  • Respirator Related Comments:

  • Are any EFS employees trained on first aid response or part of a first aid response team?

  • Employees using respirators have current medical evaluations and annual training / fit testing?

  • Are any EFS employees expected to clean up blood or bodily fluids?

  • Have employees expected to treat injuries or clean up blood/bodily fluids received Hepatitis B Training?

  • Have they been offered and received Hepatitis B vaccinations at no cost?

  • First Aid Related Comments:

  • Does our team self perform any work in confined spaces?

  • Have authorized personnel received Confined SpaceTraining?

  • Employees evidence Confined Space Entry controls and limitations

  • All necessary equipment for confined space entry and monitoring is available?

  • Confined Space Related Comments:

  • Employees aware of and how to access Hazardous Energy Control Program - Lock Out/Tag Out SWP

  • Employees demonstrate training and understanding to isolate all energy sources related to the equipment

  • LOTO Employee Observation Comments

  • Does the Site have equipment specific Lockout Tagout (LOTO) procedures?

  • LOTO Related Comments:

  • Does the Site have a work order or procedures to re-certify electrical gloves every 6 months?

  • Electrical Glove Related Comments:

  • Does anyone have occasion to work with live electric?

  • Are they trained in NFPA 70E?

  • Employees evidence knowledge of NFPA 70E Arc Flash Procedures and related equipment access,

  • Is NFPA 70E gear available and evidence of use?

  • Arc Flash Related Comments


  • Incident reporting number posted?

  • First Aid supplies available

  • Safety Bulletin Board current and orderly

  • Comments:


  • Project or active work activities - Good site layout of materials observed?

  • Work activity areas - access/dust control properly managed?

  • General site observations - Material Stacked and stable?

  • Flammables - combustibles properly stored/access clear?

  • Our work activity cords/cables routed properly out of walkway?


  • Head protection available and worn as required?

  • Eye protection appropriate for hazards?

  • Foot protection - hard soled and safety toe?

  • Hearing Protection appropriate for hazards?

  • Hand protection appropriate for hazards?

  • Respiratory protection as required for tasks?

  • Chemical Protection appropriate for exposed hazards?

  • Used/Obsserved Fall protection and anchor points have proper engineering and inspection records?

  • Proper work clothing observed being worn?

  • PPE Related Comments


  • Employees wearing correct PPE for tasks?

  • Employees working on scissor lifts properly?

  • Fall protection available in all lifts?

  • Employee's were handling materials properly?

  • Workstations are at correct height?

  • Lifting and moving devices were available?

  • Employees observed using ladders properly?

  • No materials observed being carried while ascending/descending ladder?

  • Employees are trained on operating the specific equipment being used?

  • Employees using fall protection properly?

  • Work observation comments;


  • Correct tools and tool use for task being observed?

  • No makeshift (homemade) tools Observed?


  • Defective tool procedures in place?

  • Power Tools Properly grounded or double insulated?

  • GFCI in use for extension cords observed?

  • Power Tools Observed Properly guarded and guards in good condition?

  • Observed electrical cords and connectors in good condition?


  • Are regularly scheduled ladder inspections being completed and documented? Are employees inspecting ladders prior to use?

  • Are there any wooden ladders on site and being used by us?

  • Observed employees using correct ladders for the task?

  • Observed access ladders have side rails extended 3' above top platform?

  • Rungs not over 12" on center & regular spacing?

  • Observed elevation changes of 19" - ramp or steps provided?

  • Handrails provided as required?

  • Ladder Related Comments


  • Observed universal wastes labeled, separated and stored properly according the the client's waste program?

  • Used lamps and ballasts properly stored and managed?

  • Used batteries properly stored and managed?

  • Used refrigerant oils properly stored and managed?

  • Recovered refrigerant properly stored and managed?

  • Used electronic circuit boards properly stored and managed?

  • Used mercury switches properly stored and managed?

  • List other Universal wastes as needed at end of report.

  • Environmental Related Comments


  • Good housekeeping evident?

  • Emergency road kit aboard?

  • Fire extinguisher on board?

  • Tools and materials tied down as needed?

  • Ladders properly secured to roof rack, (no bungee/rubber cords)?

  • Hazardous chemicals labeled and properly stored?

  • Cab is clean and contents secured?

  • Vehicle Related Comments


  • Is there evidence that permits are obtained as required/monitored, hot work, etc.

  • Smoking control in areas of flammable material where we are working


  • Observed cylinders secured and upright?

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

  • PPE issued and in good condition?

  • Welding shields available / in use?

  • Flash back arrestors installed?

  • Welding Related Comments:


  • Are Operator (s) qualified/trained?

  • Are we doing any crane/hoist Inspections?

  • Are crane/hoist Inspections properly documented and signed?

  • Are we managing the annual crane/hoist inspection?

  • Regarding the annual, Is the crane/hoist company providing proper reports and documentation?

  • Is there evidence that outages in the report are being addressed to assure safe crane performance?

  • Crane/hoist related comments:


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

  • Add media

  • Thank You to the site team for your time and the many courtesies. Any follow-up items are to help both you and the team to better understand and lead in the area of safety.
    We are also committed to support you in your safety efforts. If we can aid with any of the follow-up items we are a resource for you.
    In addition, "CNA" our insurance carrier can provide training, industrial hygiene, and many other on-site services. There is no charge to the site for these services. Please ask if you have any needs or concerns in this area.


  • Assessor

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.