Information
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Date and Time
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Job Name
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Company
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Job Number
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Location
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Leader
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Weather
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Inspector
General Requirements
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Potable Water, Toilet and Hand washing Facilities
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First Aid Kit
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Fire Extinguishers (minimum 2)
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SDS Collection and Electronic Pad
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Emergency Phone Number Poster
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Fall Plan and JHA signed
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Mentoring Program
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OSHA 3165/3167 Poster
Personal Protection
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Safety Glasses
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Hard Hats
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Hearing Protection
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Respirators
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Face Shields/Goggles
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Protective Clothing
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Safety Shoes
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Gloves
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Safety Harness & Lanyard
Roof Access
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Ladder
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Stairs
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Elevator
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Stair Tower
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Roof Hatch
Fall Protection
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Motion Stopping System (MSS)
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Guard Rail System
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Personal Fall Arrest System
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Parapet Walls (minimum 39")
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Restraint System (zero exposure)
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Warning Lines (between 34"-39")
Material Handling
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Hoist/Crane Inspected
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MSS in Place
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Proper Counterweights and Secured
Electrical
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Ground Fault Circuit Interupter
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Battery Powered
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Cord Sets in Compliance
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Tools in Compliance
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Generator Use/Grounding
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Guards Installed on Tools
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Power Lines Minimum of 10' from Walking/Working Area
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Power Line Owner Notified Prior to Work
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Insulated/Blanketed Power Lines
Covers Over Openings
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Capable of Withstanding Twice the Load
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Secured From Movement
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Marked "Cover-Do Not Remove"
Trash Chute Area
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Trash Chute Properly Secured
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Dumpsters Not Overloaded
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MSS in Place
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Chute Area Neat and Orderly
Housekeeping and Material Storage
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Roof Area Neat and Orderly
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Flammable Storage Separated and Posted
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Fire Extinguisher within 10'-25' of Flammable Storage
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Fire Extinguisher Within 75' of Work Area
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Materials Properly Stored and Secured to Prevent Tipping
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Materials Stored Over Column Lines and Beams
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Dumpster Not Overloaded
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Dumpster Area Properly Barricaded
Power Industrial Trucks
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Proof of Certification on Operator
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Seat Belt Worn
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Back Up Alarm and Horn Operable
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Manufacturer's Rating Visible and Legible/Load Chart
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Inspection Documented Prior to Use
Aerial Lifts
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Inspection Documented Prior to Use
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Outriggers Used (when applicable)
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Properly Barricaded (where applicable)
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PFAS Used
Scaffolding
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Scaffold Inspected Daily Before Use and Documented
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Level/Plumb/Fall Protection in Place
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Proper Securement of Scaffolding and Feet
Punch Cards
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Kettle Inspected and Documented
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Mobile Fall Protection Inspected and Documented
Comments and Observations
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Comments
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MEDIA