Information

  • General Contractor / Client

  • Job Name & Number

  • Conducted on

  • Prepared by

  • Location / Address
  • Personnel

  • Subcontractors On Site

JOB INFORMATION

  • Safety Book?

  • Tool box safety talks?

  • SDS Book?

  • Work areas properly signed and barricaded?

  • Water available?

  • Adequate Lighting?

HOUSEKEEPING

  • Work areas neat?

  • Waste containers provided and used?

  • Passageways and walkways clear?

  • Cords and leads safe?

FIRE PREVENTION

  • Adequate fire extinguishers, checked and accessible?

  • Hot Work Permit Filed?

  • "No Smoking" posted and enforced near flammables?

  • Have WSM owned fire extinguishers been inspected this month?

ELECTRICAL

  • Extension wires with bare wires or missing ground prongs taken out of service?

  • Ground fault interrupters being used?

  • Terminal boxes equipped with required covers?

HAND, POWER & POWDER ACTUATED TOOLS

  • Hand tools inspected regularly?

  • Guards in place on tools?

  • Correct tool being used for job at hand?

  • Power tools and cords inspected daily?

  • Powder actuated tools cleaned and inspected regularly?

  • Operators of powder actuated tools licensed?

FALL PROTECTION

  • Safety rails and cables secured properly?

  • Safety harnesses inspected and worn properly?

  • Employees exposed to fall hazards tied off?

  • Employees below protected from falling objects?

LADDERS

  • Extension Ladders extended at least 36" above landing?

  • Extension Ladders are secure to prevent slipping, sliding or falling?

  • Ladders inspected daily?

  • Stepladders used in fully open position?

  • No step at top two rungs of stepladder?

SCAFFOLDING

  • All scaffolding inspected daily?

  • Erected on sound rigid footing?

  • Tied to structure as required?

  • Guardrails, intermediate rails, toe boards and screens in place as required?

  • Planking is sound and sturdy?

  • Proper access provided?

  • Employees below protected from falling objects?

FLOOR & WALL OPENINGS

  • All floor openings securely covered or barricaded?

  • Perimeter protection in place?

  • Deck planks secure?

  • Materials stored away from edge?

TRENCHES, EXCAVATION & SHORING

  • Competent person identified and present?

  • Excavations are shored and sloped back?

  • Materials are stored at least 2' away from trench?

  • Ladders provided every 25' in trench?

  • Equipment is at a safe distance from edge of trench or excavation?

MATERIAL HANDLING

  • Materials properly stored or stacked?

  • Employees using proper lifting techniques?

  • Tag lines used to guide loads?

  • Proper number of workers for each operation?

WELDING AND BURNING

  • Gas cylinders stored upright?

  • Proper separating distances between fuels & oxygen?

  • Goggles or shields used?

  • Fire extinguishers readily available?

  • Hoses in good condition?

CRANES

  • Outriggers extended and swing radius barricade in place?

  • Operator is familiar with load charts?

  • Hand signal charts on crane?

  • Crane operator logs up to date?

  • Employees kept from under suspended loads?

  • Chains and slings inspected and tagged as required?

PERSONAL PROTECTIVE EQUIPMENT

  • Hard hats being worn?

  • Safety glasses being worn?

  • Respirators used when required? Proper respirator documentation available?

  • Hearing protection being worn when required?

  • Traffic vests or high visibility clothing material being worn?

Arc Flash Gear

  • Jump Suit available and inspected?

  • Arc Gloves available and inspected?

  • Arc Helmet and sock available and inspected?

Company Vehicle

  • Oil life ok?

  • Tire tread and pressure ok?

  • Windshield and mirrors in good condition?

  • Pucks and Locks in use?

  • License Plate Registration / Sticker current?

  • Class-D Safety Lane sticker current?

  • Are all tools and ladders belonging to your vehicle in good condition?

SUBCONTRACTOR'S

  • Westside Mechanical's Subcontractors working Safe?

SIGNATURES

  • Foreman Signature

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.