Everest Mechanical Services, LLC 2024

• General Contractor / Client

• Job Name & Number

• Conducted on

  Date

• Prepared by

• Location / Address
  Address

• Personnel

• Subcontractors On Site

JOB INFORMATION

• Safety Book?

  Yes

  No

  N/A

• Tool box safety talks?

  Yes

  No

  N/A

• SDS Book?

  Yes

  No

  N/A

• Work areas properly signed and barricaded?

  Yes

  No

  N/A

• Water available?

  Yes

  No

  N/A

• Adequate Lighting?

  Yes

  No

  N/A

HOUSEKEEPING

• Work areas neat?

  Yes

  No

  N/A

• Waste containers provided and used?

  Yes

  No

  N/A

• Passageways and walkways clear?

  Yes

  No

  N/A

• Cords and leads safe?

  Safe

  At Risk

  N/A

FIRE PREVENTION

• Adequate fire extinguishers, checked and accessible?

  Yes

  No

  N/A

• Hot Work Permit Filed?

  Yes

  No

  N/A

• "No Smoking" posted and enforced near flammables?

  Yes

  No

  N/A

• Have WSM owned fire extinguishers been inspected this month?

  Yes

  No

  N/A

ELECTRICAL

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

  Yes

  No

  N/A

• Ground fault interrupters being used?

  Yes

  No

  N/A

• Terminal boxes equipped with required covers?

  Yes

  No

  N/A

HAND, POWER & POWDER ACTUATED TOOLS

• Hand tools inspected regularly?

  Yes

  No

  N/A

• Guards in place on tools?

  Yes

  No

  N/A

• Correct tool being used for job at hand?

  Yes

  No

  N/A

• Power tools and cords inspected daily?

  Yes

  No

  N/A

• Powder actuated tools cleaned and inspected regularly?

  Yes

  No

  N/A

• Operators of powder actuated tools licensed?

  Yes

  No

  N/A

FALL PROTECTION

• Safety rails and cables secured properly?

  Yes

  No

  N/A

• Safety harnesses inspected and worn properly?

  Yes

  No

  N/A

• Employees exposed to fall hazards tied off?

  Yes

  No

  N/A

• Employees below protected from falling objects?

  Yes

  No

  N/A

LADDERS

• Extension Ladders extended at least 36" above landing?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Ladders inspected daily?

  Yes

  No

  N/A

• Stepladders used in fully open position?

  Yes

  No

  N/A

• No step at top two rungs of stepladder?

  Yes

  No

  N/A

SCAFFOLDING

• All scaffolding inspected daily?

  Yes

  No

  N/A

• Erected on sound rigid footing?

  Yes

  No

  N/A

• Tied to structure as required?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Planking is sound and sturdy?

  Yes

  No

  N/A

• Proper access provided?

  Yes

  No

  N/A

• Employees below protected from falling objects?

  Yes

  No

  N/A

FLOOR & WALL OPENINGS

• All floor openings securely covered or barricaded?

  Yes

  No

  N/A

• Perimeter protection in place?

  Yes

  No

  N/A

• Deck planks secure?

  Yes

  No

  N/A

• Materials stored away from edge?

  Yes

  No

  N/A

TRENCHES, EXCAVATION & SHORING

• Competent person identified and present?

  Yes

  No

  N/A

• Excavations are shored and sloped back?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Ladders provided every 25' in trench?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

MATERIAL HANDLING

• Materials properly stored or stacked?

  Yes

  No

  N/A

• Employees using proper lifting techniques?

  Yes

  No

  N/A

• Tag lines used to guide loads?

  Yes

  No

  N/A

• Proper number of workers for each operation?

  Yes

  No

  N/A

WELDING AND BURNING

• Gas cylinders stored upright?

  Yes

  No

  N/A

• Proper separating distances between fuels & oxygen?

  Yes

  No

  N/A

• Goggles or shields used?

  Yes

  No

  N/A

• Fire extinguishers readily available?

  Yes

  No

  N/A

• Hoses in good condition?

  Yes

  No

  N/A

CRANES

• Outriggers extended and swing radius barricade in place?

  Yes

  No

  N/A

• Operator is familiar with load charts?

  Yes

  No

  N/A

• Hand signal charts on crane?

  Yes

  No

  N/A

• Crane operator logs up to date?

  Yes

  No

  N/A

• Employees kept from under suspended loads?

  Yes

  No

  N/A

• Chains and slings inspected and tagged as required?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Hard hats being worn?

  Yes

  No

  N/A

• Safety glasses being worn?

  Yes

  No

  N/A

• Respirators used when required? Proper respirator documentation available?

  Yes

  No

  N/A

• Hearing protection being worn when required?

  Yes

  No

  N/A

• Traffic vests or high visibility clothing material being worn?

  Yes

  No

  N/A

Arc Flash Gear

• Jump Suit available and inspected?

  Yes

  No

  N/A

• Arc Gloves available and inspected?

  Yes

  No

  N/A

• Arc Helmet and sock available and inspected?

  Yes

  No

  N/A

Company Vehicle

• Oil life ok?

  Yes

  No

  N/A

• Tire tread and pressure ok?

  Yes

  No

  N/A

• Windshield and mirrors in good condition?

  Yes

  No

  N/A

• Pucks and Locks in use?

  Yes

  No

  N/A

• License Plate Registration / Sticker current?

  Yes

  No

  N/A

• Class-D Safety Lane sticker current?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

SUBCONTRACTOR'S

• Westside Mechanical's Subcontractors working Safe?

  Yes

  No

  N/A

SIGNATURES

• Foreman Signature

  Sign