Field Safety Inpsections

• Field Safety Inspections

• Client / Site / Customer

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel / vehicle / Equipment

Life Threatening Safety Procedures

• Working in a confined space with testing, purging, ventilating procedures followed.

  Yes

  No

  N/A

• Working ALOFT (>4ft) on a pole with prior inspection / testing of the pole, working with fall protection and securing the ladder.

  Yes

  No

  N/A

• Motor vehicle driver wearing seat belt.

  Yes

  No

  N/A

• Working with AC electric after testing and donning proper PPE.

  Yes

  No

  N/A

• Is the worker donning all the PPE required when life threatening hazards exist.

  Yes

  No

  N/A

• Not smoking in hazardous locations.

  Yes

  No

  N/A

• Cave-in protection provided when entering excavations >5ft deep.

  Yes

  No

  N/A

• Are all safety guards / mechanisms in-place. No disconnecting, mofdifying, overriding or otherwise altering.

  Yes

  No

  N/A

• Are WAP signs and orange cones in-place when working in the roadway.

  Yes

  No

  N/A

• Distracted driving habits. No texting or using any electronic device while driving.

  Yes

  No

  N/A

• Yes

  No

  N/A

Basic Safety items to be inspected

• ALOFT

  Safe

  At Risk

  N/A

• CDL License, Medical Card

  Safe

  At Risk

  N/A

• Wheel Chocks

  Safe

  At Risk

  N/A

• Eyes, Eye Protection

  Safe

  At Risk

  N/A

• Fire Extinguisher

  Safe

  At Risk

  N/A

• AED

  Safe

  At Risk

  N/A

• Flagger

  Safe

  At Risk

  N/A

• Gas Cylinder(s)

  Safe

  At Risk

  N/A

• Gas Meter

  Safe

  At Risk

  N/A

• Gloves, Hand Protection

  Safe

  At Risk

  N/A

• Hard Hat, Head Protection

  Safe

  At Risk

  N/A

• Harness, Fall Protection

  Safe

  At Risk

  N/A

• Keys, Vehicle Locked

  Safe

  At Risk

  N/A

• Ladders

  Safe

  At Risk

  N/A

• DOT Log Book

  Safe

  At Risk

  N/A

• Man Hole Blower

  Safe

  At Risk

  N/A

• Man Hole Guarded

  Safe

  At Risk

  N/A

• MSDS, SDS

  Safe

  At Risk

  N/A

• DOT Annual Inspection Sticker

  Safe

  At Risk

  N/A

• Parking, Backed In

  Safe

  At Risk

  N/A

• Sump Pump

  Safe

  At Risk

  N/A

• Seat Belt

  Safe

  At Risk

  N/A

• No Smoking

  Safe

  At Risk

  N/A

• Steel Toed Work Boot, Foot Protection

  Safe

  At Risk

  N/A

• Yellow Strobe Light

  Safe

  At Risk

  N/A

• Hi-Vis Vest

  Safe

  At Risk

  N/A

• Voltage Tester

  Safe

  At Risk

  N/A

• W.A.P. Cones, Signs

  Safe

  At Risk

  N/A

• Other

  Yes

  No

  N/A

Opportunities for Improvement

• Has this inspection been discussed with Team Leader.

  Yes

  No

  N/A

• Select date

  Date

• Add signature

  Sign