Fly & Form Inspection

• Safety inspection

• Document No.

• Location:
  Address

• Job-site Name and Number

• Conducted on

  Date

• Prepared by:

• Superintendent Onsite

• Are all work areas pertaining to our work satisfactory on housekeeping?

  Safe

  At Risk

  N/A

• Are mandatory posting requirements provided and visible at the job site?

  Safe

  At Risk

  N/A

• Is the company safety program, hazard communication program, and SDS provided?

  Safe

  At Risk

  N/A

• Is the SDS/ Globally Harmonized System up to date on all products on-site?

  Safe

  At Risk

  N/A

• Are all employee's participating in Weekly Tool-Box Training?

  Safe

  At Risk

  N/A

• Are Daily Safe-Plan of Actions being completed?

  Safe

  At Risk

  N/A

• Are all documents in order and filed?

  Safe

  At Risk

  N/A

• Are employee training records kept and accessible for review by employees, as required by OSHA standards?

  Safe

  At Risk

  N/A

• Are emergency phone numbers posted?

  Safe

  At Risk

  N/A

• Are occupational injuries or illnesses, except minor injuries requiring only first aid, recorded as required on the OSHA 300 log?

  Safe

  At Risk

  N/A

• Is the scrap material piled together through-out the site

  Safe

  At Risk

  N/A

• Is the OSHA 300 log posted and visible on the months of February, March, and April?

  Safe

  At Risk

  N/A

• Is a first aid log up to date with minor injuries?

  Safe

  At Risk

  N/A

• Is a first aid kit stocked, and easily accessible to employees?

  Safe

  At Risk

  N/A

• Adequate trash containers provided?

  Safe

  At Risk

  N/A

• Any protruding/impalement objects exposed?

  Safe

  At Risk

  N/A

• Is there an eye-wash station or sink available for quick drenching or flushing of the the eyes and body?

  Safe

  At Risk

  N/A

• Is the local fire department familiar with the job site, its location and specific hazards?

  Safe

  At Risk

  N/A

• Are portable drinking containers provided for employees on the job site?

  Safe

  At Risk

  N/A

• Are single service cups supplied both with a sanitary container for unused cups and a receptacle for disposing of the used cups provided?

  Safe

  At Risk

  N/A

• Are all spilled hazardous materials or liquids, including blood and other potentially infectious materials, cleaned up immediately and being conducted properly?

  Safe

  At Risk

  N/A

• Are walkways kept clear and identified if in need?

  Safe

  At Risk

  N/A

Additional information

• Are all employee's wearing safety glasses 100% of the time on the job-site?

  Safe

  At Risk

  N/A

• Are all safety glasses Z87 rated?

  Safe

  At Risk

  N/A

• Are all employee's wearing suitable gloves pertaining to their task?

  Safe

  At Risk

  N/A

• Are employee's wearing hard-hats at all times on the job-site?

  Safe

  At Risk

  N/A

• Are any of the hard-hats visibly damaged to take and replace?

  Safe

  At Risk

  N/A

• N-95 Dusk Mask/ respirators being used with a voluntary use of a disposable respirator filed and signed?

  Safe

  At Risk

  N/A

• Are methods put in place such as fans, water, and vacuums to contain/control dust particles in the environment?

  Safe

  At Risk

  N/A

• Reflective Vests or high visibility shirts worn on-site

  Safe

  At Risk

  N/A

• Hearing protection worn if in need at high noise levels?

  Safe

  At Risk

  N/A

• Leather work boots and Steel toe protection if using tamps?

  Safe

  At Risk

  N/A

• Face shields worn on all needed tasks such as welding,cutting, or a possible splash of harsh chemicals?

  Safe

  At Risk

  N/A

Additional information

• Safety cans are used to store gasoline or diesel? (Plastic cans are prohibited on the job-site).

  Safe

  At Risk

  N/A

• Are the cans labeled what it contains? (GAS, DIESEL, Mixed GAS, etc.)

  Safe

  At Risk

  N/A

• Are fire extinguishers provided for every 3,000 square feet of protected space?

  Safe

  At Risk

  N/A

• Are fire extinguishers available for all areas? (Fuel containers on-site, fuel storages, all equipment on-site, etc.)

  Safe

  At Risk

  N/A

• Are all the requirements met on labeling and protecting storage areas such as "no smoking signs" and a berm around the tanks?

  Safe

  At Risk

  N/A

• Are burn permits up to date where necessary on-site?

  Safe

  At Risk

  N/A

• Propane is not stored inside?

  Safe

  At Risk

  N/A

• Hoses are not exposed to damage?

  Safe

  At Risk

  N/A

• Propane storage areas have "No Smoking" signs posted and are barricaded by high visible fencing?

  Safe

  At Risk

  N/A

Additional information

• Fuel gas tanks (Oxygen/Acetylene/Gas/Diesel) are labeled and gauges and holes are free of deflects.

  Safe

  At Risk

  N/A

• If arc welding activities are being performed, screening is provided to shield arc?

  Safe

  At Risk

  N/A

• When being stored, Oxygen cylinders are separated from combustible cylinders and materials by 20ft.

  Safe

  At Risk

  N/A

• Are flashback arrestors installed on the hose/cylinders?

  Safe

  At Risk

  N/A

• Are compressed gas cylinders regularly examined for obvious signs of defects, deep rusting, or leakage?

  Safe

  At Risk

  N/A

• Are air compressors equipped with pressure relief valves and pressure gauges?

  Safe

  At Risk

  N/A

• Are employee's strictly prohibited from directing compressed air towards a person and if used for cleaning purposes trained to reduce the pressure to less than 10 pounds per square inch?

  Safe

  At Risk

  N/A

• Are safety chains or other suitable locking devices used at couplings of high-pressure hose lines where a connection failure would create a hazard?

  Safe

  At Risk

  N/A

Additional information

• Are 3-wire construction grade cords are being used that are free of damage or defects?

  Safe

  At Risk

  N/A

• Power tools that are double insulated with no damage or defects to alter safely or performance.

  Safe

  At Risk

  N/A

• Ground Fault Circuit Interrupters are provided.

  Safe

  At Risk

  N/A

• Panel box is provided with a cover. No knockouts or blanks are missing from panel.

  Safe

  At Risk

  N/A

• If overhead power lines exist, have measures been taken to address the hazard.

  Safe

  At Risk

  N/A

Additional information

• Does a competent person exist?

  Safe

  At Risk

  N/A

• Name of competent person:

• Safe access is providing at all working levels.

  Safe

  At Risk

  N/A

• Guardrails are provided on working levels 10ft or more in height.

  Safe

  At Risk

  N/A

• Bases are provided on scaffold frame legs and mudsill (2 X 10 minimum)

  Safe

  At Risk

  N/A

• Working platforms are fully planked.

  Safe

  At Risk

  N/A

• Scaffolds are anchored properly.

  Safe

  At Risk

  N/A

• Guardrails are maintained at loading area.

  Safe

  At Risk

  N/A

• Components free of damage or defects

  Safe

  At Risk

  N/A

• Scaffolds secure from any danger.

  Safe

  At Risk

  N/A

Additional information

• Guardrails provided and structurally sound.

  Safe

  At Risk

  N/A

• Floor holes are covered, secured and labeled "HOLE" or "COVER"

  Safe

  At Risk

  N/A

• Fall arrest systems properly implemented.

  Safe

  At Risk

  N/A

• Upcoming fall hazards addressed and planned for future proceedings.

  Safe

  At Risk

  N/A

• Wall openings temporarily covered or rails.

  Safe

  At Risk

  N/A

Additional information

• Netting if used checked daily

  Yes

  No

  N/A

• Drop Nets installed and used correctly

  Yes

  No

  N/A

• Body Harnesses approved for use in the field

  Yes

  No

  N/A

• Lanyards approved for use in the field

  Yes

  No

  N/A

• Is every retractable inspected and approved for use in the field

  Yes

  No

  N/A

• If Rope and Rope Grabs are used have they been inspected and approved

  Yes

  No

  N/A

• Are the Concrete anchors inspected, installed, and used properly

  Yes

  No

  N/A

• If Dyna-lines are used, are they installed and used correctly

  Yes

  No

  N/A

• If Pan-Pro anchors are used, are they installed and used correctly

  Yes

  No

  N/A

• Any other Fall Protection Equipment: Inspected, installed, and used properly.

  Yes

  No

  N/A

Additional information

• Guards are provided for tools?

  Safe

  At Risk

  N/A

• Guards are not being rigged and checked regularly?

  Safe

  At Risk

  N/A

• Tools being used are free of damage or defects?

  Safe

  At Risk

  N/A

• Are the proper tools being used for the job task.

  Safe

  At Risk

  N/A

• Are cords on the tool free from damage?

  Safe

  At Risk

  N/A

• Are broken or fractured handles or hammers, axes, sledge hammers and similar equipment removed/replaced promptly?

  Safe

  At Risk

  N/A

• Are hand tools, such as chisels, punches, etc., which develop mushroomed heads during use, reconditioned or replaced?

  Safe

  At Risk

  N/A

Additional information

• Are Operators wearing seatbelts?

  Safe

  At Risk

  N/A

• Have the Operators checked equipment before usage (Keeping log updated)?

  Safe

  At Risk

  N/A

• Are all fluids adequate on the equipment?

  Safe

  At Risk

  N/A

• Are the Operators qualified or authorized by their employer with proper training to operate the equipment (Forklift/Lull, Aerial Lift, Scissor Lift, Excavator,Skid Steer, etc.)?

  Safe

  At Risk

  N/A

• Are the back up alarms, horns, brakes, etc. operational?

  Safe

  At Risk

  N/A

• Are Spotters used when needed?

  Safe

  At Risk

  N/A

Additional information

Cranes

• Crane Operators are licensed with the state and or local jurisdiction?

  Safe

  At Risk

  N/A

• Crane Inspection Log kept up to date with routine inspections?

  Safe

  At Risk

  N/A

• Is the manual on-site?

  Safe

  At Risk

  N/A

• Accessible areas within the swing radius of the crane barricaded to prevent employee / pedestrian access/exposure?

  Safe

  At Risk

  N/A

Qualified Rigger / Signal Person

• Is an illustration of ANSI hand signals posted at the job-site?

  Safe

  At Risk

  N/A

• Are the personnel rigging and signaling the load qualified?

  Safe

  At Risk

  N/A

• Is there clear communication with the Operator?

  Safe

  At Risk

  N/A

• Are the slings, spreaders, and any shackles used for rigging inspected before being used on the job-site?

  Safe

  At Risk

  N/A

• Are the safety latches inspected and satisfactory?

  Safe

  At Risk

  N/A

• Is the one eye per hook method being implemented?

  Safe

  At Risk

  N/A

• Are tag-lines being used on every load?

  Safe

  At Risk

  N/A

• Is a warning sound blown on every load?

  Safe

  At Risk

  N/A

Additional information

• Is the underground installation accounted for by contacting the known local number?

  Safe

  At Risk

  N/A

• Is a competent person for excavations on-site?

  Safe

  At Risk

  N/A

• Name of competent person:

• Is there safe access / egress provided from the excavation and travel distance is not exceeding 25 ft

  Safe

  At Risk

  N/A

• Are daily inspections along with change due to subject matters such as rain being conducted by a competent person?

  Safe

  At Risk

  N/A

• Is the excavation or trench free of water?

  Safe

  At Risk

  N/A

• If not then are proper procedures being taken to address and correct the hazard?

  Safe

  At Risk

  N/A

• Is the excavation sloped or shored properly as per the soil type (Solid Rock, Type A., Type B., Type C.)?

  Safe

  At Risk

  N/A

Trench Box

• If a trench box is being used is it a manufactured design?

  Safe

  At Risk

  N/A

• Is documentation provided on how to properly install and the designed strength?

  Safe

  At Risk

  N/A

• Has proper training been conducted ?

  Safe

  At Risk

  N/A

Additional information

Stripping

• Are Stripping areas barricaded on all sides allowing access with proper flagging (Every 4 ft)?

  Safe

  At Risk

  N/A

• Is it at a safe distance (10 ft minimum)?

  Safe

  At Risk

  N/A

• Are areas below the Stripping area barricaded?

  Safe

  At Risk

  N/A

• Are Spotters on the lower levels to enforce none permitted access in the Stripping area?

  Safe

  At Risk

  N/A

• Are CAZ signs up with the barricade?

  Safe

  At Risk

  N/A

Leading-Edge

• Are Leading-Edge areas barricaded on all sides allowing access with proper flagging (Every 4 ft)?

  Safe

  At Risk

  N/A

• Is it at a safe distance (6 ft minimum)?

  Safe

  At Risk

  N/A

• Are CAZ signs up with the barricade?

  Safe

  At Risk

  N/A

• Is the area below the leading-edge barricaded to inform other personnel of overhead work?

  Safe

  At Risk

  N/A

Additional CAZ / Temporary Barricade areas

• Are lines up and all procedures taken place correctly?

  Safe

  At Risk

  N/A

Additional information

Outrigger

• Are guardrails installed on all three exposed sides?

  Safe

  At Risk

  N/A

• Are CAZ signs with the line up to prevent unauthorized personnel?

  Safe

  At Risk

  N/A

• When and if relocating are Spotters on the ground with area barricaded?

  Safe

  At Risk

  N/A

• Is the area the Outrigger is moving from and next expected area barricaded to prevent unauthorized personnel?

  Safe

  At Risk

  N/A

• Are warning sounds blown when releasing shoring, relocating, and setting?

  Safe

  At Risk

  N/A

Tables (Platforms)

• Are both the Stripping level and Setting level both barricaded to prevent unauthorized personnel in the area?

  Safe

  At Risk

  N/A

• Are CAZ signs and lines up on fall exposure areas?

  Safe

  At Risk

  N/A

• Are employees following correct protocol to fly the table?

  Safe

  At Risk

  N/A

• Are employees exposing themselves to a hazard?

  Safe

  At Risk

  N/A

Additional information

Ladders

• Are ladders free from damage or any defects?

  Safe

  At Risk

  N/A

• Are landing platforms secure and free from any damage or defects?

  Safe

  At Risk

  N/A

• Are step ladders fully open when in use?

  Safe

  At Risk

  N/A

• Are all ladders the proper size for the task ad used correctly?

  Safe

  At Risk

  N/A

• Are ladders secure at the top and the bottom?

  Safe

  At Risk

  N/A

• Are side-rails extending 36 inches above the landing platform?

  Safe

  At Risk

  N/A

• Is there a clear access / egress to all ladders?

  Safe

  At Risk

  N/A

• Are offset guardrails at the ladder way?

  Safe

  At Risk

  N/A

• Top step or top step ladder are not being used to work from?

  Safe

  At Risk

  N/A

• Are all labeling on the ladder legible and none are missing?

  Safe

  At Risk

  N/A

• Ladders are being used as they are designed. Planks are not supported at both ends by ladders to create a work platform?

  Safe

  At Risk

  N/A

Stairway

Additional information

• Is a permit completed before any other steps?

  Safe

  At Risk

  N/A

• Is a tester used to check the air in the confined space?

  Safe

  At Risk

  N/A

• Is there proper access into the area?

  Safe

  At Risk

  N/A

• Are Spotters used to check employees in the area?

  Safe

  At Risk

  N/A

• Is there clear communication for if any issues rise?

  Safe

  At Risk

  N/A

• Is there proper ventilation?

  Yes

  No

  N/A

Additional information

• Are re-shores properly tied back near edges?

  Yes

  No

  N/A

• Additional Information

  Yes

  No

  N/A