Title Page

  • Jobsite Number/Name

  • Conducted on

  • Prepared by

JOBSITE & TRAILER

  • SITE CONDITIONS

  • OSHA/EAP/CSP/HIPP POSTED?

  • SAFETY MEETINGS - JHA'S - PRE-TASK COMPLETED & REVIEWED?

  • FIRST AID KITS?

  • FIRE EXTINGUISHERS?

PPE - EYE/HEAD/FACE/HEARING/HAND/FOOT PROTECTION

  • WEARING REQUIRED PPE FOR TASK?

TOOLS

  • TOOLS - HAND & POWER

SIGNS & BARRICADES

  • TESTING - SIGNAGE COMPLETED & IN PLACE?

  • TEST AREA SAFED OFF?

EQUIPMENT

  • FORKLIFT USE

  • SCISSOR/BOOM LIFT USE

  • CRANE ACTIVITY

  • OTHER HEAVY EQUIPMENT

ELECTRICAL

  • GFCI

  • CORDS/PLUGS/CAPS

  • LOTO

TRENCHES/EXCAVATIONS

  • ACCESS - EGRESS -CONFINED SPACE - CAVE-IN - FALL PROTECTION - BARRICADES

FALL PROTECTION

  • GUARDRAILS - FLOOR OPENINGS - LEADING EDGE

  • PFAS REQUIRED?

WALKING/WORKING SURFACES

  • SLIP - TRIP - FALL HAZARDS?

  • RAMPS - STAIRWAYS - ACCESS

  • OPEN HOLES - COVERED - SECURED - MARKED

LADDERS

  • SET-UP & USED PROPERLY

  • LABELS INTACT & LEGIBLE

  • LADDER CONDITION

SCAFFOLDS

  • SAFE TO USE?

HOUSEKEEPING/SANITATION

  • PROPER DISPOSAL OF WASTE

  • PORTABLE TOILETS - DRINKING WATER ADEQUATE?

MATERIAL STORAGE

  • MATERIALS STORED PROPERLY?

HOT WORK

  • PERMIT - COMPLETED & CURRENT?

  • COMPRESSED GAS USED & STORED PROPERLY?

TRAINING

  • TRAINING CONDUCTED?

CERTIFICATION

  • Add 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.