Title Page
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Jobsite Number/Name
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Conducted on
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Prepared by
JOBSITE & TRAILER
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SITE CONDITIONS
- Safe
- At Risk
- N/A
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OSHA/EAP/CSP/HIPP POSTED?
- Yes
- No
- N/A
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SAFETY MEETINGS - JHA'S - PRE-TASK COMPLETED & REVIEWED?
- Yes
- No
- N/A
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FIRST AID KITS?
- Yes
- No
- N/A
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FIRE EXTINGUISHERS?
- Yes
- No
- N/A
PPE - EYE/HEAD/FACE/HEARING/HAND/FOOT PROTECTION
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WEARING REQUIRED PPE FOR TASK?
- Yes
- No
- N/A
TOOLS
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TOOLS - HAND & POWER
- Safe
- At Risk
- N/A
SIGNS & BARRICADES
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TESTING - SIGNAGE COMPLETED & IN PLACE?
- Yes
- No
- N/A
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TEST AREA SAFED OFF?
- Yes
- No
- N/A
EQUIPMENT
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FORKLIFT USE
- Safe
- At Risk
- N/A
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SCISSOR/BOOM LIFT USE
- Safe
- At Risk
- N/A
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CRANE ACTIVITY
- Safe
- At Risk
- N/A
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OTHER HEAVY EQUIPMENT
- Safe
- At Risk
- N/A
ELECTRICAL
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GFCI
- Safe
- At Risk
- N/A
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CORDS/PLUGS/CAPS
- Safe
- At Risk
- N/A
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LOTO
- Safe
- At Risk
- N/A
TRENCHES/EXCAVATIONS
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ACCESS - EGRESS -CONFINED SPACE - CAVE-IN - FALL PROTECTION - BARRICADES
- Safe
- At Risk
- N/A
FALL PROTECTION
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GUARDRAILS - FLOOR OPENINGS - LEADING EDGE
- Safe
- At Risk
- N/A
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PFAS REQUIRED?
- Yes
- No
- N/A
WALKING/WORKING SURFACES
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SLIP - TRIP - FALL HAZARDS?
- Safe
- At Risk
- N/A
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RAMPS - STAIRWAYS - ACCESS
- Safe
- At Risk
- N/A
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OPEN HOLES - COVERED - SECURED - MARKED
- Safe
- At Risk
- N/A
LADDERS
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SET-UP & USED PROPERLY
- Safe
- At Risk
- N/A
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LABELS INTACT & LEGIBLE
- Yes
- No
- N/A
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LADDER CONDITION
- Good
- Poor
- N/A
SCAFFOLDS
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SAFE TO USE?
- Safe
- At Risk
- N/A
HOUSEKEEPING/SANITATION
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PROPER DISPOSAL OF WASTE
- Yes
- No
- N/A
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PORTABLE TOILETS - DRINKING WATER ADEQUATE?
- Yes
- No
- N/A
MATERIAL STORAGE
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MATERIALS STORED PROPERLY?
- Yes
- No
- N/A
HOT WORK
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PERMIT - COMPLETED & CURRENT?
- Yes
- No
- N/A
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COMPRESSED GAS USED & STORED PROPERLY?
- Safe
- At Risk
- N/A
TRAINING
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TRAINING CONDUCTED?
- Yes
- No
- N/A
CERTIFICATION
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