Information

  • Job Name

  • Client / Site

  • Conducted on

  • Prepared by

  • Sub-contractors

1. Personal Protective Equipment (PPE)

  • Lack of, or inadequate personal protective equipment.

  • Hard Hats (used when needed)

  • Safety Glasses / Face Protection (utilized when needed)

  • Work Boots / Steel boots as needed

Work Environment

  • Lack of/or inadequate amenities? (toilets, wash areas, lunch rooms, etc)

  • Lack of / or inadequate lighting?

  • Work place is a comfortable temperature?

  • Indoor air quality and ventilation is adequate?

  • Areas are clear of debris and hazards / Clean and clear walkways ?

  • Lack of, or inadequate, Traffic Management Plan (TMP) in place for building occupants and construction workers?

  • Adequate tool box talks and OSHA postings onsite?

Emergency Preventions and Procedures

  • Fire Extinguishers for every 3,000 sq. ft. of protected building space and 100ft of travel distance

  • Lack of, or no emergency information/plans onsite?

  • Lack of, or inadequate first aid kits on site?

  • Site Safety Plan / Emergency Procedures displayed on site?

Tools and Equipment

  • Unsafe or damaged tools or equipment?

  • Lack of inspection protocol for equipment?

  • Lack of or inadequate formal training for operators?

Ladders / Scaffolds / Fall Protection

  • Unsafe or damaged ladders?

  • Unsafe positioning of ladders?

  • Ladder unsuitable for job? (e.g. metal ladder used for electrical work)

  • Unsafe or incomplete scaffold?

  • Lack of inspection protocol for scaffold?

  • Any employee working 6' or above a lower level has adequate protection?

  • Harnesses used, properly secured and inspected when needed?

Electrical Safety

  • All cords protected by GFCI, inspections current, no frayed wires or electrical tape on cords?

  • Temporary lighting properly supported?

  • Contact with overhead electrical lines?

  • Overloading outlets?

  • Leads placed on ground or on metal structures?

  • Lack of Lock-out/tag-out (LOTO) procedures for electrical equipment?

  • Proper covers, faceplates on switches and outlets in use?

  • Warning signs in place to inform of electrical hazards?

Corrective Actions

  • Enter any corrective actions that will be undertaken

Sign Off

  • On site representative

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.