Information
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Job Name
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Client / Site
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Conducted on
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Prepared by
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Sub-contractors
1. Personal Protective Equipment (PPE)
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Lack of, or inadequate personal protective equipment.
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Hard Hats (used when needed)
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Safety Glasses / Face Protection (utilized when needed)
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Work Boots / Steel boots as needed
Work Environment
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Lack of/or inadequate amenities? (toilets, wash areas, lunch rooms, etc)
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Lack of / or inadequate lighting?
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Work place is a comfortable temperature?
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Indoor air quality and ventilation is adequate?
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Areas are clear of debris and hazards / Clean and clear walkways ?
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Lack of, or inadequate, Traffic Management Plan (TMP) in place for building occupants and construction workers?
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Adequate tool box talks and OSHA postings onsite?
Emergency Preventions and Procedures
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Fire Extinguishers for every 3,000 sq. ft. of protected building space and 100ft of travel distance
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Lack of, or no emergency information/plans onsite?
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Lack of, or inadequate first aid kits on site?
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Site Safety Plan / Emergency Procedures displayed on site?
Tools and Equipment
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Unsafe or damaged tools or equipment?
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Lack of inspection protocol for equipment?
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Lack of or inadequate formal training for operators?
Ladders / Scaffolds / Fall Protection
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Unsafe or damaged ladders?
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Unsafe positioning of ladders?
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Ladder unsuitable for job? (e.g. metal ladder used for electrical work)
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Unsafe or incomplete scaffold?
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Lack of inspection protocol for scaffold?
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Any employee working 6' or above a lower level has adequate protection?
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Harnesses used, properly secured and inspected when needed?
Electrical Safety
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All cords protected by GFCI, inspections current, no frayed wires or electrical tape on cords?
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Temporary lighting properly supported?
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Contact with overhead electrical lines?
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Overloading outlets?
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Leads placed on ground or on metal structures?
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Lack of Lock-out/tag-out (LOTO) procedures for electrical equipment?
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Proper covers, faceplates on switches and outlets in use?
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Warning signs in place to inform of electrical hazards?
Corrective Actions
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Enter any corrective actions that will be undertaken
Sign Off
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On site representative