Information
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Project/Job
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Conducted on
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Prepared by
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Location
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Personnel
WORK AREAS
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A. General Housekeeping
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B. Walking - Working Surfaces
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C. Unprotected Edges or Holes
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D. Materials Storage
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E. Bin accessible and in close location to block work
PERSONAL PROTECTIVE EQUIPMENT
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A. Hard Hats
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B. Face Shield / Goggles
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C. Respiratory Protection (If Required)
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D. Hearing Protection
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E. Clothing (Hi Vis)
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F. Foot Protection (steel caps)
TOOLS EQUIPMENT AND ELECTRICAL
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A. Power Tools
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B. Inspected (in test date)
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C. In Good Condition
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D. Other:
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E. Tag Out
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F. Extension Cords
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G. Lock box tidy
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SCAFFOLD
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A. Platform Deck 4 planks wide
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B. Level Footing/Set up
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C. Setup correct (pins secured correctly)
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D. Not overloaded
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E. General Inspection
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F. Mobile scaffold setup correctly and safely
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G. Ladder setup and being used correctly for scaffold access
Communication
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A. MSDS on Site
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B. SWMS on site
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C. Has site foreman requested SWMS and MSDS from Head Office
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D. Site plans (current up to date)
OTHER
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A.
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B.
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C.
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D.
Comments/Recommendations
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Enter any corrective actions that will be undertaken
Sign Off
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Site foreman
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Bricklayer/labourer
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Bricklayer/labourer
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Bricklayer/labourer
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Bricklayer/labourer
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Bricklayer/labourer
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Bricklayer/labourer
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Bricklayer/labourer
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Bricklayer/labourer
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Bricklayer/labourer
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Bricklayer/labourer
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Bricklayer/labourer
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Bricklayer/labourer
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Bricklayer/labourer
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Bricklayer/labourer
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Bricklayer/labourer