Information

  • Site conducted

Project Information

  • Template Title

  • Location
  • Conducted on

  • Inspection reviewed with?

  • Prepared by:

Soft Tissue Operations Mitigation Program

  • Material handling plan in place. No lifting over 50 Lbs.

  • Material Moving Equipment on site and in use (i.e. carts, dolleys,hoist, wire carts, fork lifts, etc.)

  • Proper lifting procedures addressed on site specific plan and enacted on the field?

  • Team members trained on STOMP procedures

  • Repetitive motion tasks addressed and plan in place to prevent injuries?

  • Daily Safety Huddle being done

  • what was today's topic

  • was there a JHA Performed.

  • Are coordinators performing Observations and coaching?

  • Supervisor Audits and Observations being performed

  • Supervisor set proper example to address STOMP issues – mechanical aids – Observations.

Safety Mentoring and Coaching

    Coaching mentoring Opportunity
  • Description

  • Select control needed

  • Describe hazard and elimination plan in detail

  • Details of control measure

  • Were there at risk behaviors involved?

  • What type of feed back was given?

  • To whom? describe it in detail

  • Comments

Personal Protective Equipment

  • Hard hats, safety glasses in use by all personnel

  • Gloves (sharp edges, using knives, handling materials)

  • Proper foot gear and protective clothing. Traffic vest if necessary

  • comments

Administration

  • Is site specific Plan in place?

  • Employees on site signed

  • JHA updated by supervisor according to changing scope of work?

  • Emergency program in place

  • trained personnel

  • Emergency Phone Number posted

  • State / Fed. Posters (English-Spanish) Posted?

  • Safety manual available?

  • Hazard communication program available?

  • Is there cold water provided

Hazard Communication (HazCom)

  • Employees trained on Hazard communication Risks ?

  • Proper labels on containers?

  • (SDS) Safety data Sheets manual current?

  • Emergency Action Plan available?

  • First-Aid Kit Available?

  • First-Aid/CPR trained personal onsite

  • (BBP) Bloodborne Pathogens control plan available?

  • Is training upto date?

  • Is there a Silica Exposure Control Plan In Place?

  • Is the competent person performing inspections and implementing the ECP?

  • Can the competent person identify existing and foreseeable silica hazards

  • Are exposed employees trained on silica exposure control?

  • Do employees have access to SDS sheet on silica exposure in the workplace

Medical/Emergency

  • Incident investigation proecedure in place and forms available

  • Employees understand Incident<br>Reporting procedure

  • Map to medical facility posted

  • Have there been any incidents onsite

  • Employees trained to prevent similar incidents

  • Is employee back to work

  • Why

Electrical (General)

  • Are electrical rooms actionable with company policies?

  • Electrical Rooms
  • Adequate lighting

  • Signage present

  • Electrical room protected

  • Electrical panels protected and locked

  • Energized parts protected

  • Extension cords in compliance per company policy

  • Extension Cords
  • Outer insulation damage on cords

  • Approved three wire extension cords

  • Ground prongs on cords

  • Cords protected from traffic

  • Temporary Panels actionable in accordance with SOP?

  • Temporary Panels
  • GFCI's used and functioning

  • Signage present

  • Proper use of temporary power<br>boxes

  • Safety plates on outlets and J boxes

  • J box knockouts utilized and covered

  • Hardware splices in J boxes

LOCK OUT/ TAG OUT (LOTO)

  • Are LOTO procedures actionable?

  • Are employees trained on the procedure?

  • Do they need to be Trained?

  • Plan of Action and responsible person.

  • LOTO log posted according to company policy

  • Do they Have the necessary equipment for LOTO procedures including kit, tags, permanent locks

  • Company procedure being followed and enforced?

  • what is the deficiency and how will it be corrected?

Hot Electrical Work

  • Is hot electrical work actionable?

  • JSA completed

  • All affected employees briefed

  • Proper level of PPE being used

  • Insulated gloves tested and up to<br>date

  • Electrical PPE inspected

  • LOTO procedures being used

  • Boundaries established and barriers set

  • Back up person trained in emergency<br>procedure

  • JSA steps and procedure being<br>observed

  • Energized parts protected

Ladders & Stairs

  • Are we using ladders?

  • Safe procedures being followed

  • Ladders inspected

  • Are ladder being used for its intended purpose?

  • Safe work distance kept from hazards

  • Employees not using top two rungs

  • Extension ladders only used to gain access? extended 3 feet above landing or secured at top.

  • Step ladders in the open position

  • Rope for hoisting present with<br>extension ladders

  • Landings and treads filled on stairs

  • Handrails on stairs?

  • Stairs illuminated

  • Ladder inspection

  • Ladder Inspection
  • Side rails in good condition?

  • Steps or rungs not loose or damaged?

  • Spreader braces not damaged and open fully

  • Rivets, screws or bolts not missing or damaged

  • free from oil grease or slippery materials

  • is ladder stable?

  • Non slip feet in good condition?

  • is ladder wobbly or loose?

  • hinges spreaders not loose or damaged

Fall Protection (29CFR 1926.500's)

  • Are there fall hazards present?

  • Fall protection plan (site specific) in place and employees know the requirements?

  • Are guardrails installed where JBI employees are working?

  • Floor wall and window openings protected

  • Fall protection being used at 6 feet or higher

  • Proper anchorage points used

  • Harness being worn properly

  • Employees trained

  • Safety harness, lanyards, and<br>retractable inspected?

  • Overhead protection from falling<br>objects in place ?

  • HLL and vertical life lines inspected<br>and used properly

Scissor & Aerial Lifts

  • Are aerial lifts being used?

  • Operators trained

  • Equipment/workplace inspections<br>completed and documented

  • Operators following safety<br>procedures

  • Harness and lanyard used in aerial lifts

  • Safe work distance kept from<br>elevation changes

  • Gate or chain secured

  • Nothing used to increase height

  • Load ratings observed

  • Is aerial platform operated on a flat level surface?

Motorized Equipment (Sky Jack, Backhoe etc.)

  • Is there earthmoving or telescopic handler equipment being used?

  • What kind of equipment?

  • Operator trained on that particular<br>equipment?

  • Name the employees that require training and equipment.

  • what equipment is he operating?

  • How many years of experience does he have operating the equipment?

  • When do we need to conduct training?

  • Seat belt utilized

  • Back up alarm functioning

  • Horn functioning

Hand & Power Tools

  • Is there a risk associated with hand and power tools?

  • Employees trained

  • Additional PPE provided or available

  • Safe practices being observed

  • Tool in good condition

  • Proper tool for the job

  • Information label on tool

  • Manufacturer instructions being<br>observed

  • Cord in good condition

  • Guards in place

Excavations

  • Are there any risk associated with excavations?

  • Competent person present

  • Utilities located and marked

  • Walls sloped or shored to prevent cave in prior to employees getting inside?

  • Employees trained

  • Daily Inspections documented

  • Proper access if is more than 4' deep

  • Access and exits within 25 feet

  • Fissures, cracks or shrinkage evident

  • Surface conditions acceptable

  • Perimeter protected/barricaded

  • Traffic exposure controlled

  • Top of shoring18 inches above ground

  • More than 6 inches between box &<br>excavation wall

  • Spoil 2 feet back from edge

  • Excavations more than 20 feet deep<br>engineered

  • Water entering excavation

Housekeeping

  • Are there slips, trips, hazards risk?

  • Slip, trip, fall hazards protected and<br>clearly visible

  • Slip, trip, fall hazards eliminated

  • Stairs clear of tripping hazards

  • Work platforms clean

  • Walkways clear

  • Clear access to building or site

  • Materials properly stored

  • Trash in protected container

Site & Public Protection

  • is public protection signage actionable

  • Perimeter fence or barricades<br>installed

  • Adequate lighting provided

  • Security system in place

  • Hand sanitizer available

  • Superintendent Signature

  • Comments

  • Add media

  • Safety Signature

  • Address behavioral issues positive and negative – Other general comments – PPE worn – Supervisor set proper example – accidents / near misses reported

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.