Information

  • Job Name

General Project Information

  • Safety Manager Assigned to this project:

  • Site hours of operation:

  • List Sub-Contractors and Competent Persons per sub:

  • Prepared by

  • Weather Conditions

  • Conducted on

  • Location

1. Planned / Scheduled work for the day:

  • 1a. Pre-Task / Safety Briefing conducted prior to task?

  • 1b. Work performed according to plan?

  • 1c. Correct tools, materials and equipment to perform task?

  • Brief description of work performed today:

  • General job / work in progress photo's:

2. Ladders / Scaffold

  • 2a. Unsafe or damaged ladders discarded, destroyed, and removed from site?

  • 2b. Ladders correctly positioned?

  • 2c. Ladders correctly secured?

  • 2d. Is scaffold present on site?

  • 2e. Was scaffolding erected according to plan, and by qualified person?

  • 2f. Is inspection tag present and completed by competent person?

  • List responsible party for scaffold, type of scaffold, inspection frequency and competent person:

  • List corrective actions taken for this section:

3. Emergency Procedures

  • 3a. Have emergency action plans been developed, distributed and communicated?

  • 3b. Emergency procedures posted and available at site?

  • 3c. Assembly area / gathering point established and communicated to all employees?

  • 3d. First aid kits and equipment readily available and inspected?

  • 3e. Are Hazcom/SDS present, available and up to date?

4. Personal Protective Equipment (PPE)

  • 4a. Is required PPE supplied, utilized and maintained for the task?<br>

  • 4b. Training in the safe use, maitenance and inspection of PPE?

  • List any specialized PPE required for this job?

5. Fall / Perimeter Protection

  • 5a. Is fall prevention and protection plan developed, documented and communicated to all employees?

  • 5b. Guardrail systems constructed and maintained according to code or other contractual requirments

  • 5c. Holes greater than 2" covered, secured, and clearly marked?

  • 5d. Fall arrest equipment provided & personnel trained?

  • 5e. Fall exposures protected according to fall protection plan?

  • 5f. Has any FALL-ARREST equipment been removed from service due to wear, defects, or fall experience?

  • List corrective actions taken for its section

6. Restricted Access Zones

  • 6a. Are restricted access zones being used for Grinding, Window Installation, Look-Out, Hoisting Path, Excavation, etc.?

  • 6b. Are Restricted Access Zones being erected and maintained where needed?

  • 6c. Are barricades, flagging and signage in use?

7. Lifting Equipment

  • 7a. Correct Hoisting Equipment chosen for task at hand? (Right machine for the task?)

  • 7b. Hoisting plan developed and documented?

  • 7c. All workers, and operators aware of hoisting loads over head and near power lines, practices and procedures according to company policy and OSHA Standards?

  • 7d. Has any lifting equipment, including ropes, slings, chains been removed from service? If so, explain in comment section.

8. Work Environment

  • 8a. Are work areas lighted according to standards?

  • 8b. Is task lighting required and utilized in specific areas?

  • 8c. Have house keeping deficiencies been identified and addressed?

  • 8d. Are access and egress points provided to the site and all work areas?

  • List corrective actions taken for this section:

9. Fire Prevention and Protection

  • 9a. Are flammable liquids and gases being stored correctly?

  • 9b. Are flammable liquid containers in good working order and properly labeled?

  • 9c. Are compressed gas cylinders properly stored, secured and in a upright position?

  • 9d. Are Oxygen cylinders stored a minimum of 20 feet from any other combustible/flammable liquids or gases?

  • 9e. Are fire extinguishers available in all work areas and regularly inspected?

10. Incidents, Accident, Injury, Near Miss

  • 10a. Were any incidents, injuries, accidents or near miss' to report today?

  • Detailed information and narrative?

  • Photo's

  • 10b. Have investigation reports been completed and submitted to required parties?

11. Electrical Hazards

  • 11a. GFCI outlets inspected regularly?

  • 11b. Electrical equipment placed away from water?

  • 11c. Extension cords inspected prior to use?

  • 11d. Electrical equipment at safe distance from flammables?

  • 11e. Are all power tools inspected prior to use?

  • 11f. Are electrical panels covered and clearly marked?

  • 11g. Have any electrical cords or power tools been removed from service?

12. Lock Out/Tag Out: Hazardous Energy, Equipment or Other.

  • 12a. Lock-out/tag-out (LOTO) for electrical or other hazardous equipment necessary? Please specify in detail section.

13. Excavations

  • 13a. Will excavation work be performed today?

  • 13b. Has an excavator Site Safety Program been submitted to Superintendent?

  • 13c. Is there a competent person for excavating on site?

  • 13d. Have all permits, Including McHugh Ground Disturbance Planning Form, been obtained and completed prior to digging?

  • 13e. Have all surface encumbrances been identified and support planned?

  • 13f. Have underground utilities been located and identified?

  • Have "DIG" numbers been acquired and current?

  • 13g. Are 'BACK-UP'or other movement alarms in place and functioning properly?

  • 13h. Have open excavations been protected against accidental entry?

  • 13i. Have you confirmed if shoring requires design by a structural engineer?

  • 13j. Is contaminated material being handled according to plan and disposed of properly in accordance with contractual and regulatory obligations?

  • 13k. Is erosion control in place and being maintained? i.e: silt fence, drain screens, pump sock - filter bag, etc.

  • 13m. Has the Competent Person performed tests as specified by OSHA, or used an engineering soils report, to determine classification? (A,B,C)

  • 13n. Has all earthwork been inspected by the competent person prior to persons entering and after any rain or other event?

  • 13o. Are precautionary measures in place for dewatering trenches / excavations?

  • 13p. Is benching, sloping, shoring, or shielding (support system) required?

  • 13r. Are documents for support system readily available?

  • 13r. Is support system being inspected and maintained daily? (work days)

  • 13s. Is any special insurance required, if so, has it been obtained? (RR Prospective, etc..)

  • 13t. Are dust control and street sweeping equipment being used? ie... Water truck - Street sweeper

  • 13u. Have potential atmospheric hazards been identified?

  • 13v. Are access & egress devices in place according to standards (Ladders, Stairs, Ramps)?

  • List any corrective actions taken for this section:

14. Traffic Control

  • 14a. Are safety restraint / seat belts in place and being used?

  • 14b. Are 'BACK-UP' or other movement alarms in place and functioning?

  • 14c. Is traffic control required, and in place according to Traffic Control Plan, MUTCD Standards and other governing bodies?

  • 14d. Are all traffic control devices inspected, maintained, and kept in good visible condition?

  • List responsible party for traffic control devices, placement, and maintenance:

  • Are Flaggers required?

  • Are the flaggers certified according to City, State and OSHA standards?

  • Are the flaggers trained for the task at hand, and familiar with surrounding activities?

  • List any corrective actions taken for this section:

15. Administrative Procedures

  • 15a. Procedure for incident reporting followed? (Incident, witness, injury, etc.)

  • 15b. Has Company / Site Specific orientation-training been provided to workers, contractors, visitors?

  • 15c. Correct permits acquired and filled out completely prior to task? (Hot Works, Confined Space etc)

  • 15d. Site Safety Plan readily available?

  • 15e. Supervision on site? (List Supt. & PM)

  • 15f. Are there consultative arrangements in place? (Ability to get resolution to concerns)

  • 15g. Routine inspections, monitoring, audits submitted regularly?

16. Tower & Mobile Cranes

  • 16a. Is there a crane on site today?

  • 16b. Are crane inspections current and copies available?

  • 16c. Is the load chart readily available, legible, and being followed?

  • 16d. Are signal persons and riggers qualified with proof readily available?

  • 16e. Are all hook 'Safety Locks' in working order?

  • 16f. Is crane positioned at the correct safe distance from over-head power lines?

  • 16g. Is cribbing provided under outriggers for support and load dispersion?

  • 16h. Is swing radius protected / barricaded to prevent entry?

  • 16i. Are access ladders and steps protected and in good condition?

  • 16j. Does the operator have correct licensing according to Job, City, & State requirements?

  • 16k. Is all rigging properly tagged and regularly inspected?

  • Notes for this section of any special or precautionary actions taken:

17. Site exterior condition.

  • 17a. Are all perimeter side walks clean?

  • 17b. Is all public protection in place and in good visible / functional condition?

  • 17c. Are all pedestrian pathways clean, clear of debris and clearly marked or identified?

  • 17d. Is all signage for detoured walk ways in place? i.e. 'Sidewalk closed' 'use other side' 'over head work'

  • 17e. Are canopies being used, if YES, have all hazards been eliminated? i.e.(falling debris/material, sharp edges, trip hazards)

  • 17f. Are there any temporary walkways, if yes, are the ADA (American Disability Act) compliant?

  • List any corrective actions taken for this section:

18. Site Security

  • 18a. Is the site fenced to prevent un-authorized entrance?

  • 18b. Are equipment and job trucks locked at the end of shift to prevent un-authorized use?

  • 18c. Are materials and equipment stored in a secure area to prevent theft?

  • 18d. List any site security measures that are currently in place for the site, i.e. security cameras or night time security personnel.

19. Atmospheric: Lead, Asbestos, Silica

  • 19a. Have potential atmospheric hazards been Identified? (If yes, please describe)<br>

  • 19b.Has formal testing been performed prior to beginning of task to identify hazard and exposure levels?

  • 19c. Has the hazard been remediated / abated, if yes, by whom? (please provide copies of completion reports)

  • 19d. Are employee's provided with appropriate PPE to be protected from exposure to hazard?

  • 19e. Will respirators be required as part of PPE for the task at hand?

  • Has employee been Medically Cleared & F.I.T Tested to utilize respirator?

  • Has employee been assigned a respirator for task at hand?

  • Has the employee been formally trained to use and clean Respirator correctly?

  • Are F.I.T test's & training records current and accessible?

  • Has employee been assigned a respirator for task at hand?

  • 19f. Is equipment on site to monitor potential atmospheric hazards?

  • List corrective actions taken for this section:

20. General Duty Clause, Miscellaneous Findings & Other Safety Observations

  • 20a. Were observations or miscellaneous findings that pose a potential hazard discovered during audit process?

  • Brief description & photo:

21. Observational Notes:

  • 21a. List additional notes and observations of concern generated by other activities unrelated to project:

  • Add media

Sign Off

  • Auditor's signature

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.