Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location

General Office And Paperwork

  • Emergency Numbers Posted

  • Zone Maps Posted

  • SDS Information Posted

  • Emergency services notified

  • Evacuation Plan Posted

  • Weekly Safety Toolbox Talk

  • Legal Id And Quarterly Reports Last 4 Required

  • Review Of Recent Incidents, Accidents

  • Daily T-5 Safety Meeting

  • Site Specific Documentation

  • MSHA Notification Posted

  • Hearing Conservation Plan

  • Annual Refresher Certification For All Miners

  • Daily Work Place Exams For The Last Year

  • All New Miner Paperwork Is Correct

  • Task Training Documentation For All On Site

  • Ground Check Sheets Current

  • Storm Shelter Inspection Sheet

  • First Aid Cabinet Stocked And No Expired Products

  • Ladder, Gfi, And Fire Extinguisher Check sheet

  • Air Compressor Monthly inspection

  • Lock Out Log Present and Current

HOUSEKEEPING

  • Tool Area Clean And Organized Free From Hazards

  • Long Handled Brush For Cleaning Loaders

  • Lids On All Metal Only Trash Cans\Dumpsters

  • Restrooms\ Kybo's Are Clean And Sanitized

  • QC Labs Are Maintained And Free From Hazards

  • Any Storage Areas Have A Clear, Organized Path

FIRE PREVENTION

  • Fire Extinguishers Checked Monthly

  • Fire Extinguishers Have Current Annual Inspections

  • Monthly Fire Inspection Report Signed Off

  • All Flammables Are Stored Properly

HAND AND POWER TOOLS

  • Any Damaged Tools Are Tagged Out And Fixed Or Disposed

  • No Trigger Locks

  • Current Color Tape For Cord Inspections

  • Come Alongs In Good Working Order Including Safety Latch

  • Pin Bars And Chisels Are Free From Burrs And Cracks

  • No Modified tools Including Sockets And Wrenches

  • All Lifting Chains and Straps In Good Condition And Tagged

  • Tow Strap Present And In Good Condition

LADDERS

  • Weight Limit And Info Tags Are Legible

  • No Cracks In Fiberglass And Smooth To The Touch

  • Used Properly And On Stable Ground

  • Top Step Is Not Being Used

  • Monthly Inspection Punch Tag

WALKWAYS & PLATFORMS

  • Walk Ways Are Clear Of Hazards And Materials

  • Toe Kicks On All Elevated Platforms

  • Hand Rails At Proper Height

  • Double Chains Or Swing Gates At All Ladder Openings

  • Chains And Gates Are Locked While Plant Is Running

ELECTRICAL

  • All Equipment Cords Are In Good Condition

  • All Power Cabinets Are Locked

  • All LOTO Has Been Reviewed And Trained By An Approved Electrician For the Portable Plants

  • Extension Cords Are Checked And Marked For Annual Continuity

  • All Cords On The Ground Are Protected From Travel Areas

  • 3' Clearance In Front Of All Electrical Cabinets And Transformers

  • No Vegetation Around Any Outside Transformers

  • Strain Relief Used Where Needed

  • Current And Legible Arc Flash Stickers

  • Voltage Marked On All Cabinets

  • All Lighting Has Been Guarded

  • All Breakers And Panels Are Correctly Labeled

  • GFI Breakers In Place Where Needed

  • Power Supply Lock Outs Can Not Be Locked In The On Position

MOBILE EQUIPMENT

  • Loaders, SkidLoaders Are Free Of Debris In The Cabs And Exterior Is Clean.

  • Company Vehicles Are Clean Chocked And Have Daily Inspections Done

  • All Equipment Is Inspected Prior To Use And Defects Are Noted

  • Back Up Alarms Can Be Heard Over The Surrounding Area

  • Wheels Are Chocked And Brake Set On All Loaders, Pickups, Trailers

  • Fire Extinguishers Are Properly Mounted and not Loose

  • Operator Sounds Warning Device Before Moving

  • Tires On Conveyors And Plants Are In Good Condition

WELDING AND CUTTING EQP

  • Screen or Shield are in use

  • Work area is clear and Fire Protection Equipment is accessible

  • Cables, hoses, connections, gauges, and tools are inspected

  • Gas cylinders are properly stored and secured

  • Equipment is chocked or secured when parked

  • Guards over valves where required

EMPLOYEE VEHICLES

  • Vehicles are parked in a designated areas away from traffic

MATERIALS AND STORAGE

  • Storage area is kept clear and free of hazards

  • Spill prevention and control is in place and fully stocked

  • Proper fire extinguisher is available and inspected

  • Proper labeling of contents for all containers

  • Flammable materials cabinet is available and in use

  • All ignition sources are kept clear of combustibles

PERSONAL PROTECTIVE EQP

  • Hard hats, proper safety boots, eye protection and gloves worn

  • Hearing protection when needed, Double protection With Gensets

  • Personnel are wearing proper protective clothing when needed

  • CPR and first aid personnel are available for each shift

  • Fall protection equipment is used and inspected and documented

  • Respiratory protection is used when needed

OVERALL SITE

  • Site Landscaping (mowing, weeds ect.) Is Up To Company Standards

  • Safe and efficient traffic patterns for mobile equipment is established and posted

  • Sufficient berms at all locations with 5 ft minimum height

  • Storm Shelters Are Clean And Have Required Radios, Blankets, And Water Available

  • All moving parts are correctly guarded and secured from 7 ft and below

  • Warning and/or danger signs are in used where needed

  • First aid, eye wash, back board and blanket is available

  • Equipment conveyors are supported and secured correctly

  • All single level concrete blocks flagged for visibility

  • Dust control present and used when needed

  • An alarm sounds and all employees are accounted for prior to start up

DREDGE

  • Free of Over Soaked Oil Rags

  • Hydraulic Lines In Good Condition

  • Guards Over Pump Parts

  • Fire Extinguishers, GFI's & Ladders Checked And Punched

  • Work And Travel Boat Daily Inspection Sheets

  • Good General Organization And Tools

  • Flammables Stored Correctly And Cabinet Labled

  • Lock Out Log Present and Current

  • Ladder Cable Condition

  • Pontoon Confined Space Labels on Hatches

  • Ladder Safety Cables

  • Hoist Condition, Power Cord, Remote

  • Hand Rails Intact

Sign Off

  • Name and 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.