Information
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Document No.
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Completed by
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Date
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Customer name
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Job site name
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Job site address
Evaluation
Job Site Information
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Supervisor's name and contact number.
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General Contractor on job site.
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Customers & employees understand HardHat's injury reporting policy.
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Please describe.
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Safety meetings/toolbox talks being conducted by the customer.
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Please describe.
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Please list the current work tasks being performed.
Employee Interaction
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Number of HardHat employees are on the job site.
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Number of HardHat new hires are on the job site.
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Number of HardHat employees interacted with on job site.
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List safety topics discussed.
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Safety concerns reported by employees.
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Please describe.
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Required PPE worn (hard hat, glasses, gloves and vest/t-shirt).
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Please describe.
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Condition of PPE.
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Please describe.
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Employees using proper lifting methods.
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Proper number of employees for each operation.
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Please describe.
Housekeeping
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Overall cleanliness of the job site.
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Please describe.
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Slip, trips, and fall hazards.
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Please describe.
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Silica dust engineering controls in-place.
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Please describe.
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Availability of fire extinguishers on the job site.
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Please describe.
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Job site materials are stored securely to prevent falling, sliding, or collapse.
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Please describe.
Electrical
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"No energized work!", emphasized to employees and supervisors.
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Please describe.
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Electricians utilizing voltage testers (tic testers).
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Please describe.
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If needed, lock out/tag out procedures in place.
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Please describe.
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Ground fault circuit interrupters being used.
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Please describe.
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Known electrical hazards identified.
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Please describe.
Hand, Power & Powder Actuated Tools
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Are hand, power, or powder actuated tools being used?
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Hand and power tools inspected regularly and in good working condition.
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Please describe.
Fall Protection
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Are employees working at heights greater than 6ft. or on lifts?
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Employees working more than 6' above a lower level are protected by guardrails or personal fall arrest system.
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Please describe.
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Any harnesses should be fitted properly.
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Please describe.
Ladders
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Are employees using ladders?
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Employees using at least 3 points of contact while ascending and descending.<br>
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Please describe.
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Ladders are secured to prevent slipping, sliding, or falling?
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Please describe.
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Stepladders used in fully open position?
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Please describe.
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No step at top two rungs of stepladder?
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Please describe.
Scaffolding
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Are any scaffolds being used on the job?
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All scaffolding inspected and green tag visible.
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Please describe.
Trenches, Excavation & Shoring
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Are any trenches on the job site?
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Competent person on hand and inspecting daily.
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Please describe.
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Ladder access, steps, or ramp in trenches 4ft. or deeper and located every 25ft.
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Please describe.
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Excavations 5ft. or deeper are sloped back or protected inside with shields.
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Please describe.
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Material, equipment, and spoil pile are 2ft.+ from trench edge.
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Please describe.
Review of Findings
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Hazards & concerns addressed with employees and supervisors.
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Please describe.
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Job site requires a follow-up or re-inspection.
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Re-inspect before
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Today's date
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Type name & sign name below
