HardHat Job Site Safety Evaluation 3.0

• Document No.

• Completed by

• Date

  Date

• Customer name

• Job site name

• Job site address
  Address

Job Site Information

• Supervisor's name and contact number.

• General Contractor on job site.

• Customers & employees understand HardHat's injury reporting policy.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Safety meetings/toolbox talks being conducted by the customer.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Please list the current work tasks being performed.

Employee Interaction

• Number of HardHat employees are on the job site.

• Number of HardHat new hires are on the job site.

• Number of HardHat employees interacted with on job site.

• List safety topics discussed.

• Safety concerns reported by employees.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Required PPE worn (hard hat, glasses, gloves and vest/t-shirt).

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Condition of PPE.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Employees using proper lifting methods.

  Acceptable

  Addressed

  Attention Needed

• Proper number of employees for each operation.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

Housekeeping

• Overall cleanliness of the job site.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Slip, trips, and fall hazards.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Silica dust engineering controls in-place.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Availability of fire extinguishers on the job site.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Job site materials are stored securely to prevent falling, sliding, or collapse.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

Electrical

• "No energized work!", emphasized to employees and supervisors.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Electricians utilizing voltage testers (tic testers).

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• If needed, lock out/tag out procedures in place.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Ground fault circuit interrupters being used.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Known electrical hazards identified.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

Hand, Power & Powder Actuated Tools

• Are hand, power, or powder actuated tools being used?

  Yes

  No

• Hand and power tools inspected regularly and in good working condition.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

Fall Protection

• Are employees working at heights greater than 6ft. or on lifts?

  Yes

  No

• Employees working more than 6' above a lower level are protected by guardrails or personal fall arrest system.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Any harnesses should be fitted properly.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

Ladders

• Are employees using ladders?

  Yes

  No

• Employees using at least 3 points of contact while ascending and descending.<br>

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Ladders are secured to prevent slipping, sliding, or falling?

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Stepladders used in fully open position?

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• No step at top two rungs of stepladder?

  Acceptable

  Addressed

  Attention Needed

• Please describe.

Scaffolding

• Are any scaffolds being used on the job?

  Yes

  No

• All scaffolding inspected and green tag visible.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

Trenches, Excavation & Shoring

• Are any trenches on the job site?

  Yes

  No

• Competent person on hand and inspecting daily.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Ladder access, steps, or ramp in trenches 4ft. or deeper and located every 25ft.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Excavations 5ft. or deeper are sloped back or protected inside with shields.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Material, equipment, and spoil pile are 2ft.+ from trench edge.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

Review of Findings

• Hazards & concerns addressed with employees and supervisors.

  Acceptable

  Addressed

  Attention Needed

• Please describe.

• Job site requires a follow-up or re-inspection.

  Yes

  No

• Re-inspect before

  Date

• Today's date

  Date

• Type name & sign name below

  Sign