Date Location Inspector Field Representative Traffic Control
Not Inspected
Good
Fair
Poor
Site/Housekeeping
Not Inspected
Good
Fair
Poor
Public Protection
Not Inspected
Good
Fair
Poor
Environmental
Not Inspected
Good
Fair
Poor
First Aid
Not Inspected
Good
Fair
Poor
Fire Prevention & Protection
Not Inspected
Good
Fair
Poor
Employee Actions
Not Inspected
Good
Fair
Poor
Head Protection
Not Inspected
Good
Fair
Poor
Eye & Face Protection
Not Inspected
Good
Fair
Poor
Hearing Protection
Not Inspected
Good
Fair
Poor
High-visibility Clothing
Not Inspected
Good
Fair
Poor
Personal Protection Other
Not Inspected
Good
Fair
Poor
Tool Safety
Not Inspected
Good
Fair
Poor
Air Compressor/Hoses
Not Inspected
Good
Fair
Poor
Vehicle/Equipment Operation
Not Inspected
Good
Fair
Poor
Equipment Warning Devices
Not Inspected
Good
Fair
Poor
Welding/Cutting Equipment
Not Inspected
Good
Fair
Poor
Flammable Liquids
Not Inspected
Good
Fair
Poor
Chemicals/ERTK
Not Inspected
Good
Fair
Poor
Compressed Gas Cylinders
Not Inspected
Good
Fair
Poor
Energy Isolation/LOTO
Not Inspected
Good
Fair
Poor
Electrical/Extension Cords
Not Inspected
Good
Fair
Poor
Confined Space
Not Inspected
Good
Fair
Poor
Fall Protection
Not Inspected
Good
Fair
Poor
Ladders/Stairs
Not Inspected
Good
Fair
Poor
Scaffold
Not Inspected
Good
Fair
Poor
Aerial/Crane Equipment
Not Inspected
Good
Fair
Poor
Lifting/Rigging
Not Inspected
Good
Fair
Poor
Trenching/Excavating
Not Inspected
Good
Fair
Poor
Utilities
Not Inspected
Good
Fair
Poor
Marine Operations
Not Inspected
Good
Fair
Poor
Other 1
Not Inspected
Good
Fair
Poor
Other 2
Not Inspected
Good
Fair
Poor
Other 3
Not Inspected
Good
Fair
Poor
Other 4
Not Inspected
Good
Fair
Poor
Inspector's Signature Field Representative's Signature
link copied
Troy Forcier
Hennepin County Public Works Safety Inspection Copy
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