Information

  • Project:

  • Description of Work Being Conducted

  • Conducted on

  • Conducted by;

  • Location

1. Postings / Notices / Bulletins

  • Were Postings / Notices / Bulletins Audited?

  • THEN MOVE TO NEXT SECTION

  • 1.1 Required EEO, State, Federal and/or local agency required postings.

  • 1.2 Emergency Action Plan Posted

  • 1.3 Evacuation Plan, including muster points to account for employees<br>

  • 1.4 Spill Response Plan in place and posted<br>

  • 1.5 Notice to employees on where to find Material Safety Data Sheets<br>

  • 1.6 Signs indicating First Aid Station or First Aid Kit locations posted<br>

  • 1.7 No Trespassing Signs posted at entry points to the job site<br><br>

  • Site Observations:

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (If Applicable)

Relevant Photos

  • Photos:

  • Description:

2. Safety Meetings / Planning

  • Were Safety Meetings / Planning Audited ?

  • THEN MOVE TO NEXT SECTION

  • 2.1 JHA has been completed for the observed tasks<br>

  • 2.2 Weekly Toolbox Talk completed<br>

  • Site Observations:

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (If Applicable)

  • Relevant Photos
  • Photos:

  • Description:

3. Training

  • Were Training Requirements Audited?

  • THEN MOVE TO THE NEXT SECTION

  • 3.1 All employees have had required orientation (Sticker on Hard Hat)

  • 3.2 Employees have been trained for the assigned tasks<br>

  • 3.3 Crew has someone trained in First Aid / CPR

  • 3.4 Supervisors have been through supervisor safety training<br>

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

4. HazComm / Materials

  • Were Hazcomm / Materials Audited?

  • THEN MOVE TO NEXT SECTION

  • 4.1 Material Safety Data Sheets available for all Hazardous Mat'l used on site<br>

  • 4.2 Hazardous mat'l list up-dated and current

  • 4.3 Materials/Containers properly labeled - Contents and Hazard Rating<br>

  • 4.4 Hazardous materials are properly stored<br>

  • 4.5 Employees aware of Right to Know (must ask crew members)

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

5. Housekeeping

  • Was Housekeeping Audited?

  • THEN MOVE TO NEXT SECTION

  • 5.1 Project work areas are clean and free of excess trash, debris<br>

  • 5.2 Walkways and passageways clear

  • 5.3 Electrical Panels clear of debris/materials to allow full access<br>

  • 5.4 Fire Extinguishers clear of debris/materials to allow full access<br>

  • 5.5 Material and equipment properly stored<br>

  • 5.6 Electrical cords, hoses, welding leads positioned to prevent trip hazards<br>

  • 5.7 Scrap material free of protruding nails or other puncture hazards

  • 5.8 Trash receptacles are provided for work areas and water kegs

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

6. Fire Protection

  • Was Fire Protection Audited?

  • THEN MOVE TO NEXT SECTION

  • 6.1 Hot Work Permits completed<br>

  • 6.2 Fire extinguishers properly located and accessible throughout job site

  • 6.3 Fire Extinguishers fully charged & inspected monthly/annually<br>

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

7. Welding and Cutting

  • Was Welding and Cutting Audited?

  • THEN MOVE TO NEXT SECTION

  • 7.1 Welding Leads & Cutting Torch hoses maintained in good working order

  • 7.2 Combustibles moved a safe distance away from hot work operations

  • 7.3 Flash arrestors installed on all cutting torch setups<br>

  • 7.4 Oxygen, Acetylene & combustibles separated by 20' or 30 min fire rated wall installed / stored upright /secure

  • 7.5 Regulator gauges properly attached and maintained

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

8. Tools and Equipment

  • Was Tools and Equipment Audited?

  • THEN MOVE TO NEXT SECTION

  • 8.1 Tools are maintained in a safe condition<br>

  • 8.2 Tools are properly carried and stored

  • 8.3 Pneumatic / hydraulic hose connections properly secured

  • 8.4 Proper tools used for the job performed

  • 8.5 All tools are properly guarded

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

9. Electrical Safety

  • Was Electrical Safety Audited

  • THEN MOVE TO NEXT SECTION

  • 9.1 Cords to power tools inspected prior to each use

  • 9.2 No tape on any cords - Tools or Extension Cords

  • 9.3 Ground Pins in place when required

  • 9.4 Ground Fault Circuit Interruptors (GFCI) utilized with power tools

  • 9.5 Supply Cords protected against vehicular or pedestrian traffic damage

  • 9.6 Cords maintained "out of water" to prevent possible shock hazard

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

10. Personal Protective Equipment

  • Was Personal Protective Equipment Audited?

  • THEN MOVE TO NEXT SECTION

  • 10.1 Hard hats worn and maintained as required<br>

  • 10.2 High visible/reflective apparel worn as required

  • 10.3 Hearing protection worn as required<br><br>

  • 10.4 Eye protection required and worn in a proper manner<br><br>

  • 10.5 Proper foot protection worn for job performed

  • 10.6 Face shield or goggles worn as required

  • 10.7 Gloves worn at all times

  • 10.8 Proper Cutting Goggles used during cutting operations (#3 Shade Min)

  • 10.9 Respiratory Protection worn and cared for as required

  • 10.10 Other: Paper cups available/provided at all water coolers as required. If reusable bottles are provided - Name must be written on Bottle

  • 10.11 Adequate number of sanitary facilities provided & maintained as required

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

11. Fall Protection

  • THEN MOVE TO NEXT SECTION

  • 11.1 Full Body harnesses and lanyards worn properly and as required<br>

  • 11.2 Lanyards are adequately secured to suitable anchorage

  • 11.3 Perimeter guarding/Handrails in place where required<br>

  • 11.4 Static lines installed and capable of supporting 5,000 lbs. of force per user

  • 11.5 Fall protection equipment is used for fall protection ONLY

  • 11.6 Fall protection inspected and maintained in a safe-for-use condition

  • 11.7 Retrieval plan complete and communicated

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

12. Scaffolds

  • THEN MOVE TO NEXT SECTION

  • 12.1 Work Platforms fully decked between front uprights & guardrail<br>

  • 12.2 Scaffold grade planking utilized

  • 12.3 Planks extend no less than 6" , and no more than 12" over bearing rail<br>

  • 12.4 Ladder access with landing at 35' intervals as a minimum

  • 12.5 Scaffolds maintain a minimum of 15' from un-insulated electrical lines

  • 12.6 Scaffold Stairways provided with landings at 12' intervals

  • 12.7 Daily inspections conducted by competent person

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

13. Ladders, Stairways and Access

  • THEN MOVE TO NEXT SECTION

  • 13.1 Ladder access clear and unobstructed<br>

  • 13.2 Ladders positioned at 4:1 ratio - (4 feet high to 1 foot out from wall)

  • 13.3 Ladders extend 3 feet higher than landing point

  • 13.4 Employees utilizing hoist to raise or lower materials (leaving hands free)

  • 13.5 Employees ascending/descending using three points of contact at all times

  • 13.6 All "Job Made" ladders constructed according to specific requirements<br>

  • 13.7 Ladders tied off/secured properly

  • 13.8 Safe and proper access to work area

  • 13.9 Step ladders used properly - full extend - no use of top two steps

  • 13.10 Stair handrails no less than 36" high from tread to top of stair rail

  • 13.11 Stairs having 4 or more risers or more than 30" in height, have handrails

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

14. Excavations

  • THEN MOVE TO NEXT SECTION

  • 14.1 Sloped and shored properly

  • 14.2 Utilities notified prior to opening excavations

  • 14.3 Competent Person designated as required by OSHA for excavations<br>

  • 14.4 Access and egress provided within 25 ft. of employee(s)

  • 14.5 Daily inspections conducted

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

15. Marine Work

  • Any Marine Work Audited?

  • THEN MOVE TO NEXT SECTION

  • 15.1 Work Vests buckled and worn as required when working over water

  • 15.2 Gang Planks/Proper and Adequate Access in place with handrails<br><br>

  • 15.3 Adequate access to allow safe entry to barge from workboats<br><br>

  • 15.4 Barge(s) in neat and orderly condition

  • 15.5 Life Rings properly roped and located every 200 feet<br><br><br>

  • 15.6 Cranes Radius on barges barricaded/Warning devices in place<br><br><br><br>

  • 15.7 Cranes are positively secured to barges as required<br><br><br><br>

  • 15.8 Safety boats available as required<br><br><br><br>

  • 15.9 Water load charts posted and visible to operators<br><br><br><br>

  • 15.10 Rescue drill has been completed<br><br><br><br>

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

16. Railroad Safety Practices

  • Any Railroad Work Audited?

  • THEN MOVE TO NEXT SECTION

  • 16.1 Minimum distance from track (25') when train is passing, employees stopped work and observing passing train

  • 16.2 No movement towards trains or tracks after horn blown

  • 16.3 Employees know protection limits

  • 16.4 Unattended equipment is 25' from rail and 250' from crossing

  • 16.5 Unattended equipment properly secured (buckets, loads grounding)

  • 16.6 Employees look both ways before crossing rail and only do so with rail representative's authority

  • 16.7 All vehicles and equipment stop at rail crossings before crossing

  • 16.8 Self propelled equipment has first aid kit, fire ext and audible back up alarms

  • 16.9 Cranes have at least 3 orange cones displayed to designate work area

  • 16.10 Has proof of applicable and non expired railroad training along

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

17. Pile Driving

  • Were Any Pile Driving Operations Audited

  • THEN MOVE TO NEXT SECTION

  • 17.1 Pile Handling Plan (documented)<br>

  • 17.2 Controlled Access Zone-posted,documented

  • 17.3 Cushion Blocks Protected from the Elements

  • 17.4 Have the Bardon chokers been inspected for wear?

  • 17.5 Shackle pins are safety wired on leads and hammer

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

18. Material Handling Equipment

  • Were Any Material Handling Equipment Operations Audited?

  • THEN MOVE TO NEXT SECTION

  • 18.1 Back-Up Alarms operational and audible above area noise- 200 ft away

  • 18.2 Seat Belts worn by operators

  • 18.3 Daily, Pre-Operational Inspection Reports completed<br>

  • 18.4 Deficiencies noted on Inspection reports are corrected

  • 18.5 Loads properly secured prior to attempting to relocate

  • 18.6 Licenses or certifications as required

  • 18.7 Equipment operated at safe speeds

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

19. Hoisting and Lifting Equipment

  • Were there any Hoisting and Lifting Equipment Operations Audited?

  • THEN MOVE TO NEXT SECTION

  • 19.1 Chainfalls, come-a-longs and chokers in good condition with current inspection

  • 19.2 Rigging is stored properly

  • 19.3 Rigging inspected daily and prior to each use

  • 19.4 Proper rigging techniques are followed

  • 19.5 Proper crane set-up (swing radius, barricades, outrigger pads)

  • 19.6 Crane Inspections conducted daily and documented

  • 19.7 Legible capacity tags in place as required

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

20. Traffic Control

  • Were Any Traffic Control Operations Audited?

  • THEN MOVE TO NEXT SECTION

  • 20.1 Signage / Setup<br>

  • 20.2 Traffic Control Planning

  • 20.3 Certified Flaggers / Training

  • 20.4 Proper Equipment - Reflectors, arrays, crash cushion

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

22. Silica Dust Control

  • Were There Any Silica Dust Operations Observed

  • THEN MOVE TO NEXT SECTION

  • 22.1 Silica Control Plan Implemented for work performed

  • 22.2 Engineering Controls Implemented

  • Table 1 Link
    https://www.osha.gov/silica/Table1sect1926.1153.pdf

  • 22.3 Housekeeping

  • 22.4 Respiratory Protection Required?

  • 22.5 Are Other Crews at Risk of Exposure to Silica Dust?

  • Site Observations

  • Corrective Actions

  • Date Corrected

23. Monthly Focus

    Add Additional Inspections associated with Monthly Focus
  • Description of Inspection:

  • Compliant?

  • Site Obsevations

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

24. Employee Recognition

  • Recognize a job well done here

  • Employee
  • Name:

  • Describe Recognition

25. Subcontractor Safety Compliance

  • 24.1 Employees stop work while being observed

  • 24.2 Employees adjust position / PPE while being observed

  • 24.3 Employees are aware of other crews and other trades in the area

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

26. Employee Behaviors - Body Position

  • 25.1 Employees in pinch points of lines of fire?

  • 25.2 Employees can contact electricity, hot/cold, toxic chemical, other hazards?

  • 25.3 Employees at Risk for sprains/strains?

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

27. Employee Behavior - Tool Use

  • 26.1 Employees' tools are in good condition

  • 26.2 Employees are using the right tool for the job?

  • 26.3 Employees know and follow safety procedures / Rules.

  • Site Obsevations

  • Corrective Actions Assigned To (If Applicable)

  • Date Corrected (if Applicable)

  • Relevant Photos
  • Photos:

  • Description:

Sign off

    Crew Sign Off (Acknowledgment of Outcomes)
  • Print Name:

  • 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.