Information
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Conducted on
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Job Number
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Jobsite Name
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Type of Work
Are These Items Completed & Up To Date?
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Project Safety Plan
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JSA's
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Crisis Management Plan
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Project Safety Workbook
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Tool Box Talks
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Morning Huddle
Are These General Safety Items Current & Up To Date?
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Postings (State, Fed, EEOC, Drug, Work Comp)
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Date Corrected:
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Safety/MSDS Manual
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Date Corrected:
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Emergency Phone Posting (FA/CPR, Map)
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Date Corrected:
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OSHA 300 Log (February To April)
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Date Corrected:
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First Aid Kit/Eye Wash
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Date Corrected:
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Competent Person Inspections
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Date Corrected:
Housekeeping
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Trash, Scrap, And Debris Picked-Up
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Date Corrected:
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Trailer Clean
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Date Corrected:
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Material Stored, Tools/Rigging Organized
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Date Corrected:
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Cords And Leads Routed Properly
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Date Corrected:
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Stairways, Halls, And Roadways Clear
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Date Corrected:
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General Site Conditions (Describe)
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Date Corrected:
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Drinking Water
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Date Corrected:
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Sanitation (One Toilet Per 20 Workers)
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Date Corrected:
Personal Protective Equipment
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Hard Hats
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Date Corrected:
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Eye Protection (Glasses/Goggles)
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Date Corrected:
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Face Shield (Grinding/Cutting/Welding)
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Date Corrected:
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Proper Gloves (Cotton/Leather/Chemical/Kevlar)
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Date Corrected:
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Foot Protection
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Date Corrected:
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Hearing Protection
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Date Corrected:
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Respirators
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Date Corrected:
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Proper Attire
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Date Corrected:
Fall Protection System
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Harness/Retractable/Positioning Above 6'
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Date Corrected:
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Guard Rails Up (At 42"+/-3", Wire Rope Flagged Every 6')
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Date Corrected:
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Holes Protected
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Date Corrected:
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Leading Edge At 15'
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Date Corrected:
Fire Protection/Prevention
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Fire Extinguishers Accessible/Current Within 100' Travel?
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Date Corrected:
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Signage of Flammable/Combustible Materials
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Date Corrected:
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Signage/Labeling
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Date Corrected:
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Fire Watch Required/Used
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Date Corrected:
Cranes and Forklifts
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Barricade Up
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Date Corrected:
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Daily/Monthly/Annual Inspection Complete
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Date Corrected:
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Are Power Lines Further Than 20'?
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Date Corrected:
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Set-Up Correctly
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Date Corrected:
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Correct Size (Not Over-Loading)
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Date Corrected:
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Crane Operator Training (CCO)
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Date Corrected:
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Rigging Inspected
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Date Corrected:
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Taglines Used
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Date Corrected:
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Cribbing In Place
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Date Corrected:
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Forklift Training
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Date Corrected:
Welding and Cutting
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Cylinders Properly Stored
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Date Corrected:
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Flash Arrestors
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Date Corrected:
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Hard Hats Under Welding Hoods
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Date Corrected:
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Proper PPE Used
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Date Corrected:
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Conditions Of Leads
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Date Corrected:
Access Equipment
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Extension Ladder (4V:1H, 3' Extension, Secured)
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Date Corrected:
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Aerial Lifts
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Date Corrected:
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Stairways/Walkways
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Date Corrected:
Scaffolding
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Base (Sills/Plates/Jacks/Casters, Secured, Level)
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Date Corrected:
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Braces (Installed, Secured, Condition)
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Date Corrected:
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Frames (Compatible, Pinned, Condition)
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Date Corrected:
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Platform (Complete, Overhang/Secured, Condition)
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Date Corrected:
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Access (Integrated Frame, Ladder, Other)
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Date Corrected:
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Other (Secured At 4V:1H, Tagged)
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Date Corrected:
Electrical
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Panels (Covers In Place)
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Date Corrected:
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GFCI (Electrician Weekly Inspection)
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Date Corrected:
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Electrical Cords (Condition, Proper Use)
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Date Corrected:
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Power Tools
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Date Corrected:
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Temporary Lighting
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Date Corrected:
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Power Sources/Lines 20' Conductors Away?
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Date Corrected:
Excavation
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Spoils 2' From Edge
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Date Corrected:
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Access/Egress Ladder Extends At 4' (25' Travel)
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Date Corrected:
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Slope, Shoring, & Shielding At 5'
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Date Corrected:
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Competent Person
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Date Corrected:
Additional Comments
Superintendent Signature
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Inspector Signature
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