Information
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Project Name
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Conducted on
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Location
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Field Supervisor
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Project Manager
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Prepared by
PERSONAL PROTECTIVE EQUIPMENT
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All personnel wearing hard hats
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Protective eyewear in use where required
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Respiratory protection/breathing masks in use where required
EXTENSION CORDS
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Plugged in to GFI receptacles
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Minimum 14 gauge
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Ground pin intact
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Strain relief intact (no exposed wire at plug end)
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Outer jacket intact
LADDERS
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Extend 3' above walking surface or at least 4th rung from top
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Secured to prevent displacement
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All ladders in good condition
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Extension ladders at proper 1:4 angle
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All folding ladders used in fully open position only
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Standing below top or first step down on step ladder
FALL PROTECTION
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Fall protection in place at mezzanines, slab leave outs, elevator shafts, etc. <br>
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Guardrail height 39-45” <br>
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Guardrail able to withstand 200 lbs. of force <br>
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Midrail height at 21” <br>
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Toe boards installed <br>
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Cable guardrails – less than 3” of movement <br>
WORKER PERSONAL FALL ARREST SYSTEMS (PFAS)
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Wearing harness and lanyard <br>
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Proper anchor point selected <br>
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Proper lanyard selected (protect from striking lower level) <br>
SCAFFOLDING
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Erected under direction of a competent person <br>
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Mudsills properly installed under scaffold legs <br>
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Scaffolding components inspected for damage <br>
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Cross braces in place at front and rear of scaffolding <br>
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Scaffolding greater than 10’ from an electrical source <br>
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Scaffolding fully planked without any gaps <br>
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Planks extend at least 6” past frame support but less than 12” <br>
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Guardrails installed on all open sides and ends <br>
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Top rail located between 38"-45” <br>
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Midrail installed halfway <br>
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All toe boards installed and tight to the platform <br>
AERIAL/SCISSOR LIFTS
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Operator trained in equipment being used <br>
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Operator verified oil level is proper <br>
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Operator manual on the lift <br>
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Occupants using personal fall arrest system and secured off <br>
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Equipment on a stable surface <br>
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Factory approved PFAS attachments being used <br>
CONCRETE & MASONRY
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Rebar caps installed to prevent impalement hazards (flat top only) <br>
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Masks being used during cutting operations <br>
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CMU storage maximum 1 cube high <br>
ROOFING
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Warning lines set minimum of 6’ from roof edge <br>
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Steep roof pitch greater than 4:12 requires fall protection <br>
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Material storage set back 10’ from roof edge <br>
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Fire extinguishers provided on roof <br>
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Proper access to roof provided <br>
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Tar kettle area barricaded <br>
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Propane tank set minimum of 10’ from kettle <br>
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Propane tank set minimum of 10’ from ignition source <br>
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Two charged 20lb ABC fire extinguishers at kettle area <br>
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Kettle attendant PPE (face shield, long sleeves, gloves) <br>
POWER & LIGHTING
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Electrical room is clean, neat, organized to eliminate trip hazards <br>
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All energized light sockets are filled <br>
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Lamps protected by lamp guards <br>
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Lighting supported every 5’ <br>
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Lighting higher than 8’ AFF <br>
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Tool power on separate circuit from lighting <br>
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PIn use covers installed on exterior receptacles <br>
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GFCI protection is provided and used <br>
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Full panel covers installed – dead fronts only in locked rooms <br>
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Unused breaker openings are covered with blanks <br>
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No work taking place on energized panels <br>
WELDING/CUTTING
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Fuel tanks stored upright <br>
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O2 and fuel tanks separated by at least 20’ <br>
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Tanks secured to prevent falling/damage <br>
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Protective caps installed on top of tanks <br>
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Gauges free from damage <br>
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Area below welding operation is protected <br>
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Fire extinguisher readily available <br>
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Damage to welders leads <br>
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Torch hoses in good condition <br>
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PHOTOS
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Comments
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Person that completed the report
