Title Page
-
Site conducted
-
Job Number
-
Supervisor
-
Date/Time
-
Prepared by
-
Location
1) Field Conditions
-
Access (i.e. clear access onto and around work areas)
-
Air Quality (i.e. silica exposure, wild fire smoke, dust control)
-
Air Compressors (i.e. relief valves, gauges)
-
Electrical (i.e. extension cords, corded tools, GFCI/spider box)
-
Equipment (i.e. scissor, fork, aerial lifts, good condition, proper use, visual inspection upon use)
-
Excavation (i.e. utilities identified, bench, slope, shore, spoils 2ft, covers, barricades)
-
Fall Protection (i.e. proper guardrails, proper use of PFA's, PFA's inspected daily/C.P, controlled access zone, 2"+ hole covers)
-
Fire Protection (i.e. ext. within 25ft of hot work, hot work permit, ext. inspected monthly, up to date, good condition, flammable liquids stored properly)
-
Hand/Power tools (i.e. guards in place, alterations, damages, improper use)
-
Hot Work/Compressed Gas (i.e. shade 3 glasses, leather gloves w/ brazing/soldering, secured/properly stored, fire wall between oxy/acet, ventilation)
-
Housekeeping (i.e. no trip hazards, material stored properly, chemicals stored properly, work areas clean, clear access)
-
Impalement Hazards (i.e. rebar, underground stakes, obstructing objects work areas)
-
Ladders (i.e. good condition, legible labels, no alterations, proper storage, proper use per manufacturer)
-
Lighting (i.e. egress lighting, work area lighting)
-
LOTO (i.e. gas, electrical for service, equipment while servicing)
-
PPE (i.e. properly warn per ICS COSP, manufacturer specs, or GC requirement, ear plugs when needed)
-
Scaffolding (i.e. green tagged, good condition, visual inspection upon use)
-
Temp/Water/Shade (i.e. Heat index, plenty of water, plenty of shade)
Management Activities
-
First aid kit (i.e. not expired, fully stocked, eye wash station available on site)
-
First-aid personnel (i.e. Foreman CPR/AED/FA certified)
-
Safety Program Available (i.e. IIPP electronically and/or hard copy, SDS sheets available)
-
OSHA 300 Log posted Feb. 1st - Apr. 30th (i.e. ONLY in job trailers/offices on site)
-
Medical Clinic map available (i.e. nearest Concentra and ER)
-
Emergency Response posted/known (i.e. Grab N Go packet)
-
Cal/Fed OSHA postings/permit (i.e. current year poster in job trailer/office or GC has available on jobsite)
-
Toolbox talks/Weekly Safety Meetings (i.e. current week, turned in on time)
-
Jobsite checklist/inspection (i.e. conducted weekly by foreman)
-
Pre-Task Hazard (i.e. completed daily)
-
Daily Hazard Assessment (i.e. noted, discussed with crew prior to start of task)
-
Sanitary Facilities (i.e. toilets, hand wash stations, properly stocked)
-
Covid-19 Postings (i.e. posting available inside job trailer/office)
Comments
-
Other (i.e. situation that does not fit a particular category)