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)

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