Information

  • Project Name & Divisions

  • Project Name & G.C.

  • Location
  • Conducted on

  • Prepared by

  • Personnel

  • I.D.I. Superintendent(s)

Personal Protective Equipment. (PPE)

  • Hard hats / head protection worn by all employees<br>

  • Eye protection worn when required

  • Face shield being used when required

  • Gloves / hand protection being used when required

  • Hearing protection being used when required

  • Appropriate respirator being used when required

  • Work boots worn by all employees (no gym shoes, sandals, bare feet)

Electrical

  • Extension cords in safe condition for use (no cuts in outer insulation, no exposed wires, no missing ground prong)

  • Electrical cords compliant with our assured grounding program

  • GFCI being used if required by conditions or project requirement

  • Electrical panels appropriately covered or our employees protected from coming within 6' of a live exposed panel

  • 10' minimum clearance from live high voltage power lines

  • Temporary lights in our work areas guarded

  • Halogen light bulb guards in place

  • Proper use of temporary power boxes

  • Lock out / tag out procedures in place and being implemented if required

  • Are all energized electrical components protected to reduce employee exposures

Housekeeping and Other

  • Clear access to building, structure & work location

  • Are slip, trip & fall hazards in reasonable condition to minimize risk of injury

  • Impalement protection

  • Proper material storage

  • Fire extinguishers present and charged

  • Adequate lighting

Mobile Baker Type Scaffolds

  • Scaffolds in safe condition for use

  • Being used in a safe appropriate manner within our company policies

Mini-Perry Mobile Workstands

  • In safe condition for use

  • No one working above 3rd rung level

  • Being used in a safe manner and within our company's policies

Pipe or Frame scaffolding

  • Is the scaffold set up in the correct manner and safe for employees to work on

  • Scaffold fully planked at working level

  • Guardrails in place when required (10' per OSHA or must follow G.C. rule if more stringent

  • Scaffold being used in a safe appropriate manner and within our company's scaffold policies

Fall Protection (6' fall hazard exposures)

  • Guardrails or barricades in place protecting our employees from falls of 6' or more to lower levels

  • Do guardrails meet OSHA requirements

  • Floor holes adequately covered within OSHA requirements (secured, demarcated, capable of supporting 2 x load)

  • If using fall arrest or restraint equipment, was it inspected and in safe condition for use

  • Proper 5,000 lb anchorage point

  • Roof edge or sharp edges protected from cutting our lifelines, lanyards, etc.

  • Is all fall arrest and/or restraint equipment being used in the correct appropriate manner

  • Is the employee's free fall distance limited to 6' or less

  • Are all employees protected from fall exposures of 6' or more to lower levels

  • If using metal pan roof anchors, are all baseplate holes filled in with 1 1/4" # 12 tek screws and using a retractable lanyard

Aerial Lifts

  • Aerial lifts in safe condition for use

  • Floor surface free of pits, holes & depressions which could cause tipping

  • Safety gate or chain closed

  • Feet on platform floor (no climbing or standing on safety rails)

  • Lift being used within rated weight capacity

  • 10' clearance from power lines

  • If using boom lift, safety harness worn by employees and are they tied off to manbasket's anchorage point

  • Overall, are aerial lifts being used in a safe appropriate manner and within our company's policies

Ladder Safety

  • Are ladders in safe condition for use

  • Extension ladders being used to access higher levels extended 3' and secured

  • No standing on top 3 rungs of straight ladders & top 2 steps of portable A-frame ladders

  • Are portable A-frame ladders being used in the fully open position with the spreader arms locked

  • No one using make-shift ladders such as 5-gallon buckets to stand and work on

  • Ladders or stairs with handrails being used when access area has a > 19" break in elevation

  • Are ladders being used safely, appropriately and for their intended use

Stairs

  • Are stair treads filled in

  • Do stairs have handrails

  • Do stairways have adequate lighting

  • Are the stairs clear of debris, materials & equipment

Stilt Safety

  • Are stilts in safe condition for use

  • Floor conditions safe for stilt usage

  • Stilts being used in a safe manner

  • No stilt usage on computer floors

Tool safety

  • Are tools and cords in safe condition for use

  • Blade guard or machine guard in place and working appropriately

  • Ground prongs in place on tools and equipment that require them

Back Injury or Lifting Related Hazards

  • Are employees using safe lifting procedures

Hazard Communication

  • Are M.S.D.S. readily available

Medical

  • 1st aid kit accessible to employees

  • Occupational health clinic & emergency medical center established

Other Employee Safety Issues

  • Any other employee safety issues that are not noted above (unsafe acts, unsafe behavior, violating co. rules, Etc.)

Other Job Site Safety Issues

  • Any other job site safety issues that are not noted above

  • Safety Inspection Completed by Peter Graham, Safety Director for International Decorators, Inc.

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.