Interior Specialists Inc Safety Team

• Client/site

• Conducted on

  Date

• Prepared by

Report summary and overview

• Select date

  Date
• Add location
  Address

• Overview pictures of job site.

  Media

• Summarize the work being performed.

• Inspection report summary

Safety plans and records

• Hazcom and SDS sheets available?

  Yes

  No

  N/A

• Spot check job site for chemicals not in inventory

  Yes

  No

  N/A

• Check containers for proper GHS labels

  Yes

  No

  N/A

• Fall protection plan

  Yes

  No

  N/A

• Steel erection safety plan

  Yes

  No

  N/A

• First aid kit available

  Yes

  No

  N/A

• Weekly toolbox talk training

  Yes

  No

  N/A

• Fire hazards identified

  Yes

  No

  N/A

• Are fueling areas free from combustible materials

  Yes

  No

  N/A

PPE

• Have employees been trained on how to correctly use PPE

  Yes

  No

  N/A

• Is PPE being inspected prior to use

  Yes

  No

  N/A

• Is the PPE adequate for the work being performed

  Yes

  No

  N/A

• Hard hats worn at all times

  Yes

  No

  N/A

• Proper boots and gloves as needed

  Yes

  No

  N/A

• Hi-visibility vests or clothing

  Yes

  No

  N/A

• Safety glasses

  Yes

  No

  N/A

• Respirators, N95 masks and ear plugs as needed

  Yes

  No

  N/A

Silica

• Have silica specific tool box talks occurred and have sign in sheets been completed

  Yes

  No

  N/A

• Prework meeting held to minimize exposure among all trades

  Yes

  No

  N/A

• Do employees have silica training hard hat decals

  Yes

  No

  N/A

• Are wet methods to include sweeping compound being used

  Yes

  No

  N/A

• Are water integrated tools in satisfactory condition

  Yes

  No

  N/A

• Have the number of employees working in or around the area been limited to only those needed

  Yes

  No

  N/A

• Have employees from other trades entered the work area

  Yes

  No

  N/A

• Do these individuals have proper PPE

  Yes

  No

  N/A

• If not, was PPE issued to them

  Yes

  No

  N/A

Fall protection

• Is there a rescue plan

  Yes

  No

  N/A

• Harnesses and lanyards in satisfactory condition

  Yes

  No

  N/A

• Personal trained in proper fall protection procedures

  Yes

  No

  N/A

• Anchorage points acceptable

  Yes

  No

  N/A

• Guard rails and cables installed correctly and compliant with the standard

  Yes

  No

  N/A

• Open holes covered and marked as such

  Yes

  No

  N/A

Welding and cutting

• Shields being worn

  Yes

  No

  N/A

• Bottles upright and secured

  Yes

  No

  N/A

• Fire extinguishers readily accessible

  Yes

  No

  N/A

• Fire watch

  Yes

  No

  N/A

Equipment

• Are fire extinguishers present, charged, and tagged within date

  Yes

  No

  N/A

• Do operators have current proof of training

  Yes

  No

  N/A

• Equipment operating properly

  Yes

  No

  N/A

• Tires, brakes, hydraulics and safety features working and tested prior to usage

  Yes

  No

  N/A

• Backup alarms operating

  Yes

  No

  N/A

• If rental equipment, has the rental service reviewed proper operation procedures

  Yes

  No

  N/A

Handheld equipment

• Are power tools being used properly

  Yes

  No

  N/A

• Are machine guards in place, unaltered

  Yes

  No

  N/A

Electrical

• Extension cords free of damage

  Yes

  No

  N/A

• Electric tools with cords free of damage

  Yes

  No

  N/A

• Are GFCIs being used

  Yes

  No

  N/A

• Lock out tag out implemented

  Yes

  No

  N/A

Personnel platforms

• Is there a rescue plan

  Yes

  No

  N/A

• Do operators have proof of current training

  Yes

  No

  N/A

• Scissors lift

  Yes

  No

  N/A

• Boom lift

  Yes

  No

  N/A

• Fork truck

  Yes

  No

  N/A

• Lifts being operated correctly

  Yes

  No

  N/A

• Fall protection being used

  Yes

  No

  N/A

Monitoring

• Decibel level monitoring

  Yes

  No

  N/A

• Silica monitoring

  Yes

  No

  N/A

Housekeeping

• Is the general work area clean and free of debris

  Yes

  No

  N/A

• Are walking working surfaces clean and free of debris

  Yes

  No

  N/A

• Are tobacco, food and drink policies in place and being followed

  Yes

  No

  N/A

• Are there adequate personal facilities onsite for employee use

  Yes

  No

  N/A

JSA

• Was a closing meeting held

  Yes

  No

  N/A

• Summary of meeting

• Any safety concerns identified among employees, foreman superintendent or the general contractor

  Yes

  No

  N/A

• Details of concerns

• For any corrective actions identified was a implementation timeline discussed

  Yes

  No

  N/A

• Items needing correction

• Timeline

• Is a follow up plan in place

  Yes

  No

  N/A

• Follow up plan

• Add signature

  Sign