Information

  • Date - Initials - Job Number(s)

  • Job Name

General Project Information

  • Safety Manager Assigned to this project:

  • Site hours of operation:

  • List Sub-Contractors and Competent Persons per sub:

  • Prepared by

  • Weather Conditions

  • Conducted on

  • Location

1. Planned / Scheduled work for the day.

  • 1a. Pre-Task / Safety Briefing prior to start of work?

  • 1b. Work performed according to plan?

  • Brief description of work to be performed.

  • 1c. Adequate tools, materials and Safety controls to perform work?

2. Ladders

  • 2a. Unsafe or damaged ladders discarded, destroyed, and removed from site?

  • 2b. Ladders properly positioned?

  • 2c. Ladders properly secured?

3. Emergency Response

  • 3a. Adequate emergency plans for site?

  • 3b. Emergency procedures displayed at site?

  • 3c. Adequate first aid kits and equipment for site?

4. Personal Protective Equipment (PPE)

  • 4a. Adequate PPE supplied / utilized?<br>

  • 4b. Appropriate training in safe use, clean-up and inspection of PPE?

5. Fall / Perimeter Protection

  • 5a. Guard rails at required height?

  • 5b. Holes greater than 2" covered, secured, and clearly marked?

  • 5c. Fall arrest plan, equipment, & personnel properly trained?

  • 5d. Are all fall exposures from any height protected?

6. Lifting Equipment

  • 6a. Hoisting Equipment adequate for task at hand? (Right machine for the task?)

  • 6b. All workers, and operators aware of hoisting loads over head and near power lines, practices and procedures according to company policy and OSHA Standards?

  • 6c. Unsafe or damaged lifting equipment, including ropes, slings, chains, hooks removed from service?

7. Work Environment

  • 7a. Sufficient lighting?

  • 7b. Adequate housekeeping?

  • 7c. Adequate access/egress provided to the site and all work areas?

8. Flammable Liquids

  • 8a. Are flammable liquids being properly stored?

9. Incidents, Accident, Injury, Near Miss

  • 9a. Were there any incidents, injuries, accidents or near miss' to report today?

  • 9b. Detailed information narrative?

  • 9c. Detailed Information Photo's

10. Electrical Hazards

  • 10a. GFCI outlets inspected regularly?

  • 10b. Electrical equipment placed away from water?

  • 10c. Extension cords inspected prior to use?

  • 10d. Electrical equipment at safe distance from flammables?

  • 10e. Are all power tools inspected prior to use?

11. Lock Out/Tag Out: Hazardous Energy, Equipment or Other.

  • 11a. Lock-out/tag-out (LOTO) procedures for electrical or other hazardous equipment?

12. Excavations

  • 12a. Will excavation work be performed today?

  • 12b. Has an excavator Corporate Safety Program been submitted to Superintendent?

  • 12c. Is there a competent person for excavating on site?

  • 12d. Is there an excavation plan, with associated "DIG" numbers reviewed and approved?

  • 12e. Are Safety restraint belts in place and being used?

  • 12f. Are 'BACK-UP'or other movement alarms in place and functioning properly?

  • 12g. Is traffic control required, and in place according to 'traffic control plan'?

  • 12h. Are Flaggers required?

  • Are the Flaggers certified according to City, State, & OSHA standards?

  • Are the Flaggers trained for the task at hand, and familiar with surrounding activities?

  • 12i. Have open excavations been protected?

  • 12j. Is shoring designed by a Structural Engineer?

  • 12k. Is contaminated material being handled according to plan and disposed of properly in accordance to EPA expectations?

  • 12L. Is erosion control in place? I.e: silt fence, drain screens, pump sock - filter bag, etc...

  • 12m. Has all earth work been inspected by the competent person prior to entering?

  • 12n. Are precautionary measures in place for dewatering trenches / excavations?

  • 12o. Have proper permits been acquired prior to digging?

  • 12p. Has the soil been tested to determine classification by the competent person?

  • 12q. Is benching, sloping, shoring, or shielding required?

  • 12r. Is any special insurance required, if so, has it been obtained? (RR Prospective, etc..)

  • 12s. Are dust control and street sweeping equipment being used? ie... Water truck - Street sweeper

  • 12t. Are there any atmospheric hazards?

  • 12u. Are access & egress points in place according to standards?

13. Administrative Procedures

  • 13a. Procedure for incident reporting followed? (Incident, witness, injury, etc.)

  • 13b. Proper induction for workers, contractors, visitors?

  • 13c. Proper permits acquired prior to task? (Hot Works, Confined Space etc)

  • 13d. Site Safety Plan readily available?

  • 13e. Supervision on site? (List Supt. & PM)

  • 13f. Appropriate consultative arrangements? (Ability to get resolution to concerns)

  • 13g. Routine inspections, monitoring, audits submitted regularly?

14. Tower & Mobile Cranes

  • 14a. Is there a crane on site today?

  • 14b. Are crane inspections current and copies available?

  • 14c. Is the load chart readily available, legible, and being followed?

  • 14d. Are signal persons and riggers qualified with proof readily available?

  • 14e. Are all hook 'Safety Locks' in working order?

  • 14f. Is crane positioned at the correct safe distance from over-head power lines?

  • 14g. Are outriggers properly padded?

  • 14h. Are access ladders and steps properly protected and in good condition?

  • 14i. Does the operator have appropriate licensing accord to Job, City, & State requirements?

  • 14j. Is all rigging properly tagged and regularly inspected?

15. Site exterior condition.

  • 15a. Are all perimeter side walks clean?

  • 15b. Is all public protection in place and in good visible / functional condition?

  • 15c. Are all pedestrian pathways clean, clear of debris and clearly marked or identified?

  • 15d. Is all signage for detoured walk ways in place? i.e. 'Sidewalk closed' 'use other side' 'over head work'

  • 15e. Are canopies being used, if YES, have all hazards been eliminated? i.e.(falling debris/material, sharp edges, trip hazards)

  • 15f. Are there any temporary walkways, if yes, are the ADA (American Disability Act) compliant?

16. Site Security

  • 16a. Is the site fenced to prevent un-authorized entrance?

  • 16b. Are equipment and job trucks locked at the end of shift to prevent un-authorized use?

  • 16c. Are materials and equipment stored in a secure area to prevent theft?

  • 16d. List any site security measures that are currently in place for the site, i.e. security cameras or night time security personnel.

17. Other Safety Observations

  • 17a. Were safety observations made that don't fit a previously listed category?

18. Corrective Actions

  • 18a. Enter any corrective actions that will be undertaken

  • Add media

Sign Off

  • Auditor's signature

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.