Title Page
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Conducted on
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Prepared by
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Location
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Personnel
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Client / Site
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Worksite Location
Posters are visible and current?
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OSHA / State / EEO
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Emergency phone numbers
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Chemical SDS on site?
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Other
Inspections
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Vehicles
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Fire Extinguishers
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Hand / Power Tools
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Other
PPE Proper Use & Good Condition
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Hard Hats
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Safety Glasses / Shields ANSI
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Safety Toed Shoes
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Respiratory Protection
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Gloves
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Hearing Protection
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High Visibility Clothing
Ladder Usage
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Extension and lean ladders are 3 ft above edge.
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“A” Frame Spreader Engaged.
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Inspected, No Defects.
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Other
Fall Protection
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Harness & Equipment Inspections Completed Prior to Every Use.
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Lanyard & Retractable Devices Inspections Completed Prior to Every Use.
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Employees are Properly Tied Off.
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Guard Rails and Barricades in Place.
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Proper Anchor Point in Use.
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Fall Protection Will be Effective. Fall Clearance & No Swing Potential.
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Other
Excavations
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Utilities Located
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Proper Shoring / Cutback > 5ft.
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Spoil Piles > 2 ft.
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Access/Egress 25 ft. Max >4 ft.
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Barricade > 6 ft.
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Inspections Completed
Housekeeping & Sanitation
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Material Yard & Site Area Clean.
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Restroom Facilities Clean & Accessible.
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Drinking Water Daily and Accessible.
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Offices & Trailers Clean
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Other
Equipment Conditions
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Inspections Complete
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Back up Alarm Working.
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Seat Belts Used.
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Cab Clean of Trash.
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Engine off During Refueling.
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Horn Used Prior to Movement.
Rigging Equipment Inspections
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Sling/Choker Size
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Safety Latches
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Shackles/Softeners
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Equipment requests placed for aging gear.
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Other
Electrical Inspections
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GFCI working properly, tested.
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Cords free of damage
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Light Plants
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Other
Permits Completed
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Excavation
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Confined Space
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Hot Work
Miscellaneous
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Proper Barricades
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Safety Forms
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First Aid Kits
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Flammable Signage-Fuel
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Air Lines Secure-Whipcheck
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Overhead Signs
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Power Lines
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Traffic Control Maintained
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Certified Flaggers
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Other
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Audit completed
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Supervisor Signature
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Safety Director Signature
