Title Page
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Site conducted
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All R&D Electric workers and all Subcontractors must attend a start of shift meeting and complete this inspection together
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Location (if no site is entered above)
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Conducted on
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Prepared by
Hazards and discussion about safety measures
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discuss all the hazards present for the work task in this section, if hazard is present answer yes and document safety measures used.
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"Fall From" falling objects from life saving rules
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how is the risk prevented?
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"Moving Vehicles and Equipment" from life saving rules
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what method is used to prevent injury from moving equipment and vehicles?
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"working from heights" from life saving rules
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what method is used for fall arrest?
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"trench safety" from life saving rules
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what method is used for shoring of trenches in excess of 59"? what other trench safety methods are used?
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"confined Space" from life saving rules
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has the confined space program been reviewed? Has a confined space plan been made? Was it approved by a company officer?
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"Fire or Explosion Risk" from life safety rules
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what are the risks and how have they been mitigated?
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"verify no live energy" from life safety rules
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where is there a risk of live energy? how are you testing? how are you safeguarding?
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verify all employees are sober from alcohol, drugs, or medications that cause drowsiness per company drug free workplace guidelines
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what issues are present? report to your manager or company officer if clarification or action is needed.
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Required PPE per site safety plan
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MANDATORY: hard hat, eye protection, high visibility vest, gloves, work shoes and pants. In addition what PPE is required at this site?
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Strained Muscles
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discuss warm up, proper lifting techniques and roles of helpers. please note from discussion:
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Heat Stress
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how are you mitigating heat stress? (breaks, shade, water, etc?) are the heat stress symptoms known? (cramps, dizzy, weak, clammy skin, irregular pulse, etc) are the heat stroke symptoms known? (dry red hot skin, pupils constricted, high body temp, rapid pulse, possible unconsciousness, etc.
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Electrocution
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what are live parts hazards? what equipment contact hazards? has a live work plan been approved by a company officer? are LOTO methods intact and inspected at start of operation?
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Hearing Stress
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Perform "Noise Exposure Monitoring" inspection in iAuditor
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what is the hazard and how are workers protected?
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Eye Injury
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Eye protection is mandatory PPE, what additional measures are employed at this site?
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Extension Ladder
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all extension ladders shall be on level surface, tied off, and above surface by 3 feet.
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Heavy Lifting
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what lifting methods, warm up, additional labor is being used for heavy lifts?
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List other Hazards not identified above:
Site Safety Plan review, emergency response, and attendance
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Emergency Contact Number (posted on site safety plan)
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Nearest Hospital/ER (posted on site safety plan)
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Hospital/ER Number (posted on site safety plan)
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All employees and sub-contractors must review and comply with the safety plan devised above. By signing this document, you have reviewed and will implement all safety protocols required by the Competent Person
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Add signature
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Attendee Signature
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Attendee Signature
