Information
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Project name
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Superintendent
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Forman
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Prepared by
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Date
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Location
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First aid / trained persons and FA kit on Jobsite?
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MSDS on truck
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Spare PPE on truck
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Underground ticket
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Is this confined space?
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Confined space entry permit done
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job site summary
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pictures
Excavation
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Is this job below grade ?
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Trench collapse prevention
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Fall protection / open trench
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Shallow open trench < 2'
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Trip fall protection / open hole
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Overhead power lines > 20'
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Means of access / egress from trench?
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Adequate Ladders for self-rescue?
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25' distance between ladders
Heavy Equipment
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Mobile Equipment Operation on this Job site?
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Equipment Inspection complete?
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Back up alarms on all Mobile equipment?
- Safe
- At Risk
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Take out of service
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Certified equipment operator
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Crane and hoisting equipment
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Is crane operator certified (carded)
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Crane set up / stabilized
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Are pads being properly used ?
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Please explain
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Is operating area of crane clearly marked and entry denied
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Rigging equipment
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Why is this not good
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Scaffolding
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Is this Job site using scaffolding
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Is scaffolding being used greater than 6' working height
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Guardrails and toe boards
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Are guard rails in place?
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Adequate platform / work surface?
- Safe
- At Risk
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Base plates / mud sils / casters?
- Safe
- At Risk
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Bracing, locking pins?
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Scaffolding tied off / secure?
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Access ladder?
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Is scaffolding safety tagged green or yellow
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Are tool lanyards available and used?
Ladders
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Aral lift operation
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Are Ladders used on this job?
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Condition?
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Extended 3' above landing?
- Safe
- At Risk
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Tied off / secured?
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Step ladder misuse?
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Ladder / other
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Stairs / steps?
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Is ladder inspection current? 6 Mo?
electrical
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Is LOTO properly Used?
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Do all employees on jobsite have access to LOTO ?
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GFCI / assured grounding
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Extension cords
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Are the cords properly tapped for job / season?
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Temporary lighting
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Power tool condition / guards?
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Is tool taken out of service?
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Energized exposed parts
fall protection
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Is this above ground level?
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Walking / Working surfaces > 6'
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Are guard rails used or fall protection ?
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Fall arrest system and equipment
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And inspected ?
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Exposed rebar / impalement
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Falling object protection
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Leading edge protection
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Open hole > 6'
Personal Protection
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Hard hats
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Safety glasses / hood / shield?
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Traffic vest
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Is this a non traffic area ?
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Safety Shoes or boots
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Respiratory protection PAPR or 1/2 mask
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Hearing protection
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Clothing (safety colors) approved
Industrial Hygiene
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Is compressor or generator being used
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Has compressor or generator been checked out (documented)?
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Air quality
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What is being done to improve the air quality?
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Silica exposure adequate ventilation or face pieces
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Air monitor use? <br>
General
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Housekeeping?
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Lock out tag out?
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Access to work site
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Flammable material storage>
- Safe
- At Risk
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Welding and cutting
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Are Proper "hot work" conditions met?
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What else needs to be done?
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Inspected by?
