Information
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Project Name
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Conducted on
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Prepared by
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Location
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Walked With
Inspection Items
Safety Administration
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Weekly Safety Meetings
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Permits
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Emergency & Medical Response
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Injury & Illness Prevention Program
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Safety Task Analysis
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Weekly Job Site Inspection Reports
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Hazcom- MSDS / SDS
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Posters
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Training
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Other / Extra
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
Personal Protective Equipment
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Hard Hats
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Eye and Face Protection
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Footwear
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Vests
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Respiratory Protection
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Clothing (incl. Gloves)
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Hearing Protection
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Fall Restraint / Protection
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
Tools & Equipment
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Right Equipment / Tool for the job.
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Correct Use
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Safe Condition
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Inspections and Training
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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GFCI /Assured Grounding
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Other / Extra
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
General Safety Items
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Fire Prevention & Protection
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Guarding - Floor, Elevator, Roof
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Compressed Gas / Fuel Storage
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Ladders
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Scaffolds
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Trenching & Excavation
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Crane & Rigging
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Housekeeping
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Lighting / Noise
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Sanitation
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Impalement Protection
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Fall Restraint / Arrest Systems
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Electrical Safety
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Lock Out Tag Out (LOTO)
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Heat Illness Prevention
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Chemical Safety - Storage
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Confined Space
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Site Security
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Access / Egress
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Material Storage
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Traffic Control
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Demolition
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Dust Control
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
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Date Corrected
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Signature for Corrective Action
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Photo(s)
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Other / Extra
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Issues
Issue
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Contractor Name
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Description of Issue
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Corrective Action Taken
-
Date Corrected
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Signature for Corrective Action
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Photo(s)