General Information

  • List the names of the employees involved in the task

  • Description of task being inspected

Work Area

  • The area is neat, clean, and free from debris, dirt, or other materials

  • Illumination is adequate for the tasks to be performed

  • Ventilation is adequate for the task being performed

Personal Protective Equipment (PPE)

  • Employees are wearing appropriate PPE

  • PPE is in good condition and sized correctly

Job Briefing and Planning

  • JSA is properly filled out and signed

  • JSA and any other applicable work permits are properly communicated via tailboard meeting

  • Employees are following precautions listed on the JSA and any other required work permits

Safety Equipment

  • GFI protection in place and extension cords, grounding clusters in good condition

  • A fire extinguisher is staged at the worksite where hot work is being performed

  • Inspections on safety equipment have been perfromed within the required frequency

  • All safety equipment is clearly labelled and accessible

Electrical NFPA 70E

  • Electrical hazards identified

  • Proper electrical PPE used (shock/arc flash)

  • Protective grounds as needed (PPE and grounds tested & inspected)


  • Tools are in good condition

  • Tools are effectively grounded

  • Tools, equipment, and PPE tested and calibrated as needed

  • Ladders, scaffolds, lifts, working at height platforms properly inspected and secured

  • Fall protection equipment used, appropriate, and inspected

Lockout and Tagout (LOTO)

  • LOTO devices are in place

  • LOTO form has been completed correctly

  • LOTO devices adequately isolate energy from the employee

  • LOTO devices are attached correctly and provide a warning and deterant for employees

  • Employee is following LOTO procedure

Emergency Preparedness

  • Emergency preparedness is in place and evacuation procedures understood

  • First aid kit and spill kit is on station or available

  • Signature of inspector

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