Site Information

Sheet

Sing-in Sheet Pictures
Work Start Time
Lunch Start Time
Lunch End Time
Work End Time


Crews on site
# Framers/Rockers
# Finishers
# EIFS/Plaster workers
# Scaffold Crew



Emergency telephone numbers & procedures posted.

There a competent person, someone capable of identifying existing and predictable hazards which are unsanitary, hazardous or dangerous, and who has authorization to take prompt corrective measures to eliminate them, on site.

First aid supplies are adequate.

Weekly safety meetings are being held and safety sheets are being signed.

SDS is on site and accessible to all employees.



Housekeeping: aisles clean, scrap removed, work areas clean and free of dangerous waste and material.

Work areas have appropriate lighting.

Adequate supply of water or water jugs, cups and trash containers.


Personal Protective Equipment (PPE)

Head, eye, face, foot, and hand protection utilized as needed/required.

Warning/Danger signage posted as needed.

PFAS worn when needed/required.


Fire Protection & Prevention

Fire extinguishers provided in adequate number and type and in readily accessible locations.

Fire extinguishers are properly charged.

All employees and subcontractors know the location of the fire extinguishers.

Flammable & combustible liquids stored in approved containers only.



All equipment is either grounded or double insulated.

GFCI receptacle used, including when using permanent power.

Temporary light are equipped with guards (when required) to prevent accidental contact with bulb.

Extension cords are not frayed or cut and are in good repair with intact ground pin.

Electrical cords are not ran over sharp edges unprotected.

Electrical cords are hung or placed in a way to prevent a tripping hazard.



All tools are in good working order.

Tool cords are free of cuts or abrasions and are in good repair.

Proper tool being used for the task.

Tools are being used properly.

Guards are in place on tools being used.



Ladders are in good condition with all appropriate labels and have slip resistant feet and are positioned away from electrical exposures.

Ladders are properly secured to prevent slipping, sliding or falling.

Straight ladders extend 36" above top of landing.

Stepladders are fully open when in use.

No employee is standing on a ladder rung which is deemed unsafe.


Perry/Baker Scaffolding

Components are in good repair.

Scaffold is set up on baseplates or casters.

Baseplates are used in place of casters in stairway.

Wheels are locked when in use.

Stacked scaffolds have outriggers in use OR are tied/braced to prevent movement/tipping.

Working surface is free of debris and excess material.

All open sides and ends of the working platform more than 6' above ground are provided with guardrails.

No employee is standing on guardrails or material in order to gain height.


Tube & Coupler Scaffolding, Large Frame Scaffolding, or System Scaffolding

Scaffolding is constructed by a qualified person.

Scaffold equipment in good working order.

Inspected by competent person daily before use.

Scaffolding was erected per the manufacturers instructions and will meet the guidelines outlined in OSHA standards.

Footing and anchors are sound, rigid, and capable of carrying 4 times the maximum intended load without settling or displacement.

The scaffold is set up on adequate flat baseplates, mud sills, screw jacks, etc.

All connections are pinned or fastened securely.

Scaffolding is properly supported on scaffold jacks and not on stacks of wood, boxes, bricks, barrels or any other unstable materials.

Planks are certified scaffold planks or structural lumber.

Planks overlap the end of the scaffold no less than 6" and no more than 12".

The working surface is fully planked.

Planks are secured to prevent slipping.

Less than a 1" gap to prevent tools, etc. from falling through.

Less than 14" between scaffold and working surface.

Ladders are used to gain access to scaffold work platforms.

Maximum spacing of rungs is 16-3/4".

Scaffold is free of debris and excess material.

All open sides and ends of the platform more than 6' above ground are provided with top rails, midrails, and toeboards.

Top rails are between 38" to 45" high, midrails are midway between working platform and top rail.

Guardrails are capable of withstanding 200 lbs of force along the top rail.

Scaffold is tied off every 30' horizontally and 26' vertically if the height exceeds 4 times the width of the base.

On suspended scaffolds, vertical lifelines are attached to structure and a PFAS is used.


Fall Protection

Floor openings are covered OR guardrails are in place.

Open-sided floors and wall opening have guardrails.

Roof edges are adequately guarded.

Leading edge protection & signage utilized where required.

100% fall tie off for all heights above 6 ft with proper anchor points.

Employees are protected from fall exposures.

Employees are using proper equipment and work platforms to gain height as needed.

Warning lines are being used properly.


Aerial & Scissor Lifts

Only those who are authorized to operate the lift are permitted to do so.

Lift inspection checklists are being completed.

Employees are keeping their feet on the work platform in the basket.

Fall restraint & fall protection are being used correctly.

Fire extinguishers are installed on all lifts.

Lifts are being used properly.


Industrial Trucks / Forklift

Only those who are authorized to operate the forklift are permitted to do so.

Forklift inspection checklists are being completed.

Seat belts are being used.

Fire extinguishers are installed on all forklifts.

Forklifts are being used properly.

Forklift operator is within 25 feet of the forklift when the forks are raised.


General Comments

Sign Off
Framers/Rockers Supervisor Signature
Finishers Supervisor Signature
EIFS/Plaster Supervisor Signature
Scaffold Crew Supervisor Signature
Safety Representative Signature
Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.