Title Page
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Conducted on
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Prepared by
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Crew Size
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Foreman
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Location
Personal Protective Equipment (PPE)
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Hard Hats Worn (1926.100)
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Type 2 Safety Vest worn as required (1926.100)
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Eye/ Face Protection worn as required (1926.102)
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Long Sleeve Shirt worn (1926.100)
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Proper footwear worn (Steel Toes) (1926.96)
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Gloves (1926.96)
Ladders
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Ladder extension (Safety Gate) a minimum of 3' above working surface (1926.1053)
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Ladder sitting firm on ground (1926.1053)
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control access-zone (1926.1053)
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Ladder secured (1926.1053)
Scaffolding
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Trained competent person conducting daily inspection (1926.450)
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Entryway Chained/Locked after use (1926.450)
Housekeeping
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Grounds properly Maintained & Free from debris (1926.25)
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Staging area reasonably organized and maintained (1926.25)
SDS/First-Aid/JHA
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Job Hazard Analysis (JHA) available on-site (1926.25)
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Safety Data Sheet (SDS) Avaliable on-site (1926.25)
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Adequate medical supplies available on-site (1926.25)
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OSHA board posted on-site (1926.25)
Fire Protection
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Fire Extinguishers available on-site (1926.150)
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Travel distance withing 100' from extinguisher (1926.150)
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Fire Extinguishers inspected within a month (1926.150)
Electrical
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Power cords in good condition (1926.400)
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GFCI on portable generators (1926.400)
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Corded tools in good condition (1926.400)
Rigging Equipment
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Trained competent person conducting machinery (1926.251)
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Inspection done prior to use (1926.251)
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Operator certified for equipment (1926.251)
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Area of operation inspected for seen & unseen hazards (1926.251)
Flammables & Combustibles
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UL Listed Approved gas containers being used (1926.152)
LP Gas
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Propane tanks stored upright position & secured by chain/rope (1926.153)
Fall Protection
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Zip-Rails used in active work area (1926.500)
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Zip-Rails secured with pins (1926.500)
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Zip-Rails In good condition (1926.500)
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Zip-Rails Installed Per manufacturers instruction (1926.500)
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Warning lines installed 10' From leading edge (1926.500)
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Warning Lines height between 34-39 inches (even at sag point) (1926.500)
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Warning Lines Used when parapet wall is less than 39" Height (1926.500)
Holes,Skylights,Etc.
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Personal Fall Arrest System Available (1926.500)
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Secure cover for holes greater the 2 inches (1926.500)
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Is Cover Secure (1926.500)
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Is cover marked off "cover" or "hole" (1926.500)
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Cover withstands two times weight of worker (1926.500)
Sanitation
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Adequate supply of portable water available (1926.50)
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1 bathroom per 10 employees provided (1926.50)
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sanitation available in bathroom(s) (1926.50)
