Jobsite Checklist - Standard

• Document No.

• Site

• Conducted on

  Date

• Prepared by

• Personnel

Postings

• OSHA Form 3165

  Yes

  No

  N/A

• OSHA Form 300A

  Yes

  No

  N/A

• Emergency Phone Numbers

  Yes

  No

  N/A

Administrative

• Employees Demonstrate positive attitude toward safety

  Yes

  No

  N/A

• Record Keeping: AHA's, Jobsite Checklists forms, readily accessible and current.

  Yes

  No

  N/A

• Weekly safety meetings documented and up to date

  Yes

  No

  N/A

Chemicals & Hazardous Materials

• MSDS / SDS readily available

  Yes

  No

  N/A

• Signage & DOT Lables and placards in place

  Yes

  No

  N/A

Environmental Controls

• Adequate Lighting

  Yes

  No

  N/A

• Medical Services Reasonable accessible

  Yes

  No

  N/A

• Administrative and/or engineering controls in place to reduce noise levels

  Yes

  No

  N/A

• Protection from ionizing and/or non ionizing radiation in place

  Yes

  No

  N/A

• Emergency Action Plan / Fire Prevention Plan available / Accident Prevention Plan

  Yes

  No

  N/A

Jobsite

• General House Keeping - area free from debris

  Yes

  No

  N/A

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• Compactor/Trash Disposal procedure in place

  Yes

  No

  N/A

• Storage areas maintained in orderly manner

  Yes

  No

  N/A

• Adequate restroom facilities

  Yes

  No

  N/A

• Potable Water available

  Yes

  No

  N/A

• Warning signs, tags, barricades, tape in place

  Yes

  No

  N/A

• Walking/Working surfaces

  Yes

  No

  N/A

Ergonomics

• Proper Lifting Techniques being employed

  Yes

  No

  N/A

Temporary Electrical Wiring

• Extension Cords Inspected and free of defects

  Yes

  No

  N/A

• Ground Fault Circuit Interrupters (GFCI) in use

  Yes

  No

  N/A

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• All Equipment properly grounded (incl. double insulated lines)

  Yes

  No

  N/A

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• Temporary wiring clear of employee & Vehicular traffic

  Yes

  No

  N/A

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Personal Protective Equipment Required

• Hard Hats

  Yes

  No

  N/A

• Eye Protection

  Yes

  No

  N/A

• Approved work shoes

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Respiratory Protection

  Yes

  No

  N/A

Equipment including PPE, Scaffold, Tools, Ladders

• Inspected before use

  Yes

  No

  N/A

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• Defective items tagged and removed from service

  Yes

  No

  N/A

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• Powered Equipment operators trained and authorized.

  Yes

  No

  N/A

• Scaffold properly tagged

  Yes

  No

  N/A

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• Scaffold Planks overlap 12" overall; 6" past beam each way.

  Yes

  No

  N/A

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Ladders

• Side rails extend 3' above upper landing surface

  Yes

  No

  N/A

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• Ladders tied off to prevent displacement

  Yes

  No

  N/A

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• Ladder at 4 to 1 slope (75 Degrees)

  Yes

  No

  N/A

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Fall Protection

• Appropriate Fall Protection in place and in use.

  Yes

  No

  N/A

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Safety Attitude

• Employees demonstrating positive attitude toward safety

  Yes

  No

  N/A

Other

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