Information

  • Client / Site

  • Job Number

  • Conducted on

  • Location
  • Prepared by

  • Foreman

  • Supervisor

  • Personnel

Ground Set-up

  • Are grounds clean and free of debris?

  • Is the material covered or flagged off?

  • Is the crane set up properly and fenced off?

Ladders and Roof Access

  • Is the ladder set up with the 4:1 ratio?

  • Is the ladder securely tied off?

  • Are the workers using the ladder properly?

  • Is the ladder in good condition and free of any defects?

  • Does the ladder extend at least 3 feet above the roof level?

  • If the ladder is fixed, does it have a cage.

Scaffold Tower

  • Has the scaffold tower been erected by Quality Roofing or a third-party?

  • Is the scaffold tower being inspected daily?

Guard Rail System

  • Is the top edge of the guardrail or cable system between 39" and 45"?

  • Is the gap between the midrail and toprail 21" or less?

  • Can the top and mid-rail withstand enough outward and downward pressure? (200lbs)

  • Are the cable clamps installed correctly?

Perimeter Flagging (Warning line)

  • Is the warning line at least 6 feet from the roof edge?

  • Is the warning line between 34 and 39 inches?

  • Is the warning line flagged at least every 6 feet?

  • Will the warning line with stand at least 16 pounds of outward force?

Full Body Harness

  • Have all employees inspected their harness before use?

  • Are employees wearing the full body harness correctly? Snug not loose?

  • Are all harnesses in good working condition?

Safety Cart

  • Are safety carts greater than 6 feet from the roof edge or opening?

  • Is the safety cart in good working condition?

  • Are employees using the safety cart correctly?

Self Retracting Lifelines and Lanyards

  • Are SRL's in good working condition?

  • Are lanyards in good working condition?

  • Are SRL's and lanyards being used properly?

Personal Protective Equipment

  • Are all workers wearing safety glasses?

  • If applicable are all workers wearing protective hardhats?

  • Are workers handling hot asphalt wearing long sleeves and gloves?

  • If applicable are all workers wearing the appropriate footwear?

  • Are first aid kits well stocked and available to the workers?

  • If applicable are face shields in use?

Fire Safety

  • Is there a fire extinguisher on the roof?

  • Is there a fire extinguisher available by the kettle?

  • Are approved safety cans being used on the jobsite?

  • Are bulk propane tanks at least 25 feet away from the kettle?

  • Hot work permit in use? (If Required)

Electrical

  • Are all cords in good working condition?

  • Are electrical cords being used in a dry environment?

  • Do all plugs have an electrical ground prong?

  • Are working GFCI's in use on all generators?

Equipment

  • Seatbelt in use on mobile equipment?

  • Back up alarm working?

  • Park brake in use when stopped?

Miscellaneous

  • Are holes greater than 18" x 18" covered or flagged off?

  • Are single service cups or bottled water available on the roof?

  • Has the jobsite been inspected for hazards prior to work start?

  • Comments/recommendations

  • Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.