Information

  • Job Number/Name/Foreman

  • Conducted on

  • Prepared by

General Work Environment

  • Are all work areas clean?

  • Trash bin(s) available?

  • Are aisles, walkways, doorways, and exit routes kept clear and unobstructed?

  • Are toilets and washing facilities provide, kept clean, and safe?

  • Are SDS on site in an area that is readily accessible to all employees?

  • Are required postings DOL, Code of Safe Practices, etc.?

  • Are weekly "tool box" safety meetings held?

  • Is material piled, stacked, or racked in a manner to prevent it from tipping, falling, collapsing, rolling, or spreading?

First Aid and Emergency Equipment

  • Are emergency telephone numbers posted on the job site?

  • Is there at least one person on site trained in first aid and CPR?

  • Are first aid kits easily accessible?

Fire Protection and Prevention

  • Is there at lease one ABC fire extinguisher for every 3000 sq ft of work area?

  • Are fire extinguishers clearly visible and unobstructed at all times?

  • Are fire extinguishers inspected monthly for proper tags, pins, hoses not cracked or plugged, fully charged, and tags up to date?

Fall Protection

  • Are holes and other floor openings guarded by a grate, cover, guardrail, or equivalent on all sides (except at entrances to stairways or ladders)?

  • Are fall protection harnesses and lanyards used by every employee working 6 feet or higher?

  • Where a job site has protruding steel rebar or other protrusions below the work level, are they protected by covers to prevent impalement injuries?

Portable Ladders

  • Are ladders being used for their designed purpose only? (Step ladders/Extension ladders)

  • Do they have the appropriate labels?

  • Are they in good condition?

Personal Protective Equipment

  • Is the appropriate PPE worn by employees?

Materials - Handling, Storage, Use, and Disposal

  • Chemicals being stored and labeled correctly?

Scaffolding

  • Was the scaffold inspected prior to use and scaffold tag properly filled out?

  • Are scaffolds in good working condition with no damage or missing parts?

  • Have toeboards been installed to prevent falling objects?

Electrical

  • Are all cord-connected, electrically-operated tools and equipment double insulated or effectively grounded?

  • Are ground-fault circuit interrupters provided on all temporary electrical circuits?

  • Are all electrical rooms/panels secured and have proper signage?

  • Are all electrical cords inspected, protected from damage and in good working condition (i.e. no splices, frays, or the ground prong is removed)?

  • LOTO in place?

Trenching and Shoring

  • Are spoils, materials, and equipment set back a minimum of 2 feet from edge of the excavation?

  • If deeper than 6 feet, is there protection from falling?

  • Is an appropriate ladder available in all trenches that are 4 feet deep or more?

  • If deeper than 5 feet, is there cave-in protection?

Power-Actuated Tools / Hand and Power Tools

  • Are employees who operate power actuated tools properly trained and carry a valid operator's card?

  • Are grinders, saws, and other tools with moving parts, equipped with appropriate safety guards to prevent physical contact with moving parts?

Traffic Control

  • Have flaggers been properly trained and carry their flagger certification card?

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.