Information
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Site
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General Contractor
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Conducted on
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Prepared by: Hermanson Company LLP 1221 2nd Ave North Kent, Wa 98032 www.hermanson.com
1.0 Safety Plans
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1.1 Site Specific Safety Plan on site?
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1.11 Are employees oriented and signed off?
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1.2 Site Specific Safety Plan for Subcontractors?
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1.05 Other?
2.0 JHA/JSA/PTP/Work Permits
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2.1 Job description adequate?
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2.2 PTP completely understood by all?
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2.3 PTP hazards and precautions match?
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2.4 Quality of PTP steps and hazards?
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2.05 Other?
3.0 Personal Protection
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3.1 Hard hats, glasses, goggles, hearing protection?
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3.2 Barricades up where applicable?
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3.3 Proper gloves in use?
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3.4 Job-specific PPE as required?
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3.5 High visibility vests?
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3.05 Other?
4.0 Safety Equipment
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4.1 Fire extinguisher(s) in place?
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4.2 Fire extinguisher(s) inspections complete?
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4.3 Eyewash available? Not expired?
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4.4 First aid kit available?
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4.5 First aid kit stocked properly?
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4.05 Other?
5.0 General
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5.1 Lighting?
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5.2 Ventilation?
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5.05 Other?
6.0 Tools and Equipment
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6.1 Proper tools in use/used properly?
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6.2 Guards/safety devices in place?
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6.3 Tools in good condition?
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6.05 Other?
7.0 Body Positioning/Movement
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7.1 Line of fire risk?
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7.2 Attention to task?
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7.3 Pinch points?
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7.4 Proper lifting?
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7.5 Avoid/protected from sharp edges?
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7.05 Other?
8.0 Housekeeping
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8.1 Work areas clean and neat?
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8.2 Barricades maintained?
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8.3 Cords rolled and stowed?
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8.4 Materials properly staged/stored?
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8.05 Other?
9.0 Fall Protection
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9.1 Guardrails in place?
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9.2 Warning lines used?
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9.3 Guardrails/warning lines installed correctly?
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9.4 100% fall protection over 4' achieved?
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9.5 Proper fall protection equipment?
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9.6 Fall Protection Work Plan for work over 10'?
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9.05 Other?
10.0 Working at Height/Scaffolding/Ladders
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10.1 Decking complete w/o holes?
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10.2 Scaffold tag in place/current?
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10.3 Area below barricaded?
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10.4 Ladder extends 3' above landing?
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10.5 Cage on vertical ladder over 25'? Rest platform(s)?
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10.05 Other?
11.0 Walking Working Surfaces
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11.1 Aisles/stairs/floors clear/clean?
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11.2 Designated walking area?
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11.3 Holes 1" and larger covered?
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11.05 Other?
12.0 Mobile Equipment/ Lifts
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12.1 Forklift Pre-use inspection complete?
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12.2 Aerial Lift Pre-use inspection complete?
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12.3 Proper training?
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12.4 Spotter used when appropriate?
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12.05 Other?
13.0 Electrical
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13.1 Assured Grounding complete? Correct color (Q1-white, Q2-green, Q3-red, Q4-orange) if required?
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13.2 GFCI use on all power cords/tools?
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13.3 Extension cords in good shape?
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13.05 Other?
14.0 Welding/Grinding/Temporary Power
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14.1 Hoses, leads, cords hung properly?
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14.2 Sparks controlled?
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14.3 Fire watch present?
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14.05 Other?
15.0 Cranes/Lifting/Hoisting/Rigging
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15.1 Crane(s) inspected/documented?
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15.2 Operator NCCCO certificate?
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15.3 Qualified signal-person? Documentation onsite?
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15.4 Qualified rigger? Documentation onsite?
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15.5 Ground is level/firm?
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15.6 Rigging is inspected/undamaged?
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15.7 Tag lines/softeners used?
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15.8 Critical Lift Plan done, if required?
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15.9 Overhead powerlines considered?
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15.10 Personnel not under suspended loads?
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15.05 Other?
16.0 Excavation Work
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16.1 Daily inspection conducted?
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16.2 Daily inspection documented?
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16.3 Over 4' inspected by competent person?
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16.4 Excavation shored/sloped/benched?
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16.5 Spoils pile at least 2' from edge?
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16.05 Other?
17.0 Confined Space
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17.1 Attendant trained and alert?
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17.2 Confined space signs posted at entrance(s)?
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17.3 Personnel in confined space(s) checked in/out?
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17.4 Ventilation in place/adequate?
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17.05 Other?
18.0 Cylinders/Hazardous Materials/Flammables/Combustibles
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18.1 Flammable/O2 bottles stored properly?
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18.2 Proper storage containers for flammables/combustibles?
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18.3 Secondary labeling for chemicals?
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18.05 Other?
