Information

  • Customer

  • Project/Job

  • Conducted on

  • Prepared by

  • Location
  • Personnel

PERSONAL PROTECTIVE EQUIPMENT

  • A. Hard Hats

  • B. Safety Glasses

  • C. Safety Vests

  • D. Other

FALL PROTECTION

  • A. Fall risk of 6 ft or more? (Including voids, pits and trenches)

  • B. Fall protection plan in place?

  • C. Handrail and edge protection in place?

  • D. Impalement hazards?

  • E.. Harness and lanyard inspected and properly anchored?

  • F.. Ladders inspected and properly secured?

EXCAVATIONS

  • A. OUPS notified?

  • Competent person inspected?

  • B. Ladders in trenches over 4 feet deep?

  • C. Excavations deeper than 5 feet need protection. Proper layback, shoring or trench box in place?

  • Spoils greater than 2 feet from the edge of trench?

  • Soil properly classified?

HEALTH/FIRST AID

  • A. CPR/First AidTraining

  • B. First Aid Kit (No Expired Items)

  • C. Eye Wash Facilities

ELECTRICAL

  • A. G.F.C.I.'s

  • B. Extension Cords

  • Contact with overhead power lines?

SILICA

  • Potential Exposure to Silica

  • A. Equipment, respirators, etc cleaned and inspected?

SCAFFOLD

  • A. Trained Personnel (Competent Person)

  • B. Hand and Mid-rails, Toeboards

  • H. Inspection/Tagged Correctly

LIFTING AND RIGGING

  • A. Crane Inspection and set up

  • B. Loads lifted over persons, close to obstacles or overhead power lines?

  • C. Lifting equipment including ropes, slings, chains, hooks inspected?

  • D. Lifting equipment labels properly displayed?

TRAFFIC MANAGEMENT

  • A. Adequate pedestrian and vehicular traffic plan in place?

GENERAL SITE

  • A.adequate housekeeping?

  • B.adequate amenities (toilets, wash areas, lunch rooms, etc)

  • C.safety plan and hazard communication plan in place?

  • D. Subcontractors working safely?

  • Weather?

  • Conditions

COMMENTS/ RECOMMENDATIONS

  • Brief description of work being performed

  • Enter any corrective actions that will be undertaken

SIGN OFF

  • Safety Representative

  • Construction Supervisor

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.