Jobsite Safety Inspection for Platform Contracting

• Customer

• Project/Job

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

PERSONAL PROTECTIVE EQUIPMENT

• A. Hard Hats

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• B. Safety Glasses

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• C. Safety Vests

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• D. Other

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

FALL PROTECTION

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

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• B. Fall protection plan in place?

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• C. Handrail and edge protection in place?

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• D. Impalement hazards?

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

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

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• F.. Ladders inspected and properly secured?

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

EXCAVATIONS

• A. OUPS notified?

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• Competent person inspected?

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• B. Ladders in trenches over 4 feet deep?

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

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

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

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

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• Soil properly classified?

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

HEALTH/FIRST AID

• A. CPR/First AidTraining

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• B. First Aid Kit (No Expired Items)

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• C. Eye Wash Facilities

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

ELECTRICAL

• A. G.F.C.I.'s

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• B. Extension Cords

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• Contact with overhead power lines?

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

SILICA

• Potential Exposure to Silica

  Compliant, Working per Table 1

  Compliant, Working per Air Sample

  Non-Compliant

  No Silica Exposure

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

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• Silica control measures in place

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

SCAFFOLD

• A. Trained Personnel (Competent Person)

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• B. Hand and Mid-rails, Toeboards

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• H. Inspection/Tagged Correctly

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

LIFTING AND RIGGING

• A. Crane Inspection and set up

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

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

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

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

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• D. Lifting equipment labels properly displayed?

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

TRAFFIC MANAGEMENT

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

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

GENERAL SITE

• A.adequate housekeeping?

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

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

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

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

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• D. Subcontractors working safely?

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• Weather?

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

• Misc. Site Conditions?

  Low Risk

  Moderate Risk

  High Risk

  Safe

  N/A

COMMENTS/ RECOMMENDATIONS

• Brief description of work being performed

• Enter any corrective actions that will be undertaken

• Follow-Up items and/or tasks

SIGN OFF

• Safety Representative

  Sign

• Construction Supervisor

  Sign