Title Page
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Site conducted
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Conducted on
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Prepared by
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Location
Safety Equipment & Conditions
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DOL/OSHA Required Poster Posted
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Emergency Action Plan Posted
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Safety Department & Project Management Phone Numbers Posted
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Employee CPR/FA trained on site
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Fully stocked First Aid Kit Available
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First Aid Kit in date
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PPE for rendering First Aid available? Exam gloves, face shield, cpr mask
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Eye wash stations available within 10 seconds walk of employees performing work that produces flying debris (pouring concrete, cutting wood/rebar)
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Access to drinking water (cold water in hot weather)
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Restrooms available and clean
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PTP filled out correctly and being used
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CAZ properly barricaded and signage on all sides (signs should include: name of responsible party, phone number and company name, hazard inside of CAZ)
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Required permits filled out and available (Excavation, hot work, confined space, ladder, concrete pump)
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Competent person on site and inspecting frequently
HOUSEKEEPING
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Is there General neatness of the work area?
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Are projecting nails removed?
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Are waste containers provided and used?
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Are passageways and walkways clear
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Is lighting adequate?
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Is the lay down yard near and organized? (Rebar caps on verticals)
FIRE PREVENTION
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Are there adequate fire extinguishers that are accessible and inspected (monthly/annually)
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Are flammable liquids stored properly
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Bulk flammable storage and/or bulk fueling tank area have at least a 20lb ABC extinguisher no closer that 25ft and not farther than 75ft
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Are no smoking signs posted and enforced.
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Are funnels being used when refilling equipment
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Is equipment shut down while fueling?
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Is propane stored at least 25’ from occupied structures?
ELECTRICAL
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All power cords inspected for frays, bare wires, missing ground pins or other damage?
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Any cords taken out of service?
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Are GFCI being used?
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Are terminal boxes equipped with required covers?
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Are flexible cords protected from damage (not being run over by equipment, shut in doors etc)
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Are cords suspended above wet areas or areas with standing water?
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Are generators inspected and grounded
HAND TOOLS / POWER TOOLS
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Are hand tools inspected frequently?
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Are broken handles, mushroom heads present?
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Are protective guards in place on tools
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Is the right tool being used for the job
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Powder actuated tools in use? If so, are operators licensed?
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Are operators using proper PPE
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Are tools neatly stored and carried properly?
FALL PROTECTION
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Are employees working more than 6’ above a lower level protected by guardrails, safety nets, PFAS
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Are guardrails/safety nets secured properly and located at correct heights?
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Are employees exposed to fall hazards using PFAS and properly tied off? (5k anchor point, correct lanyard)
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Are employees using turbos along with rebar chains when positioning?
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Handrails at inclines (such as excavations)
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Steps of not more than 9.5”
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Steps have a proper landing?
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Steps have a hand rail?
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Tools/hard hats equipped with lanyard?
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Barricade around excavation?
LADDERS
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Ladder permit in use?
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Job Built ladders meet OSHA spec?
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Are ladders at least 3’ above landing
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Are ladders secured at top and bottom?
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Corral and offset in place to prevent falls?
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Damaged ladder taken out of service?
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All ladders equipped with all decals?
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Step ladders used in the fully open and locked position
SCAFFOLDING
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Has scaffolding been inspected by a competent person?
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Is there a green tag present and signed?
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Is scaffolding erected on sound level footing?
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Plumb, square with cross bracing?
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Are guardrails, midrails, toeboards or screens in place?
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Is planking full, sound and sturdy?
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Overlap of at least 12” at corners and edges of planking?
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Working areas free of dirt, snow, ice and grease?
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Are employees below protected from falling objects?
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Is fall protection available and in use?
FLOOR AND WALL OPENINGS
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Are all floor or deck openings planked over or barricaded?
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Is perimeter protection in place?
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Are deck planks secured?
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Are materials stored away from the edge?
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Is corral in place with offset entrance and toe boards to prevent falls to lower level?
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Do all corrals, covers and barricades include signage?
TRENCHES, EXCAVATIONS & SHORING
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Competent person present and inspecting?
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Are excavations 4’ or greater sloped or benched?
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Are materials and spoil pile at least 2ft from edge of excavation?
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Is equipment at least 2ft away from edge of excavation?
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Are ladders provided every 25’ and secured top and bottom?
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Have underground utilities been located?
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Excavation permit completed?
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Does mobile equipment have spotters?
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Are swing radius markers in place on equipment?
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Are Flagger wearing class 3 vests and have traffic wands?
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What is the soil class? Pentrometer used? What is the pentrometer reading?
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Are handrails used to enter/exit excavations?
MATERIAL HANDLING
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Are materials properly stored or stacked
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Dunnage being used?
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Tag lines used to guide loads?
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Are there adequate employees for the operation?
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Rebar 90D bars covered while in staging area?
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Material free rigged from from forklift mast?
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Material secured to forks/mast with strap?
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Materials properly rigged to forklift?
WELDING & CUTTING
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Are compressed gas cylinders stored upright and secured?
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Is there 20ft min separation between fuels and oxygen?
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Fire extinguishers within 25ft?
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Hoses and regulators in good condition?
CRANES
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Crane operator certified for type of crane being used?
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Daily crane inspection completed?
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Lift chart present in crane?
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Chains, rigging hardware and slings inspected and tagged as required?
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Hand signal charts located in crane?
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Crane Operator DOT physical in date?
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Warning whistles being used?
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Clear communication between signalman and crane operator?
CONCRETE CONSTRUCTION / SILICA
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Proper PPE being worn (faceshield,apron,chem gloves for pouring concrete) N95/Respirator for cutting/drilling ops
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Are employees protected from cement dust?
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Is exposed skin covered?
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Are walls over 8’ supported properly?
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Rebar covered by caps?
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Concrete pump permit complete?
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Saw cut operations producing acceptable amount of dust?
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Cutting operations using water/vacuum as deigned?
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Concrete bucket in good condition?
PERSONAL PROTECTIVE EQUIPMENT
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Hard hats, Safety glasses, vests and gloves being worn properly?
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Faceshields being worn when needed? (Any operation producing flying debris)
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Are respirators being used when required/needed?
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Hearing protection being worn in environments greater than 90db?
MOBILE EQUIPMENT
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Mobile Equipment equipped with back-up alarm?
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Inspection report complete?
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Operators certified for equipment?
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Seat belts being used
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Fire extinguisher on machine and inspected?
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All machines have a century label on them?
STAIRS
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Stairs with more than 4 risers equipped with handrail?
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Metal pan stairs filled with wood until filled with concrete?
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Proper landing at top of stairs?
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Stair risers no more than 9.5”
HAZARD COMMUNICATION
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Is there an SDS available to all employees?
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SDS inventory on site and accurate?
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Each original container labeled with product identifier, signal words, hazard statement, pictograms, precautionary statements, name, address, phone number of chemical manufacturer.
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Is each secondary container (example spray cans) labeled with original labeling or product ID and words, pictures, and/or symbols which provide general information regarding the chemical contained inside.
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Are materials properly stored?
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Are employees trained in HAZCOM?
Unsafe Actions Observed
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Please list all unsafe actions observed and the abatement for each
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Summary of todays activities and conversations had.
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Conference with GC
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If yes above, name and title
NEAR MISSES
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Near Miss today
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Describe near Miss and abatement
INCIDENTS TODAY?
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Any incidents / Injuries Today?
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Detail todays incident below
UPCOMING HIGH RISK ACTIVITES
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Are there any high risk activities coming up in the next 4-6 weeks?
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If so, detail below
TRAINING / TOOL BOX TALK
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Topic of training
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Copy of roster sent to GC?
SAFETY PRO COMPLETING REPORT
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