Jobsite Safety Inspection Template 2015.02.04

• Job Number

• Job Name

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1.0 Safety Plans

• 1.1 Site Specific Safety Plan for ACCO?

  Yes

  No

  N/A

• 1.2 Site Specific Safety Plan for Subcontractors?

  Yes

  No

  N/A

• 1.3 Jobsite Crisis Management Plan? Phone Tree?

  Yes

  No

  N/A

• Complete? Posted?

• 1.05 Other?

  Yes

  No

  N/A

2.0 JHA/JSA/PTP/Work Permits

• 2.1 Job description adequate?

  Yes

  No

  N/A

• Complete Description?

• 2.2 JHA completely understood by all?

  Yes

  No

  N/A

• 2.3 JHA hazards and precautions match?

  Yes

  No

  N/A

• 2.4 Quality of JHA steps and hazards?

  Yes

  No

  N/A

• 2.05 Other?

  Safe

  At Risk

  N/A

3.0 Personal Protection

• 3.1 Proper PPE worn by all workers?

  Safe

  At Risk

  N/A

• 3.1.3 Hi-viz clothing?

  Yes

  No

  N/A

• 3.1.4 Shirts with sleeves and long pants? (No sweatpants)

  Yes

  No

  N/A

• 3.1.5 Proper footwear? Substantial, leather, ankle supporting boots or shoes; no tennis shoes.

  Yes

  No

  N/A

• 3.1.1 Hard hats?

  Yes

  No

  N/A

• 3.1.2 Glasses? Side shields?

  Yes

  No

  N/A

• 3.2 Proper gloves in use?

  Safe

  At Risk

  N/A

• 3.3 Job-specific PPE as required?

  Safe

  At Risk

  N/A

• Double eye/face protection (glasses and face shield or goggles) while performing abrasive cutting, chipping, grinding, roto-hammering above waist level, or overhead drilling, cutting or demolition?

  Yes

  No

  N/A

• 3.4 Locks and tags in place?

  Safe

  At Risk

  N/A

• 3.05 Other?

  Safe

  At Risk

  N/A

4.0 Safety Equipment

• 4.1 Fire extinguisher(s) in place?

  Safe

  At Risk

  N/A

• 4.2 Fire extinguisher(s) inspections complete?

  Safe

  At Risk

  N/A

• 4.3 Eyewash available? Not expired?

  Safe

  At Risk

  N/A

• 4.4 First aid kit available?

  Safe

  At Risk

  N/A

• 4.5 First aid kit stocked properly?

  Safe

  At Risk

  N/A

• 4.05 Other?

  Safe

  At Risk

  N/A

5.0 General

• 5.1 Lighting?

  Safe

  At Risk

  N/A

• 5.2 Ventilation?

  Safe

  At Risk

  N/A

• 5.3 Nails removed from lumber?

  Safe

  At Risk

  N/A

• 5.05 Other?

  Safe

  At Risk

  N/A

6.0 Tools and Equipment

• 6.1 Proper tools in use/used properly?

  Safe

  At Risk

  N/A

• 6.2 Guards/safety devices in place?

  Safe

  At Risk

  N/A

• 6.3 Tools in good condition?

  Safe

  At Risk

  N/A

• 6.05 Other?

  Safe

  At Risk

  N/A

7.0 Body Positioning/Movement

• 7.1 Line of fire risk?

  Safe

  At Risk

  N/A

• 7.2 Attention to task?

  Safe

  At Risk

  N/A

• 7.3 Pinch points?

  Safe

  At Risk

  N/A

• 7,4 Proper lifting?

  Safe

  At Risk

  N/A

• 7.5 Pushing/pulling under control/balance?

  Safe

  At Risk

  N/A

• 7.6 Avoid/protected from sharp edges?

  Safe

  At Risk

  N/A

• 7.05 Other?

  Safe

  At Risk

  N/A

8.0 Housekeeping

• 8.1 Work areas clean and neat?

  Safe

  At Risk

  N/A

• 8.2 Trash cans available/emptied?

  Safe

  At Risk

  N/A

• 8.3 Hoses rolled and stowed?

  Safe

  At Risk

  N/A

• 8.4 Materials properly staged/stored?

  Safe

  At Risk

  N/A

• 8.5 Barricades up where applicable?

  Safe

  At Risk

  N/A

• 8.6 Barricades maintained?

  Safe

  At Risk

  N/A

• 8.05 Other?

  Safe

  At Risk

  N/A

9.0 Fall Protection

• 9.1 Guardrails in place?

  Safe

  At Risk

  N/A

• 9.2 Warning lines used?

  Safe

  At Risk

  N/A

• 9.3 Guardrails/warning lines installed correctly?

  Safe

  At Risk

  N/A

• 9.4 100% fall protection over 6' achieved?

  Safe

  At Risk

  N/A

• 9.5 Proper fall protection equipment?

  Safe

  At Risk

  N/A

• 9.6 Fall Protection Work Plan for work over 6'?

  Safe

  At Risk

  N/A

• 9.05 Other?

  Safe

  At Risk

  N/A

10.0 Working at Height/Scaffolding/Ladders

• 10.1 Decking complete w/o holes?

  Safe

  At Risk

  N/A

• 10.2 Scaffold tag in place/current?

  Safe

  At Risk

  N/A

• 10.3 Area below barricaded?

  Safe

  At Risk

  N/A

• 10.4 Ladder (portable) inspection complete?

  Safe

  At Risk

  N/A

• 10.5 Proper ladder use?

  Safe

  At Risk

  N/A

• 10.6 Ladder extends 3' above landing?

  Safe

  At Risk

  N/A

• 10.7 Cage on vertical ladder over 25'? Rest platform(s)?

  Safe

  At Risk

  N/A

• 10.05 Other?

  Safe

  At Risk

  N/A

11.0 Walking Working Surfaces

• 11.1 Aisles/stairs/floors clear/clean?

  Safe

  At Risk

  N/A

• 11.2 Designated walking area?

  Safe

  At Risk

  N/A

• 11.3 Holes/depressions guarded?

  Safe

  At Risk

  N/A

• 11.4 Planks/mats on rebar for walking?

  Safe

  At Risk

  N/A

• 11.05 Other?

  Safe

  At Risk

  N/A

12.0 Vehicles/Mobile Equipment

• 12.1 Pre-use inspection complete?

  Safe

  At Risk

  N/A

• 12.01 Tires and body in good condition?

  Safe

  At Risk

  N/A

• 12.02 Vehicle lights, horn, etc. operational?

  Safe

  At Risk

  N/A

• 12.2 Speed limit and traffic controls followed?

  Safe

  At Risk

  N/A

• 12.3 Spotter used when appropriate?

  Safe

  At Risk

  N/A

• 12.05 Other?

  Safe

  At Risk

  N/A

13.0 Electrical

• 13.1 Assured Grounding complete? Correct color (Q1-white, Q2-green, Q3-red, Q4-orange)?

  Safe

  At Risk

  N/A

• 13.2 GFCI use on all power cords/tools?

  Safe

  At Risk

  N/A

• 13.3 Panel covers installed? Dead fronts installed?

  Safe

  At Risk

  N/A

• 13.4 Panels labeled and unobstructed?

  Safe

  At Risk

  N/A

• 13.5 Exposed wiring/knockouts?

  Safe

  At Risk

  N/A

• 13.6 Extension cords in good shape?

  Safe

  At Risk

  N/A

• 13.05 Other?

  Safe

  At Risk

  N/A

14.0 Welding/Grinding/Temporary Power

• 14.1 Hoses, leads, cords hung properly?

  Safe

  At Risk

  N/A

• 14.2 Welding cables/temp cords free of damage?

  Safe

  At Risk

  N/A

• 14.3 Portable welding machine grounded?

  Safe

  At Risk

  N/A

• 14.4 Double eye/face protection (glasses and face shield or goggles) while performing abrasive cutting, chipping, or grinding?

  Yes

  No

  N/A

• 14.5 Sparks controlled?

  Safe

  At Risk

  N/A

• 14.6 Fire watch present?

  Safe

  At Risk

  N/A

• 14.7 Fire watch trained?

  Safe

  At Risk

  N/A

• 14.05 Other?

  Safe

  At Risk

  N/A

15.0 Cranes/Lifting/Hoisting/Rigging

• 15.1 Crane(s) inspected/documented?

  Safe

  At Risk

  N/A

• 15.2 Operator NCCCO certificate?

  Safe

  At Risk

  N/A

• 15.3 Qualified signal-person? Documentation onsite?

  Safe

  At Risk

  N/A

• 15.4 Qualified rigger? Documentation onsite?

  Safe

  At Risk

  N/A

• 15.5 Ground is level/firm?

  Safe

  At Risk

  N/A

• 15.6 Rigging is inspected/undamaged?

  Safe

  At Risk

  N/A

• 15.7 Tag lines/softeners used?

  Safe

  At Risk

  N/A

• 15.8 Critical Lift Plan done, if required?

  Safe

  At Risk

  N/A

• 15.9 Overhead powerlines considered?

  Safe

  At Risk

  N/A

• 15.10 Personnel not under suspended loads?

  Safe

  At Risk

  N/A

• 15.05 Other?

  Safe

  At Risk

  N/A

16.0 Excavation Work

• 16.1 Daily inspection conducted?

  Safe

  At Risk

  N/A

• 16.2 Daily inspection documented?

  Safe

  At Risk

  N/A

• 16.3 Over 4' inspected by competent person?

  Safe

  At Risk

  N/A

• 16.4 Excavation shored/sloped/benched?

  Safe

  At Risk

  N/A

• 16.5 Spoils pile at least 2' from edge?

  Safe

  At Risk

  N/A

• 16.05 Other?

  Safe

  At Risk

  N/A

17.0 Confined Space

• 17.1 Attendant trained and alert?

  Safe

  At Risk

  N/A

• 17.2 Confined space signs posted at entrance(s)?

  Safe

  At Risk

  N/A

• 17.3 Personnel in confined space(s) checked in/out?

  Safe

  At Risk

  N/A

• 17.4 Ventilation in place/adequate?

  Safe

  At Risk

  N/A

• 17.05 Other?

  Safe

  At Risk

  N/A

18.0 Cylinders/Hazardous Materials/Flammables/Combustibles

• 18.1 Flammable/O2 bottles stored separately?

  Safe

  At Risk

  N/A

• 18.2 Gas cylinders upright/secured/capped?

  Safe

  At Risk

  N/A

• 18.3 Cylinder valves closed when not in use?

  Safe

  At Risk

  N/A

• 18.4 Proper storage containers for flammables/combustibles?

  Safe

  At Risk

  N/A

• 18.5 Secondary labeling for chemicals?

  Safe

  At Risk

  N/A

• 18.6 Hazardous materials survey complete?

  Safe

  At Risk

  N/A

• 18.6.3 Areas of work containing lead identified?

  Safe

  At Risk

  N/A

• 18.6.4 Lead products abated properly?

  Safe

  At Risk

  N/A

• 18.6.5 All other hazardous materials identified?

  Safe

  At Risk

  N/A

• 18.6.6 All other hazardous materials abated properly?

  Safe

  At Risk

  N/A

• 18.6.1 Asbestos containing materials identified?

  Safe

  At Risk

  N/A

• 18.6.2 Asbestos containing materials abated properly?

  Safe

  At Risk

  N/A

• 18.05 Other?

  Safe

  At Risk

  N/A

19.0 Iterim Life Safety Measures

• 19.1 Signage?

  Safe

  At Risk

  N/A

• 19.2 Dust control? Barriers? Penetrations blocked?

  Safe

  At Risk

  N/A

• 19.3 Badging?

  Safe

  At Risk

  N/A

• 19.4 Fire extinguishers?

  Safe

  At Risk

  N/A

• 19.5 Clear stairwells/exits?

  Safe

  At Risk

  N/A

• 19.05 Other?

  Safe

  At Risk

  N/A

• Section 1. Corrections made? By whom? When?

  Yes

  No

  N/A