Information
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General Contractor
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Jobsite
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Conducted on
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Prepared by
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Personnel
Previous Jobsite Safety Survey
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Was previous survey reviewed?
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Are there any outstanding items?
Personal Protective Equipment
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High-Visibility Vest/Other
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Gloves
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Hard Hat<br>
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Safety Glasses
Material Handling & Ergonomics
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Daily stretching
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Proper use of material handling equipment
Electrical
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Overview of Our Electrical
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Enclosures Entact/Doors closed over 50 v
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GFCI In use
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Spool Handling, tuggers, puller condition
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LOTO & Electrical Safe Work Practices
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Extension cord condition or tool cord condition.
Walking & Working Surfaces
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Mud, Water-Snow-Ice Removal
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Housekeeping
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Floor Openings I.e covers and floor access
Ladders
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Extension Ladders
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Stepladders
Fall Protection
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No
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Yes, Multi Level or Roof Work Taking Place
6' Or More Fall exposure Assessment
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Add media
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Guardrails/Toeboards
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Roof Flagging
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Personal Fall Arrest Equipment Condition/Proper Use
Fire Protection
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Emergency Plan In Place
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Fire Extinguishers
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Live Sprinklers?
Employee Health
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No
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Yes
Site Conditions
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Add media
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Dust Control/Dust Masks
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Proper Clean Up of Slurry
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Sanitation
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Air Condition I.e C.O, welding
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PACM Survey & Procedures
Lifts and Scaffolding
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No
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Annual inspection (lifts only).
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Chains/gates closed
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Other concerns regarding lifts.
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Scaffolding In Use
Set Up
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Access
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Proper footing, level, feet, screw jacks ect...
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Guardrails and decking complete on working level
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Diagonal brace on rolling scaffold
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Inspected
Employee Safety Contacts
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Name & Comments:
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Name & Comments:
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Other
