Jobsite Safety Survey

• General Contractor

• Jobsite

• Conducted on

  Date

• Prepared by

• Personnel

Previous Jobsite Safety Survey

• Was previous survey reviewed?

  Yes

  No

  1st Visit

• Are there any outstanding items?

  Yes

  No

  Other

Personal Protective Equipment

• High-Visibility Vest/Other

  Yes

  No

  N/A

  At Risk

• Gloves

  Yes

  No

  N/A

  At Risk

• Hard Hat<br>

  Yes

  No

  N/A

  At Risk

• Safety Glasses

  Yes

  No

  N/A

  At Risk

Material Handling & Ergonomics

• Daily stretching

  Yes

  At Risk

• Proper use of material handling equipment

  Yes

  At Risk

Electrical

Overview of Our Electrical

• Enclosures Entact/Doors closed over 50 v

  Yes

  No

  N/A

  At Risk

• GFCI In use

  Out dated

  Currect

• Spool Handling, tuggers, puller condition

  Safe

  Repair

  At Risk

  N/A

• LOTO & Electrical Safe Work Practices

  Safe

  Repair

  At Risk

  N/A

• Extension cord condition or tool cord condition.

  Safe

  Repair

  At Risk

  N/A

Walking & Working Surfaces

• Mud, Water-Snow-Ice Removal

  Safe

  Repair

  At Risk

  N/A

• Housekeeping

  Safe

  At Risk

  N/A

• Floor Openings I.e covers and floor access

  Safe

  Repair

  At Risk

  N/A

Ladders

• Extension Ladders

  Yes

  No

  N/A

  At Risk

• Stepladders

  Yes

  No

  N/A

  At Risk

Fall Protection

• No

• Yes, Multi Level or Roof Work Taking Place
6' Or More Fall exposure Assessment

• Add media

  Media

• Guardrails/Toeboards

  Safe

  Repair

  At Risk

  N/A

• Roof Flagging

  Safe

  Repair

  At Risk

  N/A

• Personal Fall Arrest Equipment Condition/Proper Use

  Safe

  Repair

  At Risk

  N/A

Fire Protection

• Emergency Plan In Place

  Yes

  At Risk

• Fire Extinguishers

  Yes

  No

  N/A

  At Risk

• Live Sprinklers?

  Live

  No

Employee Health

• No

• Yes
Site Conditions

• Add media

  Media

• Dust Control/Dust Masks

  Safe

  Repair

  At Risk

  N/A

• Proper Clean Up of Slurry

  Yes

  No

  N/A

  At Risk

• Sanitation

  Yes

  No

  N/A

  At Risk

• Air Condition I.e C.O, welding

  Safe

  At Risk

  N/A

• PACM Survey & Procedures

  Yes

  No

  N/A

  At Risk

Lifts and Scaffolding

• No

• Annual inspection (lifts only).

  Yes

  No

  N/A

  At Risk

• Chains/gates closed

  Yes

  No

  N/A

  At Risk

• Other concerns regarding lifts.

  No

  At Risk

• Scaffolding In Use
Set Up

• Access

  Yes

  No

  N/A

  At Risk

• Proper footing, level, feet, screw jacks ect...

  Safe

  Repair

  At Risk

  N/A

• Guardrails and decking complete on working level

  Safe

  Repair

  At Risk

  N/A

• Diagonal brace on rolling scaffold

  Yes

  No

  N/A

  At Risk

• Inspected

  Yes

  No

  N/A

  At Risk

Employee Safety Contacts

• Name & Comments:

  Positive Feedback

  Coaching

  Employee Safety Violation

• Name & Comments:

  Positive Feedback

  Coaching

  Employee Safety Violation

• Other

  Safe

  Repair

  At Risk

  N/A