Information
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project name and number
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superintendent/ foreman
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Prepared by
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date
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Location
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first aid and emergency devices
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Temporary Traffic Control
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MSDS
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spare PPE
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DSTA and DVIRs
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underground ticket
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job site summary
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pictures
excavation
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trench collapse prevention
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overhead power lines
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fall protection / open trench
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means of access / egress
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shallow open trench <42"
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trip fall protection / open hole
heavy equipment
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equipment operation
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back up alarms
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certified equipment operator
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crane and hoisting equipment
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crane set up / stabilized
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rigging equipment
scaffold
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guardrails and toeboards
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platform / work surface
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base plates / mud sils / casters
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bracing, locking pins
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tired of / secured
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access ladder
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Aral lift operation
ladders
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condition
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extended 3' above landing
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tide off / secured
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step ladder misuse
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ladder /other
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stairs / steps
electrical
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GFCI / assured grounding
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extension cords
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temporary lighting
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power tool condition
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energized exposed parts
fall protection
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walking working surfaces >6'
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PFAS and equipment
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exposed rebar / impalement
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falling object protection
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leading edge protection
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open hole >6'
Personal Protection
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hard hats
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safety glasses
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traffic vest
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safety shoes
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respiratory protection
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hearing protection
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clothing / gloves
industrial hygiene / confined space
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air quality
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silica exposure
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air monitor use <br>
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employee training
General
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housekeeping
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lock out tag out
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flammable material storage
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access to work site
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welding and cutting
