KCOS DAILY SAFETY INSPECTION FORM

KCOS DAILY PROJECT INSPECTION

• PROJECT NAME

• CONDUCTED ON

  Date

• PREPARED BY

• TASK TO BE PERFORMED TODAY

• LOCATION
  Address

• Personnel

PERSONAL PROTECTIVE EQUIPMENT

• SAFETY VEST USED?

  Yes

  No

  N/A

• SAFETY GLASSES NEEDED AND AVAILABLE?

  Yes

  No

  N/A

• HEARING PROTECTION NEEDED AND AVAILABLE?

  Yes

  No

  N/A

• PERSONAL FALL PROTECTION NEEDED AND ON-SITE?

  Yes

  No

  N/A

• DUST MASK NEEDED AND ONSITE?

  Yes

  No

  N/A

HOUSEKEEPING

• SITE CLEAN WITH NO DEBRIS?

  Yes

  No

  N/A

• MATERIALS ARE STORED CORRECTLY?

  Yes

  No

  N/A

• SAFETY FENCE-CONES OR OTHER HAZARDS DELINEATED?

  Yes

  No

  N/A

• AREAS ARE CLEAN WITH NO TRIP HAZARDS?

  Yes

  No

  N/A

HAZARDOUS COMUNICATION

• SDS SHEET ON SITE FOR THE CHEMICALS/MATERIALS IN CONTACT?

  Yes

  No

  N/A

• ALL CHEMICALS STORED AND LABELED?

  Yes

  No

  N/A

EMERGENCY EQUIPMENT

• FIRE EXTINGUISHERS LESS THAN 50FT FROM WORK AREA?

  Yes

  No

  N/A

• FiRST AID KIT ON SITE AND EVERYONE KNOWS THE LOCATION?

  Yes

  No

  N/A

• TELEPHONE OR RADIO ON SITE?

  Yes

  No

  N/A

TOOLS AND EQUIPMENT

• ELECTRICAL CORDS ARE INSPECTED TODAY?

  Yes

  No

  N/A

• LADDERS ARE INSPECTED TODAY?

  Yes

  No

  N/A

• ALL GUARDS ARE INSTALLED AND WORKING PROPERLY?

  Yes

  No

  N/A

• ALL EQUIPMENT DAMAGED IS TAGGED AND OUT OF SERVICE? (click on follow up if equipment need immediate attention)

  Yes

  No

  N/A

• IS THE OPERATOR OF THE EQUIPMENT TRAINED?

  Yes

  No

  N/A

EXCAVATION AND TRENCHING

• ARE YOU EXCAVATING TODAY?

  Yes

  No

  N/A

• DIG SAFE NUMBER/ SITE IS MARKED?

  Yes

  No

  N/A

• POWER LINES LOCATION ARE IDENTIFY AND LESS THAN 10FT FROM REACH?

  Yes

  No

  N/A

• VISUAL SOIL TEST HAS BEEN PERFORMED?

  Yes

  No

  N/A

• SOIL CLASIFICATION

  A SOIL 1V TO 3/4H

  B SOIL 1V TO 1H

  C SOIL 1V TO 1 1/2H

  TRENCH BOX

• DEPTH OF THE EXCAVATION?

• LADDERS ARE AVAILABLE AND AT NOT MORE THAN 25 FT?

  Yes

  No

  N/A

• PURPOSE OF THE EXCAVATION?

  DRAINAGE

  WATER

  SEWER

  GAS

  BUILDING/TANKS

• SLOPE RATIO/TRENCH BOX?

  Yes

  No

  N/A

• IS THERE ANY WATER IN THE TRENCH AND PUMP AND GENERATOR ARE AVAILABLE ON SITE?

  Yes

  No

  N/A

• ARE ALL EMPLOYEES TRAINED ON THE HAZARDS AND PLAN TO PERFORMED THE EXCAVATION?

  Yes

  No

  N/A

• DISCUSS WITH OPERATOR THAT EXCAVATED MATERIAL TO BE LOCATED @ FT MIN FROM THE EDGE OF THE EXCAVATION?

  Yes

  No

  N/A

• HAS PEDESTRIAN AND VEHICULAR HAZARDS BEEN ADDRESSED?

  Yes

  No

  N/A

CONFINED SPACE

CLEARING AND GRUBBING

• CLEARING AND GRUBBING TODAY?

  Yes

  No

  N/A

• PERSONNEL HAS BEEN TRAINED IN USING THE CHIPPER?

  Yes

  No

  N/A

• ARE YOU WORKING IN A CONFINED SPACE TODAY?

  Yes

  No

  N/A

• GAS MONITOR, TRIPOD, HARNESS, WINCH HAS BEEN INSPECTED?

  Yes

  No

  N/A

• WAS A CONFINED SPACE PERMIT FILLED OUT?

  Yes

  No

  N/A

• HAS THE PRE-ENTRY TEST BEEN PERFORMED?

  Yes

  No

  N/A

• ALL TEAM TRAINED IN THE SPECIFIC CONFINED SPACE THEY ARE TO ENTER?

  Yes

  No

  N/A

• IS THERE A PROCEDURE TO MONITOR AIR WHILE PERFORMING THE WORK?

  Yes

  No

  N/A

• SAWS ARE IN GOOD CONDITION AND INSPECTED BEFORE USE?

  Yes

  No

  N/A

• SAW OPERATORS HAVE CHAPPS AND FACE MASK?

  Yes

  No

  N/A

• LOGGERS AND EQUIPMENT OPERATORS HAVE DEFINED SAFETY LIMITS TO AVOID HAZARDS?

  Yes

  No

  N/A

MATERIAL HANDLING

• CAN YOU LIFT THE LOAD BY HAND?

  Yes

  No

  N/A

• HOW HEAVY IS THE LOAD?

• ANY AREAS OF THE BODY THAT CAN BE AFFECTED BY PICKING THE LOAD?

  Yes

  No

  N/A

FALL PROTECTION

• WORKING TODAY HIGHER THAN 4 FT?

  Yes

  No

  N/A

• DO YOU NEED HAND RAILS AND TOES BOARDS?

  Yes

  No

  N/A

• ARE LADDERS TIED TO A FIXED LOCATION AND INSPECTED?

  Yes

  No

  N/A

• ARE YOU USING LIFT LIFE LINES?

  Yes

  No

  N/A

• HAVE THEY BEEN INSPECTED?

  Yes

  No

  N/A

• HAVE HARNESS AND EQUIPMENT BEEN INSPECTED

  Yes

  No

  N/A

TRAFFIC CONTROL

• ARE YOU USING A TRAFFIC CONTROL PLAN TODAY?

  Yes

  No

  N/A

• IS THERE A SPECIFIC TRAFFIC CONTROL FOR THE PROJECT?

  Yes

  No

  N/A

• HAVE EMPLOYEES BEEN TRAINED IN THE TRAFFIC CONTROL?

  Yes

  No

  N/A

• WHO IS IN CHARGE OF THE TRAFFIC CONTROL PACKAGE SET UP AND TRAFFIC CONTROL DAILY PLAN?

  Yes

  No

  N/A

• ARE ALL FLAGGERS CERTIFIED?

  Yes

  No

  N/A

• DO YOU HAVE ALL SIGNS, PADDLES, CONES, BARRELS TO PERFORM A CORRECT TCP?

  Yes

  No

  N/A

COMMENTS

• WERE THERE ANY ACCIDENTS YESTERDAY?

  NO ACCIDENTS

  YES ACCIDENT

• EVERYONE WENT HOME WITHOUT INJURIES YESTERDAY?

  Yes

  No

  N/A

• ARE THERE ANY SAFETY ISSUES ON SITE?

  Yes

  No

  N/A

• DO YOU NEED THE SAFETY DIRECTOR?

  Yes

  No

  N/A

• WRITE IS THERE IS ANY COMMENTS

• Cody B

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• Bob C

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• Dave D

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• Chip J

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• Ron L

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• Danny P

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• Kyle P

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• Rob T

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• Greg V

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• Bob V

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• Signatures

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