Information
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Document No.
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Job Site
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General Contractor
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Conducted on
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Prepared by
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Location
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Supervisor
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Competent Person
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Crew Size
1. Work Environment
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Drain holes same size as the drain pipe & membrane inside diameter by 1/2”
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Adequate amenities? (Toilets, potable water, cups, dumpsters, etc)
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No smoking on the roof?
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Work area maintained neat and clean?
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Tripping / puncture hazards addressed properly?
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Equipment / material properly secured? (During transportation, on the roof, loading the roof)
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Public protection?
2. Personal Protective Equipment (PPE)
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Hard hats?
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Eye and face protection?
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Hand and foot protection?
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Protective clothing? (Safety vests, long sleeve shirts, etc)
3. Hazardous Chemicals (Including Fuel and Oil)
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Safety data sheets accessible on site?
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Storage location? (Fire, spill, contamination hazards)
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Chemical containers properly labeled?
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Condition of chemical containers?
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Hand sanitizing means available?
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First aid kit stocked and available?
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Emergency phone numbers and location available?
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Exits available and accessible?
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Approved flammable containers?
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Fire extinguishers accessible?
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Fire extinguisher maintenance? (Inspected, charged, and in good condition)
4. Ladders
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Ladder condition?
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Ladder angle? (4 to 1)
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Ladder 3 feet above the landing and secured?
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Proper use of ladder?
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Ladder at least 10 feet away from electrical lines?
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Stairways and ramps condition and use?
5. Scaffolds
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Scaffold erected by certified company?
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Scaffold is safe and complete?
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Scaffold was inspected prior to use?
6. Job Site and Equipment
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Equipment on site (Skytrak, Boom, Scissor lift, Etc,)
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Condition of equipment and tools? (Missing or damaged guards, cords, etc)
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Use of proper tool / equipment for the job?
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Licensed equipment operator / vehicle driver?
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Audible back up alarm?
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Seat belts in use?
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Following proper operating techniques?
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Safe and secure loads?
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Overhead hazards properly addressed?
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GFCI in use, tested, and working properly?
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Extension cords inspected using proper color coding?
7. Fall Protection
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Guard rail / cable rail system set up properly?
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PFAS / mobile fall protection cart used properly?
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Openings in floor / wall properly protected?
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Condition of fall protection equipment?
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Warning line system set up and maintained properly?
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Using approved cover removal techniques?
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Weight of load distributed?
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Decking strength?
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Skylights / roof hatches properly protected?
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Rescue equipment available? (Including rescue plan after an arrested fall)
Corrective Actions
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Corrective actions taken while on site?
Sign Off
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Competent Person's Signature
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Auditor's Signature