Title Page
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Project Name
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Project Address
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Date of Visit
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Safety Rep
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KP Project Manager assigned to project
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Attendees during job walk
Construction Safety Assessment Report
Open items from previous inspection
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Add media
Construction activities observed during this assessment
Record keeping requirements checked this site visit:
Observations
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Observation #1
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Is this a repeat observation?
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Photo of observation
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Regulation or Contractor Performance Safety Standard reference:
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Observation #2
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Is this a repeat observation?
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Photo of observation
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Regulation or Contractor Performance Safety Standard reference:
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Observation #3
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Is this a repeat observation?
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Photo of observation
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Regulation or Contractor Performance Safety Standard reference:
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Observations discussed with
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Pre-task plan reviewed for hazards
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Actions to be taken
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Target date of completion
Additional observations/comments
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Add media
Response required by contractor
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Please provide a written response to all observations requiring correction within 5 working days upon receipt of this report. If corrections cannot be made within the 5 day period, please provide an explanation for the delay and indicate when they will be corrected. Your cooperation in these matters is appreciated. If you have any questions regarding these observations, please contact me via telephone or e-mail.
