Title Page

  • Conducted on

  • Prepared by

  • Site Location / Store Number

General

  • Job Box on site

  • Fire Extinguishers inspected

Housekeeping / Barricading

  • Work site neat and orderly

  • Barricading / Fencing / Signage in place

  • Following CDC guidelines

  • What job sites have you traveled to today.

Personal Protective Equipment

  • Head Protection being used

  • Eye Protection being used

  • Hi Vis / Proper clothing being worn

  • Other PPE

Fall Protection

  • 6 Ft. Fall Protection being followed

  • Personal Fall Arrest used properly

  • Guardrail / Toeboards installed properly/complete

  • Warning lines / Barricading installed properly/complete

  • Holes covered/labeled

Ladders and Stairs

  • Ladders suitable for the job (use, condition, size, type, secured)

  • Stairway rails / Handrails installed when required

Hand and Power Tools

  • Proper tools for the job

  • Guards in place

Electrical

  • Electrical cords protected

  • Electrical cords in good repair

  • Assured grounding program being followed

Excavation and Trenching

  • Proper shoring and/or sloping of excavation

  • Proper placement of spill piles

  • Adequate means of egress

Scaffolds

  • Erected on rigid footing

  • Scaffold, square and level

  • Cross braces are complete

  • Toe Guards secure and place

  • Complete guard rail system

  • Proper access/egress

Cranes and Derricks

  • Areas within the swing radius barricaded

  • Proper Rigging / Tag Lines

  • CCO

  • Add media

Concrete / Masonary

  • Rebar Caps in place

  • Silica controls in place

Weather Conditions

  • Temperature / Degrees

  • Rainy

  • Sunny

  • Cloudy

  • Windy

Site Activities

Subcontractors or Visitors on Site

Equipment Rental and/or Material Deliveries

  • Forklift

  • Scissors Lift

  • Straight Boom

  • Skidsteer

  • Generator

  • Temp Heater

  • Other:

Notes/Corrective Action/Follow Up/Other

Request of notifications to be sent (Sub, incident, direction)

Completed by:

  • Add signature

  • Select date

  • Add media

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.