Information

  • Project/Job #

  • Project/Job

  • Conducted on

  • Prepared by

  • Location
  • Personnel

BEHAVIOR

  • TSSP reviewed and signed

  • TSSP for each task?

  • Mentors assigned?

  • Task Hazard Boards Complete

WORK AREAS

  • General Housekeeping

  • Walking - Working Surfaces

  • Unprotected Sides or Holes

  • Impalement Hazards

  • Material Storage/Lay Down

  • Conex, Box 4 U, Gang Box

PERSONAL PROTECTIVE EQUIPMENT

  • Hard Hats

  • Safety Glasses with Side Shields

  • Face Shield / Goggles (If Required)

  • Respiratory Protection (If Required)

  • Hearing Protection (If required)

  • Clothing (FRC etc. if required)

  • Gloves

  • Foot Protection

FALL PROTECTION

  • Worn Properly

  • Suitable Anchorage Points

  • Inspected/Color Coded

LADDERS

  • Base/Footing/Set Up

  • Proper Type for Task

TOOLS AND EQUIPMENT

  • In Good Condition

  • Inspected/Color Coded

  • Right Tool for the Task

EXCAVATIONS

  • Access/Egress

  • Shoring/Shielding/Sloping

  • Barricades

  • Spoil Pile

ELECTRICAL

  • G.F.C.I.'s

  • Extension Cords

  • Power Tools

EQUIPMENT

  • Equipment Inspections

  • Flagman with Vest

  • Proper setup and use

PEOPLE

  • Behavior

  • Struck by/Caught in/between

  • Proper Lifting

COMMENTS/RECOMMENDATIONS

  • Enter any corrective actions that will be undertaken

SIGN OFF

  • Leadership/Support Representative

  • Production Leader

  • Construction Supervisor

  • Field Hourly Rep / Others

  • Field Hourly Rep / Others

  • Field Hourly Rep / Others

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.