Title Page
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Site conducted
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Document No.
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Site Name
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Job No.
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Client
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Prepared by
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Conducted on
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Location
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Additional Personnel
WEATHER
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Temperature
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Rain
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Wind
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Dust
REQUIRED DOCUMENTATION
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Confined Space Permit
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OSHA Postings
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OSHA 300 Postings (Applies Feb 1 - May 1 only)
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Worker's Comp Postings
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Safety Program
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HAZCOM / SDS
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SWPPP
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Certificates of Insurance
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Emergency Telephone List
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Emergency Action Plan
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Safety Meetings Documented
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HAZCOM Training Documented
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Specialized Training Documented
SITE / MISCELLANEOUS
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Number of Workers on Site
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Number of Subs on Site
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Fire Extinguishers in Place, Charged, & Inspected (Around Site and Near any Flammable Source)
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First Aid Kit on Site
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Chemicals / Flammable Materials Properly Stored
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All Hazardous Materials Properly Labeled
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Warning Signs Prominently Displayed
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Notices Posted at Entrances
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Fuel Containments Being Used and Kept Up
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High Pressure Gas Cylinders Chained in Place
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Fences Intact and Gates Lockable
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Storm Water BMP's in Good Condition
VEHICLES / MOVING EQUIPMENT
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Adhering to Site Speed Limit
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Seat Belts Properly Used
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Windshields Clean
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Windshields In Good Repair
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Fire Extinguisher with Vehicle
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Daily Inspection Turned In
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Backup Alarms Working
HOUSEKEEPING
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Job Site Free of Accumulated Trash / Debris
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Dumpsters on Site for Waste
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Passageways and Walkways Clear
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Forms and Materials Free of Protruding Nails and Screws
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Portable Toilets Clean
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Drinking Water Available on Site
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Construction Materials Properly Stacked and Not Scattered
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Spills, Leaks, or other Hazards
PERSONAL PROTECTIVE EQUIPMENT
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Hardhats
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Proper Footwear
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Safety Glasses / Goggles / Spoggles / Face Shields as Required
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Safety Vest / Fluorescent Shirts
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Gloves Being Worn While Performing Work
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Respirators / Dust Masks when Required
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Fit Test for Respirators
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Hearing Protection when Required
SILICA
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Dust Masks Being Worn
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Water / Vacuum to Control Dust
EXCAVATIONS
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Competent Person on Site
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Have Underground Utilities Been Located
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Trenches / Excavations Properly Barricaded / Blocked / Covered
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Trench Protection for Excavations 5' Deep or More
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Ladders Properly Located to Surface (No More than 100' Apart)
ELECTRICAL
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Ground Fault System Operational and Being Used by All Contractors
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Portable Generators GFCI Protected
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Extension Cords in Good Condition
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Power Tools in Good Condition / Ground Prong in Place
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Lighting Suitable and Properly Installed
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All Electrical Boxes Properly Covered and Protected
PORTABLE HAND TOOLS
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Powder Strips Picked Up
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Powder Strips Properly Disposed Of
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Cord and Tools in Good Condition
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Guards in Place
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Operators Wearing Proper PPE
MATERIAL HANDLING / FORKLIFTS / HEAVY EQUIPMENT
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Forklifts / Heavy Equipment in Operational Condition
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Valid Operator Certification
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Daily Inspections Done
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Fire Extinguishers on All Equipment
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Backup Alarms Working
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Seat Belts Properly Used
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Only Operator Riding on Equipment
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Rollover Protection
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Hoist / Elevators in Operational Condition
CRANES / DRILLING RIGS
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Daily Inspections Completed
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Valid Annual Crane Inspection
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Valid Operator Certifcation
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Valid Rigger Certification
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Swing Radius Properly Identified
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Fall Protection in Place when Needed
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Tag Line in Use
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Chokers, Cables, Hooks in Proper Working Condition
FALL PROTECTION ( Heights of 6' or More)
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Guard Rails in Place
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Toe Boards in Place Where Required
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All Guards and Rails Sufficient for Weight
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Fall Protection Systems in Place When Required
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Harnesses in Good Condition with Proper Label
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Openings in Floors, Walls, and Roofs Protected
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Handrails on Stairs
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Barricades in Place When Needed, and Properly Supported
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Impalement Prevention in Place (Rebar Caps etc.)
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Slips, Trips, and Fall Hazards Identified
LADDERS
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Proper Ladder Being Used for Job
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Ladders Extended 3' Above Landing
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Ladders Properly Tied Off
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Field Ladders Properly Constructed
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Commercial Ladders in Good Working Condition
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Extension Ladders Properly Joined, Secured in Place at Top and Bottom
AERIAL ELEVATED WORK PLATFORMS (SCISSOR AND BOOM LIFTS)
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Daily Inspection
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Proper Placement of Lift
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Basket Floor Free of Debris and Loose Materials
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Chain Latched / Door Closed
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Audible Alarm During Operation
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Operators Properly Secured (Boom Lift Only)
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Workers Staying on Basket Floor (Not Climbing Sides)
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Diapers for Finished Concrete Surfaces
SCAFFOLDS
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Competent Person on Site
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Tagged and Inspected Daily
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All Components are Damage Free
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Ladder Being Used for Access and Egress
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Proper Foundation and Footing
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Working Levels Fully Planked
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Proper Planking Being Used and in Good Condition
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Properly Secured / Tied Off at Required Intervals
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Rails and Toe Boards Where Required
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Area Under Scaffolds Properly Marked for Authorized Personnel Only
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Rolling / Moveable Units Properly Supported with Wheels Locked in Place
WELDING & CUTTING
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Leads and Connections in Good Condition
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Hoses in Good Operational Condition
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Compressed Gas Cylinders Properly Stored
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Gauges / Regulators in Working Order
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Fire Extinguishers at All Welding / Cutting Locations
Conclusion
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SUMMARY & RECOMMENDATIONS (Number, List, and Assign Responsibility to All Documented Issues and Violations)
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Inspected By
