Information
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Document No.
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Job Name / Number
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Conducted on
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Prepared by
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Location
Programs / Information
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Safety Policy & Standard Operating Procedure Manual / Mandatory Postings Onsite & Current
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JSA's & Foreman Daily Safety Huddles Performed
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New Hire Orientation Procedure (Yellow Hard Hat)
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Hazardous Chemical Inventory Current and Posted
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SDS Sheets Available Onsite
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Chemical Containers Properly Stored and Labeled
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Adequate Supply of Sanitary Facilities w/ Separate Hand Wash Station(s)
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Documented Daily Equipment Inspections Performed
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Weekly Tailgate Safety Training Performed
Personal Protective Equipment
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Hard Hats
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Eye Protection
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Hearing Protection
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Respirators Or Dust Masks
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High Visibility Garment (ANSI Class II Or III)
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Foot Protection - Toe Guards
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Appropriate Hand Protection
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Other:
Fall Protection (Zero Tolerance Item)
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All Personnel Protected From Fall Height Greater Than 6' (PFP, Restraint, Guard-railing, Covers, Etc..)
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All Personnel Tied Off in Aerial Lift Equipment (Zoom Boom)
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Other:
Housekeeping
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No excessive Debris On Site
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Lay-down Areas Organized, Piling & Stacking Secured
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Adequate Supply Of Trash Receptacles
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Nails Bent or Removed
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All Rebar and Similar Protrusions Capped or Troughed
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Other:
Fire Protection
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Extinguishers Certified Within Last 12 Months
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Extinguishers Inspected Monthly And Tags Signed
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Fuel Dispensed from Self Closing Container
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Oxygen/Acetylene Separated (20') and Secured
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Other:
Ladders (Zero Tolerance Item)
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Ladders Inspected And In Good Condition
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Employees Not Working from Top Cap of 1st Step Below
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Ladders In Use Are Properly Secured
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Extension Ladders Extend 36" Above Landing
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Ladder Weight Rating 300 Lb. - 1A or Greater
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Ladders Not In Use Are Properly Stored
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Other:
Electrical
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Grounded / GFCI Protected
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Cords, Plugs and Receptacles In Good Condition And Protected
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Quarterly Color Code In Use
Hand Tools
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Whip Checks In Use On Pressurized Lines
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Proper Tool In Use For Task, Proper PPE In Use
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Defective Tools Tagged / Removed From Site
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Safety Guards And Devices Installed (Zero Tolerance Item)
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Other:
Equipment
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Operator Trained, Authorized And Or Certified (Certification Proof Readily Available)
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Pre-Inspection Check List Completed
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Maintenance Inspection Current (Annual & 90 Day)
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Required Manuals, Load Charts, With Equipment
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Seatbelt In Use
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Backup Alarm Functioning
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Operating At Safe Speeds
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Wheels Chocked On Mobile Equipment
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Other:
Confined Space (Zero Tolerance Item)
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Employees Trained (Supervisor, Attendant, Entrant)
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Permit For Entry Completed & Posted
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Calibrated Air Monitor In Use (Continuous)
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Adequate Ventilation Provided (Blower/Fan)
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Retrieval System In Place
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Other:
First Aid
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Trained Personnel Available
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Kits/Supplies Available and Fully Stocked
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Designated Medical Provider Identified
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Other:
Power Lines
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Designated Spotter Used
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Adequate Distance Maintained from Power Lines Min. 10' up to 50KV
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Other:
Trenching And Excavation (Zero Tolerance Item)
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Competent Person Designated And Identified
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Annual Permit Posted And Local Cal OSHA Office Notified (Over 5' In Depth)
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Documented Daily Trench/Excavation Inspection Performed
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Proper Protective System In Place (Over 5' In Depth)
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Safe Access / Egress Provided (Ladders With In 25' Or Ramp <30 Deg.)
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Approved Potholing and Verification of Utilities Used
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Other:
Site/Public Protection
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Traffic Control In Place
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Fences In Use And In Good Condition
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All Vehicles Parked in Cone Zone
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Hazard Warning Signs In Use
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Barricades In Use
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Other:
Heat Illness Prevention (Zero Tolerance Item)
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Cool Drinking Water Available in the Work Area
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Adequate Shade Provided at 80 Degrees
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Cups Provided w/ Waste Container
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Disposable Cups Provided w/ Trash Receptacle Nearby
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Supervisors/Employees Properly Trained
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High Heat Provisions In Place (95 Deg. & Above)
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Other:
Subcontractor Compliance
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Compliance With Site Specific and Cal OSHA Safety Requirements
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Confined Space
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Scaffolding
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Trenching and Excavation
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Weekly Toolbox Safety Training Performed
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All PPE Requirements Being Met
Silica Dust Exposure Control
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Employees Trained On Silica Hazards
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Engineering Controls Used (Vacuum/Wet Methods)
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Silica Exposure Table 1 In Use
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Proper Respiratory Protection In Use
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Competent Person Designated and Identified
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Site Specific Control Plan in Place
Corrective Actions Taken / Inspection Summary
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All "Corrective Action" items are to be corrected at the jobsite within 24 hours. If corrective action is not possible, the item shall be brought to the immediate attention of the Safety Director.
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Project Supervision
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Safety Specialist
