Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • Document Number

Behaviors

  • Will this section be included in this report? If no items listed below, no applicable observations were made during this inspection.

Concrete/Masonry

  • Will this section be included in this report?

  • Rebar guarded to eliminate impalement hazard?

  • Workers avoid working under buckets?

  • Troweling machines equipped with auto shut-off?

  • Handles on concrete buggy within wheel width?

  • Connectors used to secure pressurized air hoses?

  • Safety latches prevent accidental dumping of buckets?

  • Bull float handles nonconductive or insulated?

  • Masonry saw blades guarded?

  • Formwork capable of supporting vertical/lateral loads?

  • Shoring equipment inspected?

  • Base plates secured to foundation/formwork?

  • Jacks/supports do not exceed rated capacity?

  • Rebar adequately supported to prevent collapse?

  • Precast supported until permanent connections made?

  • Lifting inserts on tilt-up precast support 2x max. load?

  • Lifting inserts on precast (non-tilt-up) support 4x max. load?

  • Lifting hardware able to support 5x max. load?

  • Only erectors allowed under precast when lifted/tilted?

  • Jacking synchronized to ensure level/uniform lifting?

  • Maximum jacks per slab does not exceed 14?

  • Temporary connections secured by tack welding?

  • Limited access zone equal to wall height plus 4 feet?

  • Limited access zone strictly enforced?

  • Walls over 8 feet braced to prevent collapse?

  • Good compliance/no safety violations?

Confined Space

  • Will this section be included in this report?

  • Worksite evaluated/permit spaces identified?

  • Host employer shared info w/controlling contractor?

  • Controlling contractor obtained/shared info w/subs?

  • Steps taken to prevent unauthorized entry?

  • Hazards of space evaluated prior to entry?

  • Procedures in place for safe entry?

  • Testing/monitoring equipment available?

  • Ventilation equipment available?

  • Communications equipment available as needed?

  • Adequate lighting available as needed?

  • Equipment for safe egress available as needed?

  • Rescue and emergency equipment provided?

  • Atmosphere tested prior to entry?

  • Periodic and/or continuous air monitoring completed?

  • Attendant available outside permit space?

  • Employee responsibilities defined/training completed?

  • Procedures in place for summoning rescue services?

  • Annual review of PRCS Program completed?

  • Entry permit available for review?

  • Employees received effective training?

  • Good compliance/no safety violations?

Cranes

  • Will this section be included in this report?

  • Does this topic apply to this inspection?

  • Outriggers or stabilizers fully extended/properly deployed?

  • Blocking material sufficient to sustain loads/maintain stability?

  • Blocking placed directly under float/pad?

  • Operator visually warned of overhead power lines?

  • Visual inspection by competent person completed each shift?

  • Monthly crane inspections completed?

  • Annual crane inspection completed/current?

  • Required safety devices installed/maintained?

  • Required operational aides installed/maintained?

  • Cranes w/ aux. line (telescopic etc.) have anti two-block device?

  • Crane operated per manufacturer requirements?

  • Crane load capacities/operator manual kept in cab?

  • Adequate communication between signal person & operator?

  • Hand signal chart available?

  • Radius guard installed on crane?

  • Workers kept clear of suspended loads?

  • Only qualified riggers allowed to rig loads?

  • Operator certified by accredited testing organization?

  • Operators properly evaluated/qualified?

  • Signal person(s) trained, qualified and authorized?

  • Fire extinguisher located in cab?

  • Tag lines used on loads that swing/rotate?

  • Are cranes operated within the wind speed service limit?

  • Crane operators trained to avoid two-block condition?

  • Good compliance/no safety violations?

Demolition

  • Will this section be included in this report?

  • Engineering survey completed, available for review?

  • Structure shored/braced if damaged by fire/flood/etc.?

  • Utilities shut off or controlled outside the building?

  • Glass fragmentation hazards removed?

  • Wall openings protected to height of 42 inches?

  • Debris landing area (w/o chutes) barricaded 6 ft. back?

  • Warning signs for falling material posted each level?

  • Non-debris floor openings properly guarded?

  • Entrances guarded 8 ft. out on multi-story building?

  • Stairs/passageways/ladders in clean & safe condition?

  • Are the walls/floors braced if the structure to be demolished has been damaged by fire, flood, explosion, or other cause?

  • Debris landing area outside building protected?

  • Does the storage of waste material/debris exceed the allowable floor load?

  • Chute openings closed when not in use?

  • Chute openings do not exceed 48 in. in height?

  • Chute openings protected by guardrail?

  • Gate installed at chute discharge and monitored?

  • Discharge chute closed off when operations cease?

  • Space between chute and structure covered?

  • Bumper 4 in. thick/6 in. high at chute opening?

  • Floor openings curbed when equipment in use?

  • Periodic inspections made by competent person?

  • Good compliance/no safety violations?

Electrical Safety

  • Will this section be included in this report?

  • Equipment installed/used as listed or labeled?

  • Ground pin attached to electrical cords?

  • GFCI used for temporary power connections?

  • Flexible cords not daisy-chained?

  • Flexible cords maintained in good condition?

  • Light bulbs protected from accidental breakage?

  • All sockets in temporary lighting have bulbs?

  • Temporary lights not suspended by electric cords?

  • Breakers/switches legibly marked to indicate purpose?

  • Cords protected/kept clear of work areas or walkways?

  • Employees avoid working near unprotected energized circuits?

  • Deenergized circuits locked or tagged out?

  • Signs posted restricting access to locations w/exposed live parts?

  • Electrical panels/circuits effectively enclosed?

  • Electrical receptacles have an approved cover/faceplate?

  • Conductors entering boxes/cabinets protected from abrasion?

  • Proper clearance maintained in front of/around panels?

  • Weatherproof enclosures on panels, outlets, etc. in damp/wet locations?

  • Repaired extension cords (No. 12 or larger) meet manufacturer’s specs?

  • Good compliance/no safety violations?

Emergency Action Plan

  • Will this section be included in this report?

  • Is Emergency Action Plan in writing (if 11+ employees)?

  • Does EAP address emergency escape procedures and escape route assignments?

  • Does EAP address procedures for those who remain behind for critical shutdown?

  • Does EAP address procedures to account for employees after evacuation is completed?

  • Does EAP address rescue and medical duties for designated employees?

  • Does EAP address means of reporting fires and other emergencies?

  • Has an effective alarm/communication system been established?

  • Are evacuations established based on emergency circumstances?

  • Is sufficient number of employees trained to assist in safe evacuation?

  • Do covered employees receive initial EAP training (i.e. when plan is developed)?

  • Do covered employees receive training when their duties change?

  • Do covered employees receive training whenever the EAP changes?

  • Is the written EAP available at the workplace for employee review (if 11+ employees)?

  • Good compliance/no safety violations?

Exits/Egress

  • Will this section be included in this report?

  • Exits available and free of obstructions?

  • Exits and access to exits marked with signs?

  • Good compliance/no safety violations?

Fall Protection

  • Will this section be included in this report?

  • Suitable fall protection provided/used?

  • Workers utilize PFAS as required?

  • Steps taken and adequate to prevent falls thru holes?

  • Ramps, walkways, catwalks etc. provided w/ guardrails at heights of 6ft.+?

  • Safety monitor used when fall arrest/restraint not utilized?

  • Suitable fall protection provided/used?

  • Suitable fall protected provided/used?

  • Steps taken to prevent falling object hazards?

  • Guardrails installed, maintained and compliant?

  • Top and mid-rail in place and proper height?

  • Screens/mesh extend from top rail to walking/working level along entire opening btwn rail supports?

  • Guardrails able to withstand 200 lb. force?

  • Guardrail deflection less than 39in. above the walking/working level when tested?

  • Top rails & midrails min. 0.25in. nominal diameter or thickness & flagged w/ high-vis. material where required?

  • Access to hoisting area adequately guarded?

  • Dee-rings & snaphooks proof-tested to minimum tensile load?

  • Lifelines protected against cuts/abrasions?

  • Suitable anchorage provided/used?

  • PFA rigged to prevent contact with lower surface?

  • PFA rigged to limit free fall to no more than 6 ft?

  • Harness D-Ring located btwn shoulder blades?

  • Harnesses inspected/maintained in good condition?

  • Lanyards inspected, maintained, spec. tag intact/legible?

  • PFA not attached to guardrail system?

  • Warning line erected on unprotected roof edge?

  • Access path formed by warning lines where required?

  • Unused access points blocked by warning line?

  • Warning line flagged and suspended at proper height?

  • Control line 6 ft. from leading edge for roofing activities?

  • Control line 6 ft. from leading edge when erecting precast?

  • Safety monitor same surface with visual/voice contact?

  • Safety monitor performs only monitoring duties?

  • Floor hole covers secured, substantial, marked?

  • Toeboards erected to prevent falling objects?

  • Workers trained on recognizing/minimizing fall hazards?

  • Fall Protection training certified/documented?

  • Retraining occurs if changes in policy or employee violates policy?

  • Harnesses worn/fitted properly?

  • Guardrail posts not more than 8 feet OC?

  • Warning line 15 ft. back for non-roofing activities?

  • Good compliance/no safety violations?

Fire Safety

  • Will this section be included in this report?

  • Fire extinguishers in good condition/fully charged?

  • Fire extinguishers inspected periodically?

  • Fire extinguishers maintained annually?

  • Travel distance to fire extinguisher within 100 feet?

  • Fire extinguisher within 50 ft. of flammables?

  • Minimum one fire extinguisher per floor?

  • Approved/UL listed fire extinguishers provided?

  • Access to fire extinguishers maintained?

  • Fire extinguishers conspicuously located?

  • Fire extinguishers mounted?

  • Flammables stored in approved/closed containers?

  • Gasoline stored in approved safety can or DOT container?

  • Smoking prohibited where fire hazard exists?

  • Scrap piles no closer than 10 ft. from buildings?

  • Flammable liquids protected from ignition sources?

  • Flammable not stored near emergency pathways?

  • Fire extinguisher kept near gas powered equipment?

  • LP tanks in storage are upright and secured to prevent tipping?

  • LP tanks are NOT stored inside of buildings?

  • Fire extinguisher available near LP storage locations?

  • LP stored in ventilated enclosure?

  • LP storage area protected against tampering?

  • Containers located to minimize exposures?

  • Good compliance/no safety violations?

Forklifts

  • Will this section be included in this report?

  • Forklifts inspected daily?

  • Forklifts free of known defects/damage?

  • Forklifts removed from service if defective?

  • Forklift operators trained?

  • Operators properly certified by employer?

  • Forklift operators evaluated every 3 years?

  • No modifications affecting lift capacity?

  • Forks lowered when truck is unattended?

  • Nameplate/markings in place and legible?

  • Seatbelts worn while operating forklifts?

  • Operator Manual available for review (Best Practice)

  • Good compliance/no safety violations?

Hazard Communication

  • Will this section be included in this report?

  • SDS kept at worksite for each hazardous chemical?

  • SDS's readily accessible to employees as needed?

  • Chemicals (in supplier container) properly labeled/legible?

  • Chemicals (in secondary container) properly labeled/legible?

  • Chemical inventory list maintained?

  • Employees effectively trained & demonstrate competency?

  • Good compliance/no safety violations?

Health Hazards

  • Will this section be included in this report?

  • Noise exposures monitored/controlled?

  • Asbestos exposures monitored/controlled?

  • CO exposures monitored/controlled?

  • Lead exposures monitored/controlled?

  • Welding fume exposures monitored/controlled?

  • Extreme heat exposures monitored/controlled?

  • Extreme cold exposures monitored/controlled?

  • Steps taken to protect workers from cold stress?

  • Steps taken to protect against insects/animals?

  • Is Mold Remediation Plan in writing/available?

  • Is Mold Remediation Plan appropriate based on size of contaminated area?

  • Do workers follow the Mold Remediation Plan guidelines?

  • Good compliance/no safety violations?

Heat Illness Prevention

  • Will this section be included in this report?

  • Is outdoor air temperature monitored?

  • Is drinking water provided/accessible during work shift?

  • Is shade provided when temp exceeds 80 degrees?

  • Shaded area(s) accommodate the number of employees on shift?

  • Preventative cool-down rest breaks encouraged?

  • Employees monitored if experiencing symptoms?

  • Is an Acclimatization Program in place and practiced?

  • Are High-Heat Procedures in place if temp exceeds 95F?

  • Are heat-illness response procedures in place?

  • Heat Illness training provided at time of hire?

  • Steps taken to reduce shift severity/duration?

  • Appropriate clothing worn to reduce heat burden?

  • Good compliance/no safety violations?

Housekeeping

  • Will this section be included in this report?

  • Worksite reasonably organized/good housekeeping?

  • Combustible scrap/debris removed at regular intervals?

  • Job trailer clean and reasonably organized?

  • Material staging area kept reasonably organized?

  • Gang box(es) reasonably clean and organized?

  • Garbage disposed of at frequent/regular intervals?

  • Loose scrap/light materials susceptible to wind secured?

  • No protruding nails on scrap lumber?

  • Containers used for oily/flammable waste covered?

  • Good compliance/no safety violations?

Ladders/Stairs

  • Will this section be included in this report?

  • Ladders inspected/no visible defects?

  • Side rails extend 3 ft. above landing surface?

  • Ladders set up at 4:1 angle?

  • Ladders set up on stable/level surface?

  • Top of ladder secured to prevent side shift?

  • Base of ladder secured when conditions warrant?

  • Ladders used correctly/as intended by mfg?

  • Stairs/ladder/ramp at elevation break of 19+ inches?

  • Spreaders fully engaged on stepladders?

  • Workers avoid using top 2 steps of stepladder?

  • Area at top and bottom of ladder kept clear?

  • At least one hand free to grasp ladder?

  • Loads not carried that could cause loss of balance/fall?

  • Job-made ladders compliant?

  • Non-conductive ladder used if exposed to electrical hazard?

  • Damaged ladders tagged and removed from service?

  • Handrails on stairs with 4 or more risers?

  • Treads/landings on pan stairways filled?

  • Good compliance/no safety violations?

Mechanized Equipment

  • Will this section be included in this report?

  • Equipment in good condition/no obvious defects?

  • Seatbelts on earth-moving equip. w/ROPs?

  • Seat belts worn on equipment with ROPs?

  • Parking brake set when equipment is parked?

  • Wheels chocked when needed (i.e. parked on incline)?

  • Bidirectional machines equipped with functional horn?

  • Reverse alarm and/or spotter when backing?

  • No passengers allowed on single-operator equipment?

  • Windshields in good condition/no cracks?

  • Personnel platform secured to carriage/forks?

  • Personnel on raised platform have access to operating controls?

  • Beacon light activated on equipment when conditions warrant?

  • Slow Moving Vehicle placard when operating in traffic?

  • Blades/buckets/dump bodies lowered or blocked when not in use?

  • Operator(s) competent/familiar with equipment controls?

  • Equipment/attachments safe distance from energized power lines?

  • Good compliance/no safety violations?

Medical/FA Services

  • Will this section be included in this report?

  • First aid supplies easily accessible when required?

  • First aid supplies refilled/maintained?

  • Certified FA/CPR provider available at remote worksites?

  • Emergency numbers posted when 911 service unavailable?

  • Location of nearest medical facilities known/posted?

  • Eye/body flushing facilities available when needed?

  • Eye wash station(s) properly maintained?

  • AED system status indicator show green?

  • AED pads current?

  • Employees trained in AED use and current?

  • AED visible and unobstructed?

  • AED in good condition/properly maintained?

  • Good compliance/no safety violations?

MEWP's (Aerial/Boom Lifts)

  • Will this section be included in this report?

  • Workers use harness/lanyard tied to approved anchor in basket?

  • Workers not tied off to adjacent structure/equipment?

  • Operator(s) trained and/or authorized?

  • Both feet on floor of basket?

  • Boom/basket load limits not exceeded?

  • MEWP is stationary when elevated?

  • MEWP controls clearly marked/identified?

  • MEWP is inspected prior to use/documented?

  • MEWP is at least 10 feet from energized power lines?

  • Access gate/opening closed when working in MEWP?

  • MEWP operated on level surface per mfg. specs?

  • Outriggers (when available) utilized as needed?

  • Work platform kept reasonably clear of debris?

  • Is MEWP operated within the wind speed service limit?

  • Is a legible copy of Operators Manual kept with MEWP?

  • Does MEWP have current annual inspection sticker?

  • Is there a written Rescue Plan to address falls from platform?

  • Have operators received Fall Rescue training?

  • Good compliance/no safety violations?

MEWP's (Scissor Lifts)

  • Will this section be included in this report?

  • MEWP inspected and free of defects?

  • MEWP is inspected prior to use/documented?

  • Both feet on floor of lift?

  • Workers trained on use of MEWP?

  • MEWP is at least 10 feet from energized power lines?

  • MEWP operated on level surface per mfg. specs?

  • No modifications/additions affecting lift capacity?

  • Directional controls return to neutral when released?

  • Directional controls clearly marked?

  • Access gate/opening closed when working in MEWP?

  • Is MEWP operated within the wind speed service limit?

  • Is a legible copy of Operators Manual kept with MEWP?

  • Does MEWP have current annual inspection sticker?

  • Outriggers (when available) utilized as needed?

  • Employees utilize PFAS when working from scissor lift?

  • Barricades erected to keep bystanders clear (as needed)?

  • Floor of lift kept reasonably clean?

  • Good compliance/no safety violations?

PPE

  • Will this section be included in this report?

  • PPE provided as required?

  • PPE used/worn as required?

  • PPE maintained in good/sanitary condition?

  • Eye protection worn as required?

  • Face protection used when required?

  • Approved eye protection worn by those using prescription lenses?

  • Eye protection meets ANSI standards?

  • Hard hats worn as required?

  • Hand protection worn when needed?

  • Recommended Product:

  • Safety footwear worn as needed?

  • Respirators provided/used as required?

  • Workers reviewed App D/voluntary dust mask use?

  • Hearing protection used as required?

  • High-visibility clothing worn as required?

  • Appropriate shade protection used by welders?

  • Replacement PPE readily available?

  • Good compliance/no safety violations?

Postings/Safety Signs

  • Will this section be included in this report?

  • OSHA Workplace Poster displayed?

  • Emergency numbers/contacts posted?

  • OSHA 300 Summary posted Feb. 1st to Apr. 30th?

  • Danger/caution signs posted as needed?

  • Warning signs around perimeter of worksite?

  • Good compliance/no safety violations?

Public Protection

  • Will this section be included in this report?

  • Public warned of potential for sudden/loud impact noises?

  • Public exposure to airborne contaminants (dust/fumes/smoke) controlled?

  • Construction operations near pedestrian/vehicular traffic controlled?

  • Where pedestrian areas are closed, suitable/safe alternatives provided?

  • Lighting (incl. welding flash) directed/shielded to minimize impact on public?

  • Radiation exposure hazards controlled and shielded to protect public?

  • Areas where public is exposed to mobile equip. are barricaded?

  • Barriers, enclosures, netting used to protect public from falling/wind-borne objects?

  • Measures taken to restrict public access to jobsite?

  • Measures taken to restrict public access to haz. equipment/supplies?

  • Operations generating waste/debris controlled to min. exposure to adjacent areas?

  • Controls in place where water run-off may pose a pollution hazard?

  • Utilities located and marked prior to start of construction?

  • Haz. materials stored away from public in approved/labeled containers or structures?

  • Hazards associated with vibrations (pile driving, blasting, etc.) analyzed?

  • When blasting occurs, an audible warning signal is established to warn public?

  • Excavations/trenches in public areas backfilled as soon as practicable?

  • Personnel trained on action to take if emergency arises affecting public?

  • Good compliance/no safety violations?

Respiratory Protection

  • Will this section be included in this report?

  • Respiratory Protection Program established?

  • Respirators used in hazardous atmospheres?

  • Respirators properly maintained/sanitary?

  • Medical evaluation completed prior to fit-test?

  • Fit-test completed prior to initial use/annually?

  • Facial hair does not compromise respirator seal?

  • Approved respirator for application used?

  • Employees trained in proper respirator use?

  • Appendix D reviewed when voluntary use?

  • Compressed air quality at least Grade D?

  • Compressors maintained as required?

  • Good compliance/no safety violations?

Rigging

  • Will this section be included in this report?

  • Rigging equipment inspected/good condition?

  • Damaged/defective rigging removed from service?

  • Rigging equipment properly tagged/labeled?

  • Rigging used per manufacturer’s specifications?

  • Rigging equipment properly stored?

  • Good compliance/no safety violations?

Safety Training

  • Will this section be included in this report?

  • Toolbox talks completed daily?

  • Toolbox talks completed weekly?

  • Toolbox talks documented?

  • Equipment/machine operator training documented?

  • Job-specific safety training provided/documented?

  • Safety Orientation Training provided?

  • Good compliance/no safety violations?

Scaffolds (Rolling/Baker)

  • Will this section be included in this report?

  • Scaffolds inspected/free of defects?

  • Working platforms fully planked/decked?

  • Platform clean/free of excessive debris?

  • Only supplies needed stored on scaffolds?

  • Fall protection provided above 10 feet?

  • Scaffolds and components do not exceed rated capacities?

  • Employee remains within wheels/supports of scaffold?

  • Scaffold bracing is secured, squared, aligned?

  • Wheel/caster brakes operable and set as required?

  • Caster/wheel stems pinned/secured to scaffold legs?

  • Employee only rides scaffold if surface is level/no obstructions?

  • Outriggers used when platform extends beyond supports?

  • Outriggers (if required) properly installed?

  • Workers trained on use of scaffolds?

  • Are scaffolds used within the wind speed service limit?

  • Scaffold integrity not compromised by intermixing parts?

  • Modified scaffold components approved by CP?

  • Good compliance/no safety violations?

Scaffolds (Supported)

  • Will this section be included in this report?

  • Scaffolds inspected by competent person?

  • Planking is free of visible defects?

  • Framing is free of visible defects?

  • Bracing is free of visible defects?

  • All other scaffold components free of visible defects?

  • Working platforms fully planked/decked (spacing 1" or less)?

  • Maximum distance from face for outrigger scaffolds is 3” or less?

  • Fall protection provided/used on scaffold above 10 feet?

  • Legs/frame bear on base plates/mud sills?

  • Footings level, rigid, no visible settling?

  • Ladder provided/used to access platform?

  • Only scaffold-grade lumber used?

  • Platform clean/free of excessive debris?

  • When platforms overlap, overlap is 12 inches or more?

  • Platform supports plumb/braced to prevent swaying?

  • Toeboards used to prevent tools/materials falling on employees?

  • Makeshift devices not used to gain additional height?

  • Scaffolds and components do not exceed rated capacities?

  • Only materials needed stored on scaffold?

  • Non-cleated platforms extend at least 6 in. over support?

  • Platforms <10 ft. do not extend more than 12 in. past support?

  • Platforms (10+ ft.) do not extend more than 18 in. past support?

  • Platform attached to forks when supported by forklift?

  • Scaffold not moved horizontally when occupied?

  • Workers not allowed on scaffolds covered in snow/ice?

  • Bracing installed per mfg. recommendations (i.e. 4:1 height)?

  • Cross-bracing is installed/maintained?

  • Top rail of guardrail (or equivalent) at proper height?

  • Midrails (or equivalent) installed between toprail and platform?

  • Midrail cross-bracing midpoint between 20-30 inches?

  • Toprail cross-bracing midpoint between 38-48 inches?

  • Workers trained on use of scaffolds?

  • Workers trained to erect/disassemble/move scaffolds?

  • Proper distance maintained from exposed energized power lines?

  • Scaffold integrity not compromised by intermixing parts?

  • Modified scaffold components approved by CP?

  • Good compliance/no safety violations?

Scaffolds (Suspension)

  • Will this section be included in this report?

  • Scaffolds inspected/free of defects?

  • Supports (beams/hooks/clamps) rest on surface rated for load?

  • Outrigger beams made of structural metal or equivalent strength?

  • Outrigger beams restrained to prevent movement?

  • Outrigger beams adequately secured to deck (bolts, counterweights)?

  • Competent Person approves suspension design prior to use?

  • Only approved, specifically designed counterweights allowed?

  • Counterweights mechanically attached to outrigger beams?

  • Tiebacks used when outrigger beams not mechanically fastened?

  • Outrigger beams perpendicular to building when possible?

  • Tiebacks secured to structurally sound anchor?

  • Tiebacks installed perpendicular or at opposing angles?

  • Wire rope shackle/clevis placed directly over center line of stirrup?

  • Support devices (i.e. hooks, clamps, etc.) made of steel/iron?

  • Support devices (i.e. hooks, clamps, etc.) supported by bearing blocks?

  • Support devices (i.e. hooks, clamps, etc.) secured against movement?

  • Min. 4 wraps on drum hoist at lowest point of travel?

  • No repairs made to wire rope used for suspension?

  • Wire ropes inspected/maintained in good condition?

  • Minimum 3 clips installed on wire rope?

  • Clips installed per manufacturer recommendations?

  • Gears and breaks on power-operated hoists guarded?

  • Brake engages immediately upon uncontrolled movements?

  • Manually operated hoist has positive crank force to descend?

  • Steps taken to prevent scaffold from swaying when required?

  • Equipment designed solely for escape/rescue not used as work platform?

  • Proper distance maintained from exposed energized power lines?

  • Good compliance/no safety violations?

Scaffolds (Mast Climber)

  • Will this section be included in this report?

  • Scaffolds inspected/free of defects?

  • Scaffold integrity not compromised by intermixing parts?

  • Modified scaffold components approved by CP?

  • Are access panels clear of material and equipment?

  • Are safety guardrails in position and doors operational (no fall hazard)?

  • Is a legible copy of owner's manual kept on site?

  • Is construction traffic controlled on and around scaffolding (proper barriers installed)?

  • If the work platform is accessed from inside the building or off a scaffold stair tower, is transfer safe and free from obstruction?

  • Mast climbing is not impeded in any way?

  • Access walkway is clear of debris and working properly?

  • Minimum clearance from overhead power lines is maintained according to local regulation?

  • On special facade shapes, cross box kits, face guardrails and plank guardrails are properly installed and secure?

  • Perimeter of setup is safe and delimited (warning tape, concrete blocks)?

  • Setup and installation meet the requirements prescribed by owner's manual or approved engineering drawing?

  • The platform clears all obstacles (building, balconies, etc.) and can be raised or lowered?

  • Work and circulation areas on the platform are clear of any obstruction?

  • Base is level and cribbing under jacks has not moved?

  • Cables and control levers have been verified and are functioning properly?

  • Each cylinder hook, secondary hook and lowering cam is in good condition and functioning properly?

  • Each cylinder, hydraulic hose and hydraulic component is free of leaks and signs of wear?

  • Each roller has been greased?

  • Each roller has been verified and is in good condition?

  • Gasoline and engine oil levels are appropriate or have been replenished?

  • Air filter has been verified and is in good condition or has been replaced, if necessary?

  • Hydraulic oil level has been verified and hydraulic tank has been replenished, if required, with oil recommended by manufacturer?

  • Lifting mechanism is clear of debris (mortar, masonry material, etc.) and shows no signs of excessive wear?

  • Motorized unit structure has been inspected and shows no signs of damage or distortion?

  • On an electrical unit, the power cable has been inspected and shows no signs of damage?

  • Input power is adequate and phases are in sync?

  • On an electrical unit, the routing of power cable is free from obstruction and the cable recoils properly?

  • Rubber on each cylinder hook has been verified as described in Owner's manual procedure and is in good condition?

  • Each backup safety hook has been inspected and shows no sign of engagement prior to inspection?

  • Each safety hook is clean and can move freely?

  • Motorized unit is placed out of service if any safety hook is found to be defective or shows signs of having been engaged previously?

  • Mast bolts are tightened at the proper torque (120 lb-ft or 163 N-m)?

  • Mast bolt washers have been replaced if bent?

  • Mast sections have been inspected and show no signs of damage or distortion?

  • Mast ties are in good condition, show no signs of distortion and are secure?

  • Masts are plumb (both front and side axis) and all bolts and nuts are in position?

  • Bridges have been inspected and their structure shows no signs of damage or distortion?

  • On angled or 90 degrees bearing bridges, is proper overlap and special chains installed on bridge and motorized unit undercarriage?

  • On linear bearing bridges, is 6-12 in. overlap maintained at each end & bridge safety chains tied properly w/slack not exceeding 1 in.?

  • Plank outriggers are clean and in good condition?

  • Outrigger lock bolts are all tightened properly and plank stop pins are in place?

  • Planking is in good condition and set properly?

  • Planking clears all obstacles (building, balconies, etc.) and is properly supported, overlapped and secured?

  • Loads on the platform do not exceed those prescribed by the capacity charts and are equally distributed?

  • Good compliance/no safety violations?

Scaffolds (Pump Jack)

  • Will this section be included in this report?

  • Scaffolds inspected/free of defects?

  • Scaffold integrity not compromised by intermixing parts?

  • Modified scaffold components approved by CP?

  • Poles are straight and undamaged?

  • No makeshift components are used?

  • Pole systems >24' hoisted into position using a rope?

  • Metal braces secured to structure with 3" screws or equivalent?

  • Above 24' intermediate braces are at 16' spacing?

  • Pole system braces secured to solid support of at least 1/2" plywood?

  • Max. working height of pole system scaffolds is 50' or less?

  • No wooden poles used to support aluminum pole system components?

  • Pole system scaffold platforms installed 14" or less away from wall?

  • Pole system scaffold work bench not used as work platform?

  • Pole system scaffolds on base plates and mud sills?

  • Work from pole system scaffolds performed from level platform?

  • Area below pole system scaffolds is cordoned off, or no employees below?

  • Walls are within 14" or end rails are used to prevent falls?

  • Max 2-men (400lbs) & 100 lbs. of tools/materials used on pole system scaffolds?

  • Proper distance maintained from exposed energized power lines?

  • Good compliance/no safety violations?

Scaffolds (Stairtower)

  • Will this section be included in this report?

  • Competent person inspects stairtower each shift/as needed?

  • Bottom step no more than 24 in. high?

  • Stair rail (top & mid) provided on each side?

  • Handrails provide adequate handhold for grasping?

  • Handrails smooth and free of snags?

  • Ends of stair rails do not pose a projection hazard?

  • Handrails provide min. 3 in. clearance?

  • Stair rail at proper height (btwn. 28-37 in.)?

  • Landing platform (min. 18x18 in.) at each level?

  • Min. 18 in. clearance between stair rails?

  • Treads/landings slip-resistant?

  • Riser/tread height uniform?

  • Bracing installed per mfg. recommendations (i.e. 4:1 height)?

  • Stairtower placed on firm foundation?

  • Footings are level/no signs of settling?

  • Stairtower is plum/braced to prevent swaying?

  • Stairtower removed from service if defective?

  • Scaffold integrity not compromised by intermixing parts?

  • Modified scaffold components approved by CP?

  • Good compliance/no safety violations?

Silica Exposure

  • Will this section be included in this report?

  • Controls (based Table 1 Tasks) in place to minimize silica exposure?

  • Controls in place when using stationary masonry saws?

  • Controls in place when using handheld power saws?

  • Controls in place when using walk-behind saws?

  • Controls in place when using jackhammers/powered chipping tools?

  • Controls in place when using handheld grinders for mortar removal?

  • Controls in place when using handheld grinders (other than mortar removal)?

  • Controls in place when using walk-behind milling machines/floor grinders?

  • Controls in place when using crushing machines?

  • Exhaust provided for indoor tasks where silica exposure occurs?

  • When wet-method is used, is water applied at proper rate to minimize dust?

  • When cab is used to control dust, is it air tight with climate controls?

  • Proper respirator used (as required) and worn properly?

  • Wet sweeping or HEPA vacuuming used to clean up silica dust?

  • Compressed air is prohibited when cleaning silica dust?

  • Written exposure control plan developed/implemented?

  • Exposure control plan reviewed at least annually?

  • Competent person conducts frequent site inspections?

  • Medical surveillance program in place?

  • Initial medical examination completed within first 30 days of assignment?

  • Medical evaluation completed every 3 years or more often as needed?

  • Employees trained on hazards associated with silica exposure?

  • Records of air sampling and medical surveillance maintained?

  • Good compliance/no safety violations?

Steel Erection

  • Will this section be included in this report?

  • Site layout graded, drained and adequate space?

  • Documentation rec'd that footings can support load?

  • Crane(s) visually inspected at start of shift?

  • Rigging equipment inspected at start of shift?

  • Workers not allowed under suspended load?

  • Multiple lifts do not exceed 5 members?

  • Multiple lifts rigged 7 feet apart?

  • Multiple lifts rigged at center of gravity/balanced?

  • Decked floor at least 30 ft. below erectors?

  • Metal decking secured upon placement?

  • Guardrails/toeboards around structural openings?

  • Floor opening covers substantial, marked, secured?

  • Columns anchored by min. 4 anchor rods/bolts?

  • Structural members secured with two bolts per connection?

  • Diagonal bracing secured with one bolt per connection?

  • Tools aloft secured against accidental displacement?

  • Contractors barred from working below erection activities?

  • Steel workers above 15 ft. protected from fall hazards?

  • Connectors 2 stories/30 ft. up protected from fall hazards?

  • Perimeter cables installed when decking completed?

  • Perimeter cables flagged at 6 foot intervals?

  • Custody of fall protection transferred when work is finished?

  • Ramps/runways properly guarded?

  • Good compliance/no safety violations?

Stormwater Management

  • Will this section be included in this report?

  • Are all slopes and disturbed areas not actively being worked properly stabilized?

  • Are natural resource areas (e.g., streams, wetlands, mature trees, etc.) protected with barriers?

  • Are perimeter controls and sediment barriers adequately installed (keyed into substrate) and maintained?

  • Are discharge points and receiving waters free of any sediment deposits?

  • Are storm drain inlets properly protected?

  • Is the construction exit preventing sediment from being tracked into the street?

  • Are washout facilities (e.g., paint, stucco, concrete) available, clearly marked, and maintained?

  • Are vehicle and equipment fueling, cleaning, and maintenance areas free of spills, leaks, or any other damaging material?

  • Are materials that are potential stormwater contaminants stored inside or under cover?

  • Are non-stormwater discharges (e.g., wash water, dewatering) properly controlled?

  • Good compliance/no safety violations?

Temporary Heating Devices

  • Will this section be included in this report?

  • Fresh air/ventilation provided as needed?

  • Circulating type heating devices have min. 12” side/rear clearance?

  • Radiant type heating devices have min. 36” side/rear clearance?

  • Proper insulating material placed under heater on wood floors?

  • Heaters placed at least 10’ from tarps, canvas, or similar coverings?

  • Tarps, canvas or similar coverings used near heaters are secured?

  • Heating devices used on stable, level surface?

  • Salamanders used per manufacturers' instructions?

  • Good compliance/no safety violations?

Tools (Hand & Power)

  • Will this section be included in this report?

  • Hand and power tools in safe operating condition?

  • Guards in place/functional on power tools?

  • Impact tools free of mushroom heads?

  • Handles free of splinters/cracks and kept tight in tool?

  • Power tools double-insulated or grounded?

  • Electric cords NOT used to hoist/lower power tools?

  • Secondary restraint used on pneumatic tools to prevent hose whip?

  • Safety clips/retainers installed/maintained on pneumatic impact tools?

  • Safety device on muzzle of pneumatic fasteners?

  • Compressed air under 30psi when used for cleaning?

  • Tool(s) used withing mfg. safe operating pressure?

  • Air hose NOT used to lower/hoist pneumatic tools?

  • Pressure release on hoses exceeding 1/2-inch inside diameter?

  • Power tools stopped during refueling/maintenance?

  • Angle grinders equipped with safety guards?

  • Circular saws adequately guarded?

  • Hand-fed ripsaw (table saw) adequately guarded?

  • Load capacity legibly marked on jacks/not exceeded?

  • Raised loads are cribbed/blocked when using jacks?

  • Air receiver equipped w/working pressure gauge?

  • Air receiver equipped w/ pressure release valve?

  • Equipment/machine guards in place and functional?

  • Approved clamps used on air hose connections?

  • Good compliance/no safety violations?

Tools (Powder Actuated)

  • Will this section be included in this report?

  • Only trained employees use powder-actuated tools?

  • Powder-actuated tools (when in use) tested daily?

  • Defective tools immediately removed from service?

  • Tools remain unloaded until just prior to use?

  • PAT's are always pointed away from employees?

  • Hands/body parts kept clear of open barrel end?

  • Loaded tools are attended at all times?

  • Fasteners only driven into suitable/safe surfaces?

  • Tools prohibited in explosive/flammable atmospheres?

  • Tools equipped with approved shield, guard, attachment?

  • Only ANSI approved tools used?

  • Powder-actuated tools and loads marked and stored properly?

  • Powder-actuated loads (spent and unspent) properly discarded?

  • Good compliance/no safety violations?

Trenching/Excavation

  • Will this section be included in this report?

  • Competent Person completes daily inspection?

  • Employees protected from cave-in by protective system (if equal to or greater than 5')?

  • Sloping/benching adequate for soil type?

  • Spoils/material/equipment set back 2 feet from edge?

  • Proper/safe means of access/egress provided?

  • Travel distance to egress no more than 25 feet?

  • Utilities located/identified prior to start of excavation?

  • Surface encumbrances removed or supported?

  • Water runoff controlled to prevent accumulation?

  • Access prohibited when water accumulation is uncontrolled?

  • Trench barricaded when left unattended?

  • Manual/visual test used to confirm soil classification?

  • Workers exposed to traffic wearing high-viz clothing?

  • Stability of adjacent structures ensured?

  • Backfilling occurs as work proceeds?

  • Soil not excavated more than 2 ft. below protective system?

  • Pavements/structures not undermined unless supported?

  • Atmospheric conditions tested prior to entry?

  • Good compliance/no safety violations?

Welding & Cutting (Hot Work)

  • Will this section be included in this report?

  • Valve caps in place when storing/transporting cylinders?

  • Cylinders in transportation secured in vertical position?

  • Cylinder valves closed when work is finished?

  • Cylinders secured in upright position?

  • Fuel gas cylinders separated from O2 cylinders 20 ft./5 ft. high 30 min. fire rating?

  • Welding hoses in good condition?

  • Regulators/gauges/valves in proper working order?

  • Flashback arrestors utilized?

  • Manual electrode holders w/proper capacity used?

  • Electrode holders fully insulated?

  • Arc welding cables/connectors fully insulated?

  • Is weld cable free of repair/splices for a min. of 10 feet from the electrode holder?

  • Cable lugs or splices equal to cable capacity and completely insulated?

  • Are cables in need of repair removed from service as required?

  • Are worn or exposed areas protected by means of adequate insulation?

  • Does ground return cable carrying capacity exceed load demand as required?

  • Are flammable gas/liquid pipelines and electrical conduits excluded from use as ground return?

  • Does electrical contact exist at all joints of ground return circuit as required?

  • Are all joints of continuously employed ground return circuits bonded and inspected as required?

  • Are all frames for arc welding and cutting machines grounded as required?

  • Do grounding circuits have sufficiently low resistance to allow for fuse or circuit interruption?

  • Are all ground connections inspected for mechanical and electrical soundness?

  • Are noncombustible/flameproof screens used for shielding as required?

  • Fire extinguishing equipment in close proximity?

  • Fire watch maintained as required?

  • Combustibles removed/protected from heat/sparks/slag?

  • Good compliance/no safety violations?

Temporary Fencing

  • Will this section be included in this report?

  • When moveable fencing used, is it sandbagged to prevent it from moving?

  • If used, are sandbags maintained intact without tears or holes and positioned on the interior side of the construction fence?

  • Are fences locked when construction personnel are not present?

  • Does fencing have signs warning of the safety risk of trespassing, as well as the legal penalties of doing so?

  • Are building/structure exits arranged and maintained as to provide free and unobstructed egress from all parts of the building/structure?

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.