Title Page
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Site conducted
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Conducted on
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Prepared by
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Client/Site
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Conducted On
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Supervisor
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Prepared by
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City
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Type of weather
- Clear Sky
- Cloudy
- Raining
- Foggy
- Windy
- Other
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What type of work is being done on location
- General
- Demolition
- Formwork
- Steel Placement
- Excavation
- Clean up
- Elevated Work
- Other
Protective Equipment
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Hard Hats
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Eye/Face Protection
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Safety Footwear
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Body Harness
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Safety Vest
Excavation and Shoring
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Shoring or Sloping
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Spoil Bank
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Ladder Available
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Competent Person
Highway Equipment
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Back up Alarms/Horns
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Seat Belts
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Windows
Electrical/Hand Tools
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Extension cords/GFCI’s
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Power Tools/Guards
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Tool Handles
Scaffolds/Fall Protection
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Fully Decked/Guardrails
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Construction
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Training Documentation<br>
Aerial LIfts
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Safety Chain
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Training Documentation
First Aid & Emergency
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First Aid Supplies
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SDS/Hazard Communication
Housekeeping/Santation
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Housekeeping
Ladders
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Tied off/3 Feet Above
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Secured Top
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Secured Bottom
Oxygen/Acetylene Bottles
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Secured
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Stored Upright
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Gauges/Hoses
Fuel Storage
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Proper Safety Cans
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Fire Extinguishers
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Labeling
Cranes
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Inspections
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Load Charts
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Angle Indicator
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Power Lines
Elements
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Silica
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Confined Space
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Gas Free
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Describe Non-Compliant Issues
