Information
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Project
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Foreman
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Conducted on
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Prepared by
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Location
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Weather
Administrative
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Was previous survey reviewed?
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Are there any outstanding items?
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Review daily tailboard talk
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Project JHA signed and clinic directions posted
Personal Protective Equipment
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Safety Glasses
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Gloves
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High-Visibility Vest
Material Handling & Ergonomics
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Material Handling Aids
Electrical
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GFCI Inspections Current
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Enclosures Intact
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Cord & Cable Condition
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Temporary Lighting
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LOTO & Electrical Safe Work Practices
Walking & Working Surfaces
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Housekeeping
Ladder Use
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Stepladders- inspect, spreaders locked
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Extension Ladders - inspect, proper angle, tied off
Fall Protection
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Guardrails
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Holes Covered
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Personal Fall Arrest System
Fire Protection
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Fire Extinguishers
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Hot Work Procedures
Employee Health
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Dust Control
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Sanitation
Scaffolding
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Inspected by Competent Person and tagged
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Guardrails
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Working Level Completely Decked
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Proper Access (Ladders & Stairs)
Excavations
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Proper Slope, Shore or Bench
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Spoil piles >2' from the edge
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Egress within 25 Feet
Cranes & Rigging
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Equipment grounds installed, where applicable
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No work under loads
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Outriggers - extended, cribbing
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Tag lines used on all loads
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Sling Condition
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Protection setup for equipment below work area
Employee Interactions
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Employee name:
Aerial Lifts & Summary
Aerial Lifts
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100% Fall protection
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Equipment grounds installed, where applicable
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Comments:
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Overall Grade: Excellent - no deficiencies noted, Good up to 3 minor deficiencies, Needs Improvement more than 3 minor or one major deficiencies
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Pictures
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I have reviewed the results of this Safety survey.