Safety Inspection

• Contractor Company:

• Client:

• Job Name / Number:

• Task Observed:

• Location:
  Address

• Conducted on:

  Date

• Jobsite Supervisor:

• Prepared by:

• Personnel Onsite: (Head Count)

Task Hazard Analysis (or equivalent-section must be completed for all jobs)

• Task Hazard Analysis (check box if none apply to the current job)

• Was a THA completed for all tasks being performed?

  Yes

  No

  N/A

• Are all hazards addressed on the THA?<br>

  Yes

  No

  N/A

• Are appropriate control measures in place for the hazards?

  Yes

  No

  N/A

• Have all employees signed the THA?

  Yes

  No

  N/A

• Has the Take 5 Meeting been held and documented on the THA Form?

  Yes

  No

  N/A

• Does the contractor review the THA with all visitors to jobsite?

  Yes

  No

  N/A

• Are all tasks properly and identified on the THA?

  Yes

  No

  N/A

• Are all obstructions such as, overhead lines, or items unique to the jobsite identified on the THA?

  Yes

  No

  N/A

• Add section additional / other media.

  Media

• Add section notes and comments.

Mechanical Equipment

• Mechanical Equipment (check box if none apply to the current job)

• Have pre-use inspections been completed on all equipment?

  Yes

  No

  N/A

• Is all equipment in satisfactory condition?

  Yes

  No

  N/A

• Is there a fire extinguisher on equipment or available onsite? And properly tagged and in date?

  Yes

  No

  N/A

• Have all operators been trained in the operation of their equipment?

  Yes

  No

  N/A

• Has equipment been grounded where needed?

  Yes

  No

  N/A

• Is there a backup alarm on all equipment or is the contractor using a spotter?

  Yes

  No

  N/A

• Add section additional / other media.

  Media

• Add section notes and comments.

Housekeeping (section must be completed for all jobs) Must provide comments if “No” is marked.

• Housekeeping (check box if none apply to the current job)

• Has the contractor addressed all housekeeping issues on jobsite?

  Yes

  No

  N/A

• Are flammable liquids properly stored?

  Yes

  No

  N/A

• Are flammable liquids properly labeled?

  Yes

  No

  N/A

• Have all employees completed OSHA 10 hour training, including subcontractor employees?

  Yes

  No

  N/A

• Has job site supervision completed OSHA 30hour training, including subcontractor employees?

  Yes

  No

  N/A

• Add a section additional / other media.

  Media

• Add section notes and comments.

Personal Protective Equipment (section must be completed for all jobs)

• Personal Protective Equipment (check box if none apply to the current job)

• Are all employees wearing at a minimum a hardhat, safety glasses w/side shields, proper footwear, and proper safety vest? I

  Yes

  No

  N/A

• Are all employees wearing work gloves appropriate for the hazard?

  Yes

  No

  N/A

• Are all employees wearing appropriate fall protection when required? Note: 100% fall protection is required while working at elevated heights.

  Yes

  No

  N/A

• Are all employees working on or near energized equipment outfitted and wearing FR clothing properly. ***IF NOT STOP WORK IMMEDIATELY***

  Yes

  No

  N/A

• Is PPE in good condition?

  Yes

  No

  N/A

• Add a section additional / other media.

  Media

• Add section notes and comments.

Weather Conditions:

• Weather Conditions (check box if none apply to the current job)

• Are mitigation measures for Heat Stress in place addressed and reviewed?

  Yes

  No

  N/A

• Is storm or severe weather preparedness and evacuations addressed during the THA meeting and noted?

  Yes

  No

  N/A

• Add a section additional / other media.

  Media

• Add section notes and comments.

Work Zone Protection (If there is no content, this section does not apply to the current job)

• Work Zone Protection (Check box in none apply to the current job)

• Are the workers properly protected from vehicle traffic?

  Yes

  No

  N/A

• Are all persons in the work zone wearing high visibility clothing?

  Yes

  No

  N/A

• Have all required permits been obtained for any public road crossings?

  Yes

  No

  N/A

• Have all road crossings been properly guarded?

  Yes

  No

  N/A

• Are all staying out of the work zone when not involved in the task?

  Yes

  No

  N/A

• Are spotters being used at all times?

  Yes

  No

  N/A

• Add a section additional / other media.

  Media

• Add section notes and comments.

Right of Way or Substation

• Right of Way or Substation (Check box in none apply to the current job)

• Does contractor keep gates closed and locked?

  Yes

  No

  N/A

• Is the crew/crews staying on R.O.W.?

  Yes

  No

  N/A

• Add a section additional / other media.

  Media

• Add section notes and comments.

Fall Protection

• Fall Protection (Check box in none apply to the current job)

• Is 100% Fall Protection being observed while working at elevated heights? ****STOP ALL WORK IMMEDIATELY IF NOT****

  Yes

  No

  N/A

• Does each person working at elevated heights have the appropriated PFAS? ****STOP ALL WORK IF NOT****

  Yes

  No

  N/A

• Add a section additional / other media.

  Media

• Add section notes and comments.

Excavation (check box if none apply to current job)

• Excavation (check box if none apply to current job)

• Have locates been called, located, marked, and cleared?

  Yes

  No

  N/A

• Has an excavation competent person inspected the job site prior to entry each shift and when conditions change?

  Yes

  No

  N/A

• Are all evacuations properly shored and/or sloped?

  Yes

  No

  N/A

• Are opened excavations & opened trench ways barricaded/identified when unattended?

  Yes

  No

  N/A

• Add a section additional / other media.

  Media

• Add section notes and comments.

Communications (section must be completed for all jobs)

• Communications (Check box if none apply to current job)

• Are adequate first aid supplies available on site?

  Yes

  No

  N/A

• Is there a Blood Borne Pathogen kit onsite?

  Yes

  No

  N/A

• Are SDS available to on site personnel?

  Yes

  No

  N/A

• Is a copy of the safety manual on site?

  Yes

  No

  N/A

• Has the plan been reviewed with all employees?

  Yes

  No

  N/A

• Is a complete emergency plan documented and on site? Note: Plan shall include emergency contacts, map to local hospital and procedures to follow in the event of an emergency.

  Yes

  No

  N/A

• Add a section additional / other media.

  Media

• Add section notes and comments.

Hand Tools (check box if none apply to current job)

• Hand Tools (check box if none apply to current job)

• Are hand tools in good working conditions (i.e. broken handles, etc.)?

  Yes

  No

  N/A

• Are ladders in good working condition?

  Yes

  No

  N/A

• Are GFCIs used on all electrical equipment? Are all power cords in good condition

  Yes

  No

  N/A

• Are all power hand tools in good working condition with appropriate guards?

  Yes

  No

  N/A

• Add a section additional / other media.

  Media

• Add section notes and comments.

Work performed under an operating order (check box if none apply to current job)

• Work performed under an operating order (check box if none apply to current job)

• Does the Foreman know who holds the clearance, non-reclose order or hold order for the facilities being worked?

  Yes

  No

  N/A

• Do the Foreman and crew know and understand the clearance points?

  Yes

  No

  N/A

• Add a section additional / other media.

  Media

• Add section notes and comments.

Working on or Near Energized Equipment

• Working on or Near Energized Equipment (Check box if none apply to the current job)

• Are all employees maintaining appropriate approach distances?

  Yes

  No

  N/A

• Are all energized facilities covered or guarded to prevent contact?

  Yes

  No

  N/A

• Has contractor been advised of equipment under an NRO order and have they logged in with Dispatch?

  Yes

  No

  N/A

• Are all employees working on or near energized equipment outfitted and wearing FR clothing properly. ***IF NOT STOP WORK IMMEDIATELY***

  Yes

  No

  N/A

• Add a section additional / other media.

  Media

• Add section notes and comments.

Grounding (check box if none apply to current job)

• Grounding (check box if none apply to current job)

• Have all lines and equipment been de- energized, tested, and grounded when required?

  Yes

  No

  N/A

• Have all sources of energy been considered including induced voltage?

  Yes

  No

  N/A

• Add a section additional / other media.

  Media

• Add section notes and comments.

Notes of Obersavation: Please provide comments below:

• Enter the Notes of the Observations

  Safe

  At Risk

  N/A

Sign Off

• Supervisor

  Sign

• Date:

• Auditor

  Sign

• Date: