Information

  • Client / Site

  • Select date

  • Superintendent

  • Prepared by

Communication

  • Pre-Task Planning (Completed, Shared/Discussed/Understood & Signed by Employees

  • Work Strong Program Being Completed (Stretch-N-Flex)

  • Tip of Day Shared

First Aid/Emergency

  • Incident Report and Authorization for Medical Treatment Form READILY Available

  • After Hours Emergency Number and Hospital Information, (location, directions, contact number) displayed/known by all

  • First Aid & Blood Borne Kit Available

  • Personnel, at least one, Sup/Foreman) trained in 1st Aid CPR on Site

PPE

  • Safety Glasses (including side shields on prescription safety glasses) being worn by all

  • Miron Hardhat with individuals Name on Front, worn by all

  • Correct Gloves being worn by all, (example, cut resistant gloves for doctor blade changes, demo, ceiling grid work, working with utility knives,etc.

  • Safety Toed Shoes/Boots (steel or fiber toed) being worn by all

  • High Vis Clothing (and visible) being worn by ALL (NO COMPETITORS)

  • Other PPE Being Used (face shields while grinding, cut resistant sleeves for demo, chemical suits where required, etc.)

LOTO

  • Equipment Locked Out and Verified (restart completed)

  • ALL Individuals working on said Equipment, have Their Locks on

  • All Locks have Company and Personal name on lock tag

Aerial/Scissors Lifts

  • Inspected Daily and Documented

  • Employees Tied Off in Boom Lift with 6' Retractable

  • Employees trained to operate Aerial Lifts

Fall Protection

  • RESCUE PLAN IN PLACE, DISCUSSED, PRIOR TO PUTTING EMPLOYEES AT RISK OF FALLING

  • Employees Properly Tied off, (overhead, correct anchorage, enough clearance, limited swing radius)

  • Openings Properly Barricaded

  • Personnel Below Protected from Falling Objects

  • ROOF Fall Hazards Addressed with Proper Flagging, Barricading, and or Tying Off

Inspections

  • Monthly Fire Extinguisher Inspection Complete

  • Quarterly Ground Fault Inspection Complete

  • Quarterly Chain Fall Inspection Complete

Confined Space

  • Completed Permit in place and Discussed by ALL

  • Rescue plan in place

  • Adequate ventilation

  • Air Monitor in Continuous Use (current calibration, properly used)

  • Designated Attendant in Place, (their only assigned task)

Cranes, Rigging, Signaling

  • Rigging Inspected, Used Properly (chains not clipped back into themselves, correct capacity, legible tags, etc.)

  • Critical Lift Worksheets Complete

  • Qualified Rigger/Signal Person Conducting Work

  • Crane Signals posted in the immediate work area

  • Overhead Power Line Hazards Addressed

Cutting/Welding/Hotwork

  • Hot Work Permit In Place (filled out completely and correctly)

  • Fire Protection in Place

  • Welding Screens in Place

  • Cylinders Upright and Secured From Tipping

  • Cylinders Capped for Storage, Oxygen and Acetylene Stored 20' apart (or appropriate fire barrier in place)

Electrical

  • GFCI in place

  • Cords NOT being run over by Carts/Equipment, etc. (cords out of pathways, kept out of water, etc.)

Excavations

  • Overhead & Underground utilities located

  • Competent Person Inspecting and Documenting Daily

  • Proper Sloping and Access provided

  • Spoil piles, equipment and materials minimum of 2' from edge of excavation

Concrete/Masonry

  • All impalement hazards addressed (rebar, conduit, pipe, steel pins)

  • Engineer controls in use for Dust (water, ventilation, vacuum)

General Items

  • Tobacco Free Worksite, or Designated Smoking Areas be followed

  • Client expectation being met (hair nets, beard nets, hospital and food regulations)

  • Personal Devices not used (cell phone, radios other entertainment devises)

Hand/Power Tools

  • Guards/Safety Features in Place

  • Compressed Air Lines Secured

Haz Com

  • Employees Trained

  • SDS's Available to All

  • Containers Properly Labeled

Ladders

  • Properly Inspected

  • Properly Used (step ladders in open position, extension ladders tied off, 3 feet above landing, landing edge protected from damaging ladder)

  • Hoist Rope being used to lift items above, (Employees not allowed to carry items)

Mobile Equipment/Material Handling

  • Daily Inspections Completed and Documented

  • Operators Trained and Current

  • Seat Belts being Worn

Scaffolding

  • Set Up & Used Properly

  • Inspected Before Use

  • Proper Access

Insight

  • Site All Around Condition

  • Concerns

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.