• A. Are JSA (Job Safety Analysis) reviewed and signed?

  • B. Are WTSR (Work Task Safety Requirements) for each job?

  • C. Is the Water Blast Checklist being completed and followed?

  • D. Is the Wet/Dry Vacuuming Checklist being completed and followed?

  • E. Is the EH&S checklist being completed and followed?

  • F. Are crew leaders / supervisors identified with White Hard Hats?

  • G. Are any incidents being discussed?

  • H. Are meaningful observations being completed?

  • I. Other


  • A. General Housekeeping

  • B. Walking - Working Surfaces

  • C. Unprotected Sides or Holes

  • D. Restrooms identified and available? Trash cans present?

  • E. Material Storage/Lay Down


  • A. OSHA Posters<br> 300A during Feb 1st thru April 30th

  • B. Emergency Evacuations Plans / Maps / Muster points posted

  • C. Emergency Contacts List


  • A. Hard Hats

  • B. Safety Glasses with Side Shields

  • C. Face Shield / Goggles (If Required)

  • D. Respiratory Protection (If Required)

  • E. Hearing Protection (If required)

  • F. Clothing (FRC etc. if required)

  • G. Gloves

  • H. Foot Protection


  • A. Trained Personnel (Competent Person)

  • B. Worn Properly

  • C. Suitable Anchorage Points

  • D. Inspected/Color Coded

  • E. Stored Properly

  • F. Emergency High Angle Rescue Plan


  • A. Base/Footing/Set Up

  • B. Inspections/Color Coded

  • C. Proper Type for Task


  • A. In Good Condition

  • B. Inspected/Color Coded

  • C. Whip-Checks

  • D. Water Blast Guns with shrouds?

  • E. Are Foot Pedals with Carbon Steel fittings?


  • A. Trained Personnel (Competent Person)

  • B. Attendant Trained

  • C. Entrants Trained

  • D. Attendant has means to summon rescue

  • E. Attendant completing the Sign In/Out Sheet

  • F. Permit Required

  • G. Permit Followed

  • H. Air Monitoring

  • I. Emergency Rescue Plan


  • A. G.F.C.I.'s

  • B. Extension Cords

  • C. Power Tools

  • D. Lock Out/Tag Out


  • A. Capacity Tags

  • B. Hooks and Latches

  • C. Chain falls/Come-a-longs

  • D. Tag Lines

  • E. Inspected/Color Coded


  • A. Trained Personnel (Competent Person)

  • B. Hand and Mid-rails, Toeboards

  • C. Platform Decked/Secured

  • D. Level Footing/Set up

  • E. Access/Egress

  • F. Away from Powerlines

  • G. Barricades

  • H. Inspection/Tagged Correctly


  • A. Equipment Inspections

  • B. Operator Qualified and Certified

  • C. Operator Manual

  • D. Flagman with Vest

  • E. Proper setup and use


  • A. MSDS on Site

  • B. MSDS for all Chemicals on Site

  • C. Proper Storage of Chemicals

  • D. Proper PPE for Handling Chemicals


  • A.

  • B.

  • C.

  • D.


  • Suggested corrective actions

Sign Off

  • Health and Safety Representative

  • Account Manager

  • Field Supervision / Supervisor

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