Title Page

  • Conducted on

  • Week ending

  • Community

  • Prepared by

1. Community

  • Work areas properly signed and barricaded?

  • First aid suppplies readily accessible?

  • Are portable toilet facilities available at the site?

2. Housekeeping

  • General neatness of work area/job sites

  • Projecting nails removed of bent over?

  • Waste containers provided and used?

  • Passageways and walkways clear?

3. Fire Prevention

  • Phone no. of fire department posted?

  • "No Smoking" signs posted and enforced?

4. Electrical

  • Extension cords missing ground prongs or bare wires exposed?

  • Ground fault circuit interrupters being used?

  • Terminal boxes equipped with required covers?

  • Are flexible cords and cables protected from damage?

  • Are unused openings in cabinet boxes and fittings closed?

  • Are all cabinets, panels, and switches located in wet locations enclosed in weather proof enclosures

5. Hand, Power & Power Actuated Tools

  • Hand tools inspected regularly?

  • Gaurds in place on machines, such as saws?

  • Right tool being used for the job at hand?

  • Operators of power actuated tools are licensed?

6. Fall Protection

  • Safety rails and cables are secured properly?

  • Employees exposed to fal hazards are tied off?

  • Employees below protected from falling objects?

  • Employees using body belts for positioning devices only?

  • Are employees working more than 6' above a lower level protected by gaurdrails, safety nets, personal fall arrest system?

7. Ladders

  • Ladders extend at least 36" above the landing?

  • Ladders are secured to prevent slippnig, sliding, or falling?

  • Ladders with split or mising rungs taken out of service?

  • Stepladders used in fully open position?

  • No step at top two rungs of stepladder?

8. Scaffolding

  • All scaffolding inspected daily?

  • Erected on sound rigid footing?

  • Tied to structure as required?

  • Gaurdrails, intermediate rails, toeboards and screens in place?

  • Planking is sound and sturdy?

  • Proper access provided?

  • Employees below protected from falling objects?

9. Floor & Wall Openings

  • All floor or deck openings are planked over or barricaded?

  • Perimeter protection is in place?

  • Deck planks are secured?

  • Materials are stored away from edge?

10. Material Handling

  • Materials are properly stored or stacked?

  • Employees are using proper lifting methods?

  • Proper number of workers for each operation?

11. Concrete Construction

  • Employees are protected from cement dust?

  • Exposed skin covered?

  • Walls over 8' are supported?

  • Are all protruding reinforcing rods covered?

12. Personal Protective Equipment

  • Hard hats being worn?

  • Safety glasses being worn?

  • Respirators are used when required?

  • Hearing protection being worn when required?

13. Vehicles

  • Do vehicles or earth moving equipment with an obstructed view to the rear have backup alarm or used with an observer?

  • Do vehicles or earth moving equipment have seat belts and are they used?

14. Stairs

  • Are flights of stairs with 4 or more risers equipped with standard stair railings or handrails?

Violations or warnings given this week?

  • Violations, lot # and date

  • Warnings , lot # and date

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.