Information

  • Project/Job #

  • Project/Job

  • Conducted on

  • Prepared by

  • Location
  • Personnel

BEHAVIOR

  • TSSP reviewed and signed?

  • TSSP for each task?

  • Mentors Assigned

WORK AREAS

  • General Housekeeping

  • Dust Control (i.e. carpenter's shed)

  • Walking - Working Surfaces

  • Impalement Hazards

  • Sanitary Facilities

  • Trash Receptacles

  • Material Storage/Lay Down

JOB SITE POSTERS

  • All OSHA Required Posters

  • Emergency Evacuations

  • Emergency Contacts List

HEALTH/FIRST AID

  • CPR/First AidTraining

  • First Aid Kit (No Expired Items)

  • Eye Wash Facilities

  • Access to Eye Wash

  • AED inspected

PERSONAL PROTECTIVE EQUIPMENT

  • Safety Glasses with Side Shields

  • Face Shield / Goggles (If Required)

  • Hearing Protection (If required)

  • Clothing (Welding Leathers, Hi-Viz, etc. if required)

  • Gloves

  • Foot Protection

FALL PROTECTION

  • Worn Properly

  • Suitable Anchorage Points

  • Inspected/Color Coded

LADDERS

  • Base/Footing/Set Up

  • Inspections/Color Coded

  • Proper Type for Task

HAND AND POWER TOOLS

  • In Good Condition

  • Inspected/Color Coded

  • Whip-Checks

  • Machine Guarding

ELECTRICAL

  • G.F.C.I.'s

  • Extension Cords

  • Power Tools

  • Lock Out/Tag Out

FIRE SAFETY

  • Fire Extinguisher/Inspected

  • Combustibles removed/isolated

  • Hot Work Barricade (if required)

  • Gas Can(s)

  • Fire Extinguisher w/in 50'of portable fuel storage

  • Portable fuel storage secured

RIGGING AND HOISTING

  • Capacity Tags

  • Hooks and Latches

  • Tag Lines

  • Qualified Rigger

  • Stored Properly

  • Damage

EQUIPMENT

  • Equipment Inspections completed

  • Operator Qualified and Certified

  • Spotter (if necessary)

  • Proper setup and use

  • LOTO/Equipment Maintenance

HAZCOM

  • SDS for all Chemicals on Site

  • Proper Storage of Chemicals

  • Proper PPE for Handling Chemicals

OTHER

  • A.

  • B.

  • C.

  • D.

Comments/Recommendations

  • Enter any corrective actions that will be undertaken

Sign Off

  • Safety Representative

  • Production Leader

  • OSC Rep / Others

  • OSC Rep / Others

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.