OSHA Compliance Inspection

• Job Name

• Job Number

• Report Date (YYYYMMDD)

• Superintendent

• Project Manager

• Location
  Address

PRE-INSPECTION

• Who did the inspector first contact at the jobsite? (Name and Position)

• Did Compliance Officer show his/her credentials?

  Yes

  No

• Attach copies of the Compliance Officer's credentials to this report.

  Yes

  No

• Give a brief explanation why no credentials are attached.

Credentials

• Compliance Officer's credentials

  Media

• Inspector's Name. (List all inspectors, if more than one)

• Was the Corporate Office contacted?

  Yes

  No

• Who, from the Corporate office, was contacted?

• Was the Safety Manager contacted?

  Yes

  No

• Name of Safety Manager that was contacted.

OPENING CONFERENCE

• List who was present at the Opening Conference.

Person

• Full Name - Company Name - Position

  Sign

• Purpose of visit (attach a copy of written complaint, if applicable)

  Select Imminent Danger Fatality / Catastrophe Complaint Referral Prgrammed Follow-up Records

  • Imminent Danger
  • Fatality / Catastrophe
  • Complaint
  • Referral
  • Prgrammed
  • Follow-up
  • Records

• Was there a complaint filed?

  Yes

  No

• Did Corporate office get a copy of the complaint? (If so, attach the copy to this report. If not, ask the Inspector for a copy)

  Yes

  No

• Photo of complaint

  Media

• Was there a search warrant served? (Attach the search warrant to this report)

  Yes

  No

• Photo of search warrant

  Media

• Did the Compliance Officer request to review records?

  Yes

  No

• List what was requested and what was reviewed. If items were requested and were not reviewed, explain why.

Request

• Requested:

• Reviewed?

  Yes

  No

  N/A

• Comments:

• Were employees selected to be interviewed with the Compliance Officer during opening conference?

  Yes

  No

• How many employees were interviewed?

• List employees selected, employee companies, and craft represented.

Employee

• Employee Name - Company Name - Trade

  Sign

THE INSPECTION

• List who was present during the Inspection Process.

Person

• Employee Name - Company Name - Position

  Sign

• Were pictures taken? (If so, attach the photograph log to this report)

  Yes

  No
Photo

• Inspection Photo

  Media

• Were any portions of the job-site shut down?

  Yes

  No

• List areas shut down, why they were shut down, and for how long.

Photo

• Add media

  Media

• Were "red tags" used?

  Yes

  No

• Describe what was "red tagged", why, and for how long.

• List any employees that were talked to by the Compliance Officer and what Company they worked for.

Person

• Employee Name - Company Name

  Sign

• NOTE: YOU ARE NOT ALLOWED TO ASK THE EMPLOYEE WHAT THEY DISCUSSED WITH THE COMPLIANCE OFFICER.

• Other comments that should be noted as being discussed during the inspection.

• Were the interviews videotaped or tape recorded?

  Yes

  No

  N/A

CLOSING CONFERENCE

• List who was present during the Closing Conference.

Person

• Employee Name - Company Name - Position

  Sign

• Were alleged violations of standards discussed?

  Yes

  No

• List alleged violations.

Alleged Violation

• Alleged violation:

• Type?

  Serious

  Non-Serious

• Did the Compliance Officer give any indication of future OSHA inspections (required or otherwise)?

  Yes

  No

• List comments from CO.

• Additional Comments:

• Signature of Safety Manager

  Sign

• Signature of Superintendent or Project Manager

  Sign