Pentagon Safety Inspection Report

• Owner Name

• Project Name

• Conducted on

  Date

• Prepared by

• Location
  Address

PROGRAM ADMINISTRATION

• 1.1 OSHA Postings / Permits<br>

  Yes

  No

  N/A

• 1.2 Safety manual - IIPP

  Yes

  No

  N/A

• 1.3 Weekly toolbox talks

  Yes

  No

  N/A

• 1.4 First aid kits

  Yes

  No

  N/A

• 1.5 Emergency action plan posted / up to date

  Yes

  No

  N/A

• 1.6 Fire extinguishers

  Yes

  No

  N/A

• 1.7 Hazardous Communication SDS

  Yes

  No

  N/A

• Notes

  Corrected

  Still needs corrected

• Drawing area

  Drawing

HOUSEKEEPING

• 2.1 Work areas orderly / Clean up

  Yes

  No

  N/A

• 2.2 Adequate lighting

  Yes

  No

  N/A

• 2.3 Stairways / Exits / walkways

  Yes

  No

  N/A

• 2.4 Break areas orderly / Water Stations / Shade / Cups

  Yes

  No

  N/A

• 2.5 Storage of materials / storage racks

  Yes

  No

  N/A

• 2.6 Impalement hazards / Rebar

  Yes

  No

  N/A

ELECTRICAL / UTILITY

• 3.1 Electrical panels / Lockout Tagout / Temporary power

  Yes

  No

  N/A

• 3.2 Electrical cords / Grounding

  Yes

  No

  N/A

HAND AND POWER EQUIPMENT

• 4.1 Power & Hand tools

  Yes

  No

  N/A

• 4.2 Machinery / Equipment / Guards

  Yes

  No

  N/A

EQUIPMENT

• 5.1 Forklift / Reachlift / Bobcat / Tractors

  Yes

  No

  N/A

• 5.2 Aerial lift - Boom lift & Scissor lift

  Yes

  No

  N/A

• 5.3 Cranes / Rigging / Hoisting / Pumping

  Yes

  No

  N/A

BARRICADES, FENCING AND FALL PROTECTION

• 6.1 Barricading / Traffic Control / Pedestrian & Sidewalk

  Yes

  No

  N/A

• 6.2 Warning signs

  Yes

  No

  N/A

• 6.3 Ladder access

  Yes

  No

  N/A

• 6.4 Floor / Wall / Roof openings

  Yes

  No

  N/A

• 6.5 Guardrails are set at 42-45 with a mid rail and uprights every 8 feet.

  Yes

  No

  N/A

• 6.6 Fall harness, lanyards, retractable and anchor points

  Yes

  No

  N/A

EXCAVATION / CONFINED SPACE

• 7.1 Excavations / Spoils / Access / Shoring<br>

  Yes

  No

  N/A

• 7.2 Dig Alert / Underground Utilities / Confined Space Entry

  Yes

  No

  N/A

SCAFFOLDING

• 8.1 All scaffolding erected is plum and level

  Yes

  No

  N/A

• 8.2 Proximity to high voltage power lines is safe

  Yes

  No

  N/A

• 8.3 Ladder access, Guardrails, crossbracing, planks, base plates, mud sills, and toeboards are in place

  Yes

  No

  N/A

• 8.4 Scaffolding is securely anchored at 3 to 1 vertically and every 30 feet horizontaly

  Yes

  No

  N/A

• 8.5 Daily documented inspections are being conducted by competent person

  Yes

  No

  N/A

ENVIRONMENTAL CONTROLS

• 9.1 Silt fencing maintained, drain protection, swpps inspections

  Yes

  No

  N/A

• 9.2 Hazardous materials stored properly / Spill clean up kits on site

  Yes

  No

  N/A

FIRE PREVENTION

• 10.1 Compressed gas cylinders / Propane secured- upright- protected from damage

  Yes

  No

  N/A

• 10.2 Fire extinguishers immediately available and inspection current

  Yes

  No

  N/A

• 10.3 Hot work permit posted / Welding, cutting and brazing

  Yes

  No

  N/A

PPE

• 11.1 Hard hats, Eye Protection, Face Protection, Work Boots, Hand protection, Hearing Protection, Reflective Vest & Clothing

  Yes

  No

  N/A

• 11.3 Respirators / Dust mask

  Yes

  No

  N/A

SUBCONTRACTOR VIOLATIONS

• Subcontractor Audit Violations

  Corrected

  Still needs corrected

• Add signature

  Sign

• Subcontractor Audit Violations

  Corrected

  Still needs corrected

• Add signature

  Sign

• Subcontractor Audit Violations

  Yes

  No

  N/A

• Add signature

  Sign

EMPLOYEE VIOLATIONS

• Employee Violation

  Yes

  No

  N/A

• Add signature

  Sign

• Employee Violation

  Yes

  No

  N/A

• Add signature

  Sign

SIGNATURES

• Add signature

  Sign

• Add signature

  Sign

• Yes

  No

  N/A