Perioidic Safety Inspection Report

• Document No.

• Project name:

• Site/Location:

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Conducted on:

  Date

• e-Builder Project Number (Format is CAP123456):

• Project Superintendent:

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Project Foreman:

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Prepared By:

  Select Yes No N/A

  • Yes
  • No
  • N/A

THE FOLLOWING IS A LIST OF SAFETY FOCUS ITEMS THAT HAVE A HIGH PRIORITY FOR COMPLIANCE. NON-COMPLIANCE DETAILS SHOULD BE NOTED IN THE EXPLANATION AND REQUIRE CORRECTION.

• Is required PPE being worn?

  Yes

  No

  N/A

• Are safe work practices being followed by CPFC employees?

  Yes

  No

  N/A

• Are subcontractors compliant with subcontractor performance safety standards?

  Yes

  No

  N/A

• Is the Project Safety Checklist correctly completed, posted, and signed by each subcontractor?

  Yes

  No

  N/A

• Is the Project Safety Check List accurate in identifying need for lockout/tagout in all applications?

  Yes

  No

  N/A

• Is the Project Safety Check List accurate in other areas of hazard identification?

  Yes

  No

  N/A

• Is lockout/tagout adequate in protection and identification (locked & tagged)?

  Yes

  No

  N/A

• Is energized electrical work adequately documented including a contingency plan and safe work practices being followed per plan?

  Yes

  No

  N/A

• Is the PCRA correctly filled out and posted on site?

  Yes

  No

  N/A

• Is the Infection Control Risk Assessment level accurate to risk and exposure level per site exposure?

  Yes

  No

  N/A

• Are ICRA/PCRA dust control measures in compliance?

  Yes

  No

  N/A

• Have ILSM been implemented?

  Yes

  No

  N/A

• Is there an inventory list and a Safety Data Sheets (SDS) for material on the project per company?

  Yes

  No

  N/A

• Are engineering controls, work practices, training and supervision adequate for asbestos exposures?

  Yes

  No

  N/A

• Are engineering controls, work practices, training and supervision adequate for lead exposures?

  Yes

  No

  N/A

• Are confined spaces identified and controlled by recordkeeping downgrading or by engineering, administrative or PPE controls per project requirements?

  Yes

  No

  N/A