Information
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Project
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Foreman
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Conducted on
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Prepared by
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Location/Address
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Weather
Administrative
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Describe any outstanding items from the previous survey?
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Review daily tailboard talk/pre-task plan
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Project JHA/HASP signed and clinic directions posted
Personal Protective Equipment
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Safety Glasses
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Gloves
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High-Visibility Vest
Material Handling & Ergonomics
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Material Handling Aids Utilized (forklifts, carts, etc)
Electrical
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GFCI Inspections Current
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Enclosures Intact
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Cord & Cable Condition - ground prong intact, no cuts in the outer jacket, cords not pulling free from the plug ends.
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Temporary Lighting - lights are lit, cages closed/installed, adequate light
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LOTO & Electrical Safe Work Practices
Walking & Working Surfaces
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Housekeeping
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Access/Egress - pathways clear and uncluttered. No tripping hazards.
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Holes Covered
Ladder Use
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Stepladders- inspect, spreaders locked
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Extension Ladders - inspect, proper angle, tied off
Fall Protection
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Guardrails
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Personal Fall Arrest System
Fire Protection
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Fire Extinguishers - present and inspected
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Hot Work Procedures
Employee Health
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Dust Control
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Sanitation
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First Aid Kit (Available, correct size, stocked)
Employee Interactions
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Employee name:
Aerial Lifts & Summary
Aerial Lifts
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100% Fall protection
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Verify Operator Qualification
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Equipment grounds installed, where applicable
Summary / Comments / Pictures
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Comments:
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Positive Observation:
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Other Project Hazards (caused by others)
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Follow Up Actions
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Overall Grade: Excellent - no deficiencies noted, Good up to 3 minor deficiencies, Needs Improvement more than 3 minor or one major deficiencies
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Pictures
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I have reviewed the results of this Safety survey.
