Information
-
Project
-
Project Manager
-
Group
-
Foreman
-
Conducted on
-
Prepared by
-
Location/Address
-
Weather
-
Response Key: SAFE - item inspected and found to be satisfactory, IC - (Immediately Corrected) - item inspected and found to be not in compliance, but was immediately corrected, NC - (Not Compliant) - Item was inspected and found to be not in compliance and could not be immediately corrected.
Administrative
-
Review daily tailboard talk/pre-task plan
-
Project JHA/HASP signed and clinic directions posted
Personal Protective Equipment
-
Safety Glasses
-
Gloves
-
High-Visibility Vest
Material Handling & Ergonomics
-
Material Handling Aids Utilized (forklifts, carts, etc)
Electrical
-
Employees not exposed to unprotected energized circuits
-
Electrical receptacles/outlets have approved covers/faceplates.
-
Signs - posted to restrict access to locations with exposed live parts
-
GFCI Inspections Current
-
Enclosures - cabinets intact, no knockouts missing or other open holes, panels effectively enclosed
-
Enclosures - Breakers/Switches legibly marked to indicate purpose
-
Enclosures - proper clearances are maintained in front of and around electrical panels
-
Enclosures - Conductors entering panels and boxes are protected from abrasion
-
Cord & Cable - Cords protected & kept clear of work areas and walkways.
-
Cord & Cable - ground prong pin attached to electrical cords
-
Cord & Cable - flexible cords not daisychained
-
Is there Temporary Lighting on the project?
-
Are Light bulbs are protected from accidental breakage
-
Do all sockets have bulbs installed?
-
Light strings are not suspended by the electric cord.
-
LOTO & Electrical Safe Work Practices
-
Ask at least one random employee if they have a lock for performing LOTO.
Walking & Working Surfaces
-
Housekeeping
-
What was the housekeeping issue?
-
What is the issue and who is responsible for correcting it?
-
Access/Egress - pathways clear and uncluttered. No tripping hazards.
-
Holes Covered - covers need to support twice the intended load, be marked "Hole" and be secured in place to prevent accidental displacement
Ladder Use
-
Are ladders in use on this project
-
Extension Ladders - inspect, proper angle, tied off
-
Step ladders - inspect, spreaders locked, proper use, etc.
Tool & Equipment Use
-
Tools used to accomplish the work are being used in accordance with the manufacturer's instructions. For example, cordless 1/2" drills have side handles attached during operation, cordless band saws are being operated with two hands, inspected before use, right tool for the job, etc.
Fall Protection
-
Guardrails
-
Personal Fall Arrest System
Fire Protection
-
Fire Extinguishers - present and inspected
-
Hot Work Procedures
Employee Health
-
Dust Control
-
Sanitation - Port-O-Lets accessible, adequate number, hand sanitizers and clean
-
First Aid Kit (Available, correct size, stocked)
Employee Interactions
-
Employee name:
-
Employee Encounter
Aerial Lifts & Summary
Aerial Lifts
-
Are there aerial/scissor lifts at this site?
-
100% Fall protection
-
Please contact site supervisor via Action.
-
Verify Operator Qualification
-
Equipment grounds installed, where applicable
Summary / Comments / Pictures
-
Comments:
-
Positive Observation:
-
Other Project Hazards (caused by others)
-
Follow Up Actions
-
Pictures
-
I have reviewed the results of this Safety survey.
