PM Safety Inspection Form

• Project Number and Name

• Conducted on

  Date

• Prepared by

General

• Is the work site properly cordoned off with barricades, traffic barriers, cones, caution tape, and/or hoarding?

  Yes

  No

  N/A

• Are all openings in floors and walls through which people can fall protected?

  Yes

  No

  N/A

• Is adequate lighting provided on site?

  Yes

  No

  N/A

• Is a worker on their own following a check-in procedure?

  Yes

  No

  N/A

Housekeeping

• Are emergency exit path cleared of materials and debris?

  Yes

  No

  N/A

• Are work areas free of slip and trip hazards?

  Yes

  No

  N/A

• Are dust controls measures being used (vacuuming, water)?

  Yes

  No

  N/A

Site Notices

• Is a copy of the FAP posted on the work site?

  Yes

  No

  N/A

• Is a hot work permit displayed on site?

  Yes

  No

  N/A

• Are safety warning signs posted on site?

  Yes

  No

  N/A

• Are emergency telephone numbers posted?

  Yes

  No

  N/A

Security

• Are workers' security passes visible?

  Yes

  No

  N/A

• Is the jobsite secured so that unauthorized persons are not at danger from tools, equipment and materials?

  Yes

  No

  N/A

Personal Protective Equipment

• Are hardhats being worn?

  Yes

  No

  N/A

• Is protective footwear being worn?

  Yes

  No

  N/A

• Are reflective safety vests being worn?

  Yes

  No

  N/A

• Is eye or face protection being used?

  Yes

  No

  N/A

• Is hearing protection being used?

  Yes

  No

  N/A

• Is respiratory protection being used?

  Yes

  No

  N/A

• Is protective clothing being worn (coveralls, overalls, aprons)?

  Yes

  No

  N/A

• Are personnel using gloves when handling sharp, rough, hot, cold, or chemical materials?

  Yes

  No

  N/A

• Is fall protection being used (potential fall of 3m or more)?

  Yes

  No

  N/A

Clothing (General)

• Is the clothing of workers not too loose and not in danger of getting caught in something?

  Yes

  No

  N/A

• Are workers not wearing hoodies (potential for reduced peripheral vision if hood up)?

  Yes

  No

  N/A

Material and Equipment Movement

• Is a spotter being used?

  Yes

  No

  N/A

• Are workers wearing reflective safety vests?

  Yes

  No

  N/A

Lifts

• Are the bases of lifts cordoned off?

  Yes

  No

  N/A

• Are lift movement warning sounds functioning?

  Yes

  No

  N/A

Ladders

• Is the proper ladder for each job being used?

  Yes

  No

  N/A

• Are ladders in good condition (no missing or broken rungs)?

  Yes

  No

  N/A

• Are ladders placed on even ground?

  Yes

  No

  N/A

• Are the bases of ladders cordoned off?

  Yes

  No

  N/A

• If ladders are set up in front of a door, is the door open or locked?

  Yes

  No

  N/A

• Are step ladders fully open with locked spreader arms when in use?

  Yes

  No

  N/A

• If ladders are being used for accessing an area, are the tops of the ladders at least 1m above the landing?

  Yes

  No

  N/A

• Are ladders tied off or secured at the top?

  Yes

  No

  N/A

• Are ladders within appropriate reach of the work?

  Yes

  No

  N/A

Scaffolding

• Is scaffolding erected on a firm and substantial surface?

  Yes

  No

  N/A

• Are scaffolds fully planked?

  Yes

  No

  N/A

• Are toeboards and guardrails in place on scaffolding?

  Yes

  No

  N/A

• Do rolling scaffolds have locking wheels that are locked when occupied?

  Yes

  No

  N/A

Swingstages

• Are workers wearing harnesses?

  Yes

  No

  N/A

• Are swing stages connected to anchors approved by a structural engineer?

  Yes

  No

  N/A

• Are toe boards and handrails in place?

  Yes

  No

  N/A

Tools

• Are shields/guards on tools being used?

  Yes

  No

  N/A

• Are cords in good condition not frayed, damaged or missing ground pins?

  Yes

  No

  N/A

Electrical

• Is a signaller/spotter being used for overhead power lines?

  Yes

  No

  N/A

• Are all switch panels and devices that are energized marked and guarded to prevent accidental contact?

  Yes

  No

  N/A

• Are lockout devices used on all circuits that could become energized while work is being performed?

  Yes

  No

  N/A

• Are extension cords being correctly used? (They are not fastened with staples, hung from nails, or suspended by wire.)

  Yes

  No

  N/A

• Are extension cords not damaged, frayed, missing ground pins, and are of the three wire type?

  Yes

  No

  N/A

Traffic Controls

• Are traffic control personnel in place?

  Yes

  No

  N/A

• Are traffic control personnel using stop/slow signs?

  Yes

  No

  N/A

• Are lowered speed limits posted and being observed?

  Yes

  No

  N/A

Trenching and Excavation

• Have underground utilities been marked off with flags?

  Yes

  No

  N/A

• Have control zones been established by the contractor in which non-destructive exposure techniques (hand excavation, hydrovaccing) will be used?

  Yes

  No

  N/A

• Are all trenches and excavations barricaded?

  Yes

  No

  N/A

• Is all excavated material being stored away from the edge of the trenches/excavations?

  Yes

  No

  N/A

• Has the sloping, shoring, and worker access/exits for the trenches/excavations been inspected by a Professional Engineer hired for the project?

  Yes

  No

  N/A

• Other Notes

• Add media

  Media