Project Name & Number


  • Daily JSA forms for each crew available for review?

  • Weekly Tool Box talk conducted and signed by crew?

  • First aid kit stocked?


  • Adequate number of toilets available and clean?

  • Trash being removed daily?

  • Job site swept clean and free from related trash and debris?

  • Walkways and passages clear to walk?

Personal Protective Equipment

  • Employees wearing safety glasses at all times?

  • Employees wearing company issued safety vest?

  • Employees wearing hard hats?

  • Employees wearing gloves when exposed to cut/chemical hazards?

  • Employee wearing hearing protection?

  • Employee wearing face shield?

  • Respiratory Protection worn by employees when required?


  • GFCI protection in use on all temporary power sources?

  • Extension cords in good condition?

  • Plug ends in good shape?

Hand and Power Tools

  • Power Tools free from damage (switches, cords, and guards)?

  • Crew member carrying certificate to operate powder actuated tool?

  • Hand tools free from damage ( shaft, head, splinters, etc.)?

  • Dustless attachment in use?


  • Have utilities been located and protected?

  • Adequately sloped or shored if below 5' in depth?

  • Means of egress every 25 feet?

  • Spoil pile and equipment back at least 2 feet from edge?

  • Water being pumped out if present?

  • Documented daily inspection available for review?

Fall Protection

  • Employees using anchor capable of supporting 5,000 lbs?

  • Elevated work levels have guardrails or cables at 21" and 42"?

  • Is leading edge well defined and warning system in place at 15'?

  • Is employee wearing 100% fall protection when working outside 15' warning line and anchored to 5000 lb. anchorage?

  • Employees working above 6 feet using 100% fall protection?

  • All holes covered and labeled?

Fire Protection

  • Only NFPA approved containers used for fuel?

  • Flammable fluids stored in fire cabinet?

  • Are ABC fire extinguishers available and strategically place?

  • Adequate number of fire extinguishers in place?

  • Are fire extinguishers fully charged?


  • Do extension or job built ladders extend 36 inches above landing?

  • Are ladders tied off at top?

  • Are spreader bars locked on step ladders?

Powered Industrial Equipment

  • All equipment have ROPS installed?

  • Back up alarm working on on equipment?

  • Operator wearing seatbelt?

  • Operator have training card available for forklift, Aerial Boom Lift?

  • Employees wearing fall protection when using aerial lift?


  • Mudsill, base plate, and Screwjack in place?

  • Guardrails, Midrails and Toeboards installed?

  • Ladder access provided for employees on all working levels?

  • Rolling scaffold wheels locked?

Hot Work

  • Fire extinguisher available and inspected?

  • Gas cylinders separated when not in use?

  • Gas cylinders secured from falling over?

Dustless Engineering

  • Are dustless attachments being used for angle grinders?

  • Can fans be used to direct dust away from employee?

  • Is the public protected from dust exposure?

  • Is wet method to control dust being used?

  • Is floor sweep being used to control airborne dust when sweeping?

On Site Management Review

  • Superintendent signature

  • Safety Director signature

  • Foreman Signature

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