• Pad

  • Location
  • Conducted on

  • Prepared by

  • Project Manager

  • Superintendent

  • Supervisor

  • Construction Operations

  • Production Operations

  • Midstream Operations


  • JSA, Permits to work, tailgate meetings; properly filled out?

  • First aid supplies and readily available?

  • Muster point and emergency egress identified

  • Manpower and equipment adequate for job?

Personal Protective Equipment

  • Hard hats, eye and face, hearing, fall protection, dress apparel, respiratory all adequate?


  • Walkways, stairs, cords, spills, restrooms and eating areas, trailer site/ conex, trash , debris, scrap organized?

Fire Extinguisher

  • Monthly inspected, pressure correctly, third party inspected, free of debris, extinguishers located at welders?

Material Handling and Storage

  • Stored properly, tag lines in place when lifting materials, safety latches on hoisting hooks, slings and chokers in good working condition, loose materials contained or palletized?

Tools/ small tools

  • Guards in place, double insulated tools, cords free of damage, plugs not missing ground pin, tools taken of of service, proper tools for the job, adequate tools for the job?

Welding and Cutting

  • Gas cylinders stored properly upright, caps in places of cylinders if not in use, welding leads free from damage, permits issued (if required), fire watch posted as needed, fire extinguisher located close to hot work?


  • Equipment properly grounded, lock out in used if needed, extension cords free from damage/ with ground pin in place. damage equipment taken out of service?


  • Ladders secured to landing, ladder extends 36 inches above top of landing, ladder has 4 to 1 slope, employees have 3 points contact at all times, employees hoisting equipment by rope instead of carrying tools?


  • Good working condition, trained employees only allowed to operate, employees tied off to man lift, using man lift properly?

Handrails and Hole Covers

  • Handrails properly secured at 42 inches + or - 3 inches, mid rails in place, hole covering in place with proper labeling (hole).

Excavation And Trenching

  • Excavations deeper then 5' (shored, sloped, benched), spoil piles kept safe distance away, back fill placed after work finshed, fencing and barricades in placed when need be.

Employee Communications

  • Do superintendents and supervisors communicate properly, do superintendents and supervisors address unsafe actions and conditions, are safety meetings held weekly with all employees?

  • Addition notes

  • Add signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.