Information

  • Add location
  • Job-site Name and Number

  • Conducted on

  • Prepared by:

  • Superintendent Onsite

General Items

  • Are all work areas pertaining to our work satisfactory on housekeeping?

  • Is combustible scrap, debris and waste stored safely and removed from the worksite promptly?

  • Are mandatory posting requirements provided and visible at the job site?

  • Are Daily Job Hazard Analysis (Pre-Task Plan) being completed?

  • What areas if found not completed?

  • If found area did not have completed Pre-Task Plan (JHA) and was stated to conduct one before proceeding any further, did employees follow the proper steps and conduct the PTP?

  • Are all Pre-Task Plans turned in on time? If not then state what companies and or crews.

  • How many were submitted late?

  • Are all other documents to your knowledge being submitted in a timely manner?

  • Are emergency phone numbers posted?

  • Are occupational injuries or illnesses, except minor injuries requiring only first aid, recorded as required on the OSHA 300 log?

  • Is the scrap material piled together through-out the site

  • Is the OSHA 300 log posted and visible on the months of February, March, and April?

  • Is a first aid log up to date with minor injuries?

  • Is a first aid kit stocked, and easily accessible to employees?

  • Adequate trash containers provided?

  • Any protruding/impalement objects exposed?

  • Is there an eye-wash station or sink available for quick drenching or flushing of the the eyes and body?

  • Are portable drinking containers provided for employees on the job site?

  • Are walkways kept clear and identified if in need?

  • Are changes of direction or elevations readily identifiable?

  • Are proper barricades being used per the task ( Caution/Danger)

  • Is proper contact information placed on the barricade?

  • When lasers are in use has all proper signage and warnings been displayed?

  • If not then has the issue been addressed and immediately corrected? Explain.

Additional information

  • Any additional information:

Personal Protective Equipment

  • Are all employee's wearing safety glasses 100% of the time on the job-site?

  • How many are found to be hazardous.

  • Add detail

  • Are all safety glasses Z87 rated?

  • Are all employee's wearing suitable gloves pertaining to their task?

  • How many are found?

  • Are employee's wearing hard-hats at all times on the job-site?

  • Are any of the employee's hard-hats visibly damaged or in need of replacement?

  • N-95 Dust Mask/ respirators being used with a voluntary use of a disposable respirator filed and signed?

  • Are control measures put in place such as fans, water, and vacuums to contain/control/reduce dust particle exposure to employee's and the environment?

  • Reflective Vests or high visibility shirts worn on-site

  • Hearing protection worn if in need at high noise levels?

  • Leather work boots and Steel toe protection if using tamps?

  • Face shields worn on all needed tasks such as welding,cutting, or a possible splash of harsh chemicals?

  • If hazards or the likelihood of hazards are found, are Supervisors and Foremen selecting appropriate and properly fitted PPE suitable for protection from these hazards and ensuring that affected employees use it?

  • Have both the Supervisor and the employees been trained on PPE procedures, i.e., what PPE necessary for job task, when workers need it, and how to properly wear and adjust it?

  • Are appropriate procedures in place to dispose of or decontaminate PPE contaminated with, or reasonably anticipated to be contaminated with, blood or other potentially infections materials?

Additional information

  • Any additional information:

Fire Protection

  • Safety cans are used to store gasoline or diesel? (Plastic cans are prohibited on the job-site).

  • Are cans properly labeled with what it contains? (Glue, Primer, Mixed GAS, etc.)

  • Are fire extinguishers provided for every 3,000 square feet of protected space?

  • Are fire extinguishers available for all areas? (Fuel containers on-site, fuel storages, all equipment on-site, etc.)

  • Are all the requirements met on labeling and protecting storage areas such as "no smoking signs" and a berm around the tanks?

  • Propane is not stored inside?

  • Hoses are not exposed to damage?

  • Propane storage areas have "No Smoking" signs posted and are barricaded by high visible fencing?

Additional information

  • Additional information:

Welding, Cutting, and Compressed Air

Hot Work

  • Are Hot Work area being conducted properly?

  • Are Hot Work Permits needed to do the task?

  • Is a 20 lb. fire extinguisher present for the job task?

  • Are the permits filled out and approved prior to conducting the work?

  • Are flashback arrestors installed on the hose/cylinders?

  • If arc welding activities are being performed, screening is provided to shield arc?

  • Are all objects subject to being caught on fire by the heat source away from the designated area?

  • Source containers (Oxygen/Acetylene) are labeled?

  • Are gauges and hoses free of defects?

  • Are welding leads for arc welding not damaged or repaired 10 feet from the end of the lead.

  • Are fire blankets necessary for the task being conducted?

Storage

  • Are containers (Oxygen, Acetylene, etc.) labeled?

  • Are they damaged in any way that warrants a removal from service tag?

  • When being stored, Oxygen cylinders are separated from combustible cylinders and materials by 25ft.

Compressors

  • Are compressed gas cylinders regularly examined for obvious signs of defects, deep rusting, or leakage?

  • Are air compressors equipped with pressure relief valves and pressure gauges?

  • Are employee's strictly prohibited from directing compressed air towards a person and if used for cleaning purposes trained to reduce the pressure to less than 10 pounds per square inch?

  • Are safety chains or other suitable locking devices used at couplings of high-pressure hose lines where a connection failure would create a hazard?

Fire Watch

  • Was the Fire Watch for the Hot Work present for the required time? (Duration plus 30 minutes)

  • Was a Monitor present one hour after Hot Work has been completed?

  • Is a 35 foot radius being monitored from the Fire Watch surrounding the Hot Work being conducted?

Additional information

  • Any additional information:

Electrical

  • Is the Assured Ground Program being implemented by all subcontractors including ASP.

  • Checkbox those that have issues.

  • FitzGerald

  • Amin/R.F. Knox

  • F&S Mech

  • Peachtree Mech

  • Tebarco Mechanical

  • SSMC/BHW

  • JCI/New Energy/Kilcrease

  • Vulcan

  • Alpha

  • ASP

  • Other

  • Did the companies conduct their inspection on the needed cords and power tools after being noticed and discussed?

  • If not, then what company or companies are needed to be addressed and corrected immediately?

  • Are 3-wire construction grade cords being used that are free of damage or defects?

  • Have safety measures been removed from the power tools and or equipment?

  • When found did employees take them out of service?

  • Are Ground Fault Circuit Interruptors being utilized for all power tools and equipment?

  • Panel box is provided with a cover. No knockouts or blanks are missing from panel.

  • Are cords being suspended?

  • If overhead power lines exist, have measures been taken to address the hazard.

Lock Out / Tag Out

  • Did you observe or been informed of a Lock-out Tag-out procedure occurring today?

  • List Authorized Employees doing the task

  • Have all employees been trained in the procedure being conducted?

  • Name who has not received training and from what company.

  • Do authorized employees know the location of the written procedure?

  • Do authorized employees have access to the procedure?

  • Have affected employees been notified when the procedure is being used?

  • Did each authorized employee lock out all energy sources?

  • Does this procedure involve group lockout/tag out?

  • Did the authorized employees verify that the equipment was de-energized?

  • Did authorized employees follow the lockout/tag out procedure?

  • Does the lockout/tag out procedure adequately protect employees?

  • List and describe the deficiencies requiring corrective action.

  • Did the foreman review will all authorized and employees their responsibilities under the procedure? Note: A review can be accomplished by meeting with employees with the Pre-task

Additional information

  • Any additional information?

Scaffolding

  • Did you observe a scaffolding operation or inspect a scaffold?

  • Does a competent person exist?

  • Name of competent person:

  • Safe access is providing at all working levels.

  • Guardrails are provided on working levels 10ft or more in height.

  • Bases are provided on scaffold frame legs and mudsill (2 X 10 minimum)

  • Working platforms are fully planked.

  • Scaffolds are anchored properly?

  • Guardrails are maintained at loading area.

  • Are scaffolds being inspected prior to use?

  • Components free of damage or defects

  • Scaffolds secure from any danger (Electrical, foundation issues, etc.)?

Additional information

  • Add additional information.

Fall Protection

Guardrails

  • Guardrails provided and structurally sound.

  • Are guard rails set at the appropriate height in the working area being the Top rail ( 42 inches high + or - 3 inches)?

  • Are guard rails set at the appropriate height in the work area being the mid-rail ( 21 inches + or - 3 inches)?

  • Are the guard rails set at the appropriate heights in the working area being a Toe-board (3 1/2 inches tall supporting 50 pounds)?

  • If guardrails are removed, is there a barricade established at least 15 feet away?

Holes

  • Floor holes are covered, secured and labeled "HOLE" or "COVER"

  • Are floor hole covers able to support twice the intended load?

  • Are all floor hole covers placed correctly and serving their purpose protecting and covering the hole?

  • Wall openings temporarily covered or guard railed?

Personal Fall Arrest Systems

  • Fall arrest systems properly implemented.

  • Upcoming fall hazards addressed and planned for future proceedings.

  • Are personal fall arrest systems being properly used?

  • Has the individual using fall protection been properly trained?

Additional information

  • Any additional information?

Fall Protection Equipment

  • Did you observe any fall protection equipment in use?

  • Netting if used checked daily

  • Body Harnesses approved for use in the field

  • Drop Nets installed and used correctly

  • Lanyards approved for use in the field

  • Is every retractable inspected and approved for use in the field

  • If Rope and Rope Grabs are used have they been inspected and approved

  • Are the Concrete anchors inspected, installed, and used properly

  • If Dyna-lines are used, are they installed and used correctly

  • Any other Fall Protection Equipment: Inspected, installed, and used properly?

  • Name other Fall Protection Equipment?

Additional information

  • Any additional information?

Tools / Power Tools

  • Guards are provided for tools?

  • Guards are not being rigged and checked regularly?

  • Are Ground Fault Circuit Interrupters being utilized for all power tools and equipment?

  • Tools being used are free of damage or defects?

  • Are power tools including double insulated found to have no damage or defects?

  • Are the proper tools being used for the job task?

  • Are cords on the tool free from damage?

  • Are broken or fractured handles or hammers, axes, sledge hammers and similar equipment removed/replaced promptly?

  • Are hand tools, such as chisels, punches, etc., which develop mushroomed heads during use, reconditioned or replaced?

  • Is all machinery and equipment kept clean and properly maintained?

  • Is equipment and machinery securely placed and anchored to prevent tipping or other movement that could result in personal injury?

Powder Actuated Tools

  • Are employees who operate powdered actuated tools trained in their use and required to carry valid operator's card?

  • Are powdered actuated tools left unloaded until they are ready to be used?

  • Are powdered actuated tools inspected for obstructions or defects each day before use?

  • Are methods provided to protect the operator and other employees in the machine area from hazards created at the point of operation, ongoing nip points, rotating parts, flying chips, and sparks?

Additional Information

  • Any additional information?

Motor Vehicle and Heavy Equipment

  • Are Operators wearing seatbelts?

  • Has the Operator performed and documented inspection prior to use?

  • Are the Operators qualified or authorized by their employer with proper training to operate the equipment (Forklift/Lull, Aerial Lift, Scissor Lift, Excavator,Skid Steer, etc.)?

  • Are aisles or walkways that pass near moving or operating machinery, welding operations, or similar operations arranged so employees will not be subjected to potential hazards?

  • Are Spotters used when needed?

Roadways and Traffic

  • Are flagmen properly trained for DOT regulations and have the qualification/certification up to date to perform the task?

  • Are proper PPE worn for the task?

  • Are proper communication methods taking place when directing traffic?

  • Are paddles at the proper height for visibility?

  • Are manhole covers, trench covers and similar covers, and their supports designed to carry a truck rear axle load of at least 20,000 lbs. (9,072 kilograms) when located in roadways and subject to vehicle traffic?

Scissor Lifts

  • Has the Pre-Start Scissor Lift Inspection Log been conducted for all Scissor Lifts approached and used by the personnel?

  • If not then state what company and the employee operating the lift.

  • Are there any recognized issues while observing the lifts operation?

  • Is a barricade or spotter used when needed during operation?

Aerial Lifts (Boom Lifts)

  • Has the Pre-Start Aerial Lift Inspection Log been conducted for all Aerial Lifts approached and used by personnel?

  • If not then state what company and the employee operating the lift?

  • Are there any recognized issues while the lift is being operated?

  • Is a barricade or spotter used when needed during operation ( Includes under the basket)?

ForkLifts

  • Are personnel conducting free-rigging?

  • Is there an attachment available if free rigging is being conducted?

  • Has the issue been resolved?

Additional Information

  • Any additional information?

Cranes

  • Did you observe a Crane operation today pertaining to our work?

Cranes

  • Crane Operators are licensed with the state and or local jurisdiction?

  • Crane Inspection Log kept up to date with routine inspections?

  • Is the manual on-site?

  • Accessible areas within the swing radius of the crane barricaded to prevent employee / pedestrian access/exposure?

  • Did you observe a Rigging operation in any manner?

Qualified Rigger / Signal Person

  • Is an illustration of ANSI hand signals posted at the job-site?

  • Are the personnel rigging and signaling the load qualified?

  • Is there clear communication with the Operator?

  • Are the slings, spreaders, and any shackles used for rigging inspected before being used on the job-site?

  • Are the safety latches inspected and satisfactory?

  • Is the one eye per hook method being implemented?

  • Are tag-lines being used on every load?

  • Is a warning sound blown on every load?

  • Any additional information on this subject?

Additional information

  • Any additional information?

Excavation

  • Did you witness any Excavation activities today?

  • Is the underground installation accounted for by contacting the known local number?

  • Is a competent person for excavations on-site?

  • Name of competent person:

  • Is there safe access / egress provided from the excavation and travel distance is not exceeding 25 ft

  • Are daily inspections along with change due to subject matters such as rain being conducted by a competent person?

  • If not are proper procedures being taken to address and correct the hazard?

  • Is the excavation or trench free of water?

  • Is the excavation sloped or shored properly as per the soil type (Solid Rock, Type A., Type B., Type C.)?

Trench Box

  • Was a trench box involved with this excavation?

  • If a trench box is being used is it a manufactured design?

  • Is documentation provided on how to properly install and the designed strength?

  • Has proper training been conducted ?

Additional information

  • Any additional information?

Outriggers

Outrigger

  • Did you observe an Outrigger or a trade of ours using a outrigger?

  • Are guardrails installed on all three exposed sides?

  • Are CAZ signs with the line up to prevent unauthorized personnel?

  • Is the area the Outrigger is moving from and next expected area barricaded to prevent unauthorized personnel?

  • When and if relocating are Spotters on the ground with area barricaded?

Additional information

  • Any additional information?

Ladders / Stairways

Ladders

  • Is the ladder Inspected prior to use (Inspection Tag)?

  • Are ladders free from damage or any defects?

  • Are landing platforms secure and free from any damage or defects?

  • Are step ladders fully open when in use?

  • Are all ladders the proper size for the task and used correctly?

  • Are ladders secure at the top and the bottom?

  • Are side-rails extending 36 inches above the landing platform?

  • Is there a clear access / egress to all ladders?

  • Are offset guardrails at the ladder way?

  • Top step of ladder(s) are not being used to work from?

  • Are all labeling on ladders accounted for and legible?

  • Ladders are being used as they are designed. Planks are not supported at both ends by ladders to create a work platform?

  • If exposed to a fall hazard, is the worker using proper fall protection?

Stairway

  • Stairs

  • Do standard stair rails or handrails on all stairways have at least four risers?

  • Are stairways at least 22 inches wide (55.88 centimeters)?

  • Are steps slip resistant?

  • Are stairway handrails located between 30 inches and 34 inches above the leading-edge of stair treads?

  • Do stairs have landing platforms not less than 30 inches (76.20 centimeters) in the direction of travel and extend 22 inches (55.88 centimeters) in width at every 12 feet (3.6576 meters) or less of vertical rise?

  • Are stairway handrails capable of withstanding a load of 200 lbs. applied within 2 inches of the top edge in any downward or outward direction?

  • Do stairway landings have a dimension measured in the direction of travel at least equal to the width of the stairway?

  • Are the access entry and exit ways clear for safe entry and exiting?

  • Do stairs angle no more than 50 degrees and no less than 30 degrees?

Additional information

  • Any additional information?

Confined Space

  • Did you observe or go over a confined space operation?

  • Is a permit completed before any other steps?

  • Are rescue measures in place?

  • Is an air monitor used to check the air in the confined space prior to entry?

  • Is there proper access into the area?

  • Are Spotters used to check employees in the area?

  • Is there clear communication for if any issues rise?

  • Is the atmosphere in the confined space being continuously monitored?

  • Is there proper ventilation?

Additional information

  • Any additional information?

Additional Issues

  • Are there any additional comments or issues that are in need to be added?

  • Additional information?

  • Additional Information

  • Additional Information?

  • Additional Information?

Haz Com

  • Is the SDS/Globally Harmonized System up to date on all products on-site?

  • Is the company safety program, hazard communication program, and SDS provided?

  • Are all spilled hazardous materials or liquids, including blood and other potentially infectious materials, cleaned up immediately and being conducted properly?

  • Has personnel conducting a task with a chemical, read and understand the safety data sheets of that chemical?

  • Is a spill kit available?

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.