Information

  • Safety Inspection

  • Area inspected

  • Location
  • Conducted on

  • Coordinator:

  • Assisted by:

1. Volunteer Habits and Actions

  • Applicable for this project

  • 1.1. Have volunteers been given adequate training for the job?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 1.2. Are unsafe actions of any kind visible?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 1.3. Is anyone cleaning near moving machinery?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 1.4. Are proper material-handling methods and lifting techniques being used?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 1.5. Has any risk-taking or horseplay been noted, or is it known of?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 1.6. Is proper respect shown for others, for equipment, and for machinery?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 1.7. Do entrants and attendants have a written permit for confined space work?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

2. Lockout / Tagout

  • Applicable for this project

  • 2.1. Are personal lockout devices being used?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 2.2. Are write-ups posted or readily available?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 2.3. Are lockout or tagout steps followed properly?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 2.4. Have pressure lines been bled down?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 2.5. Are valve blocks in place?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 2.6. Are blocks for gravity restraint in place?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 2.7. Are circuit breaker lockout devices in use?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 2.8. Have valve handles been removed or chained in the "off" position?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 2.9. Are cords and plugs under worker control?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

3. Personal Protective Equipment

  • Applicable for this project

  • 3.1. Are respirators provided and used?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 3.2. Are gloves, safety shoes, and hard hats in use?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 3.3. Is protective clothing available?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 3.4. Is eye protection used?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 3.5. Is hearing protection worn as needed?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 3.6. Are welding helmets and aprons in use as needed?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

4. Equipment Safeguard

  • Applicable for this project

  • 4.1. Are all guards in place?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 4.2. Are necessary guards provided, and are pinch points protected?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 4.3. Are compressors and other fixed-place machinery securely anchored?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 4.4. Are breakdowns promptly reported?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 4.5. Is machinery safety-checked before being put into use?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 4.6. Is machinery designed for its present use?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 4.7. Is machinery well maintained?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 4.8. Are guards durable and strong?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 4.9. Are all shafts, chains, and belts guarded?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

5. Hand and Power Tool

  • Applicable for this project

  • 5.1. Are tools in good condition?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 5.2. Are cords and extension cords in good shape with no damage to insulation or plug?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 5.3. Do chisels have mushroomed heads?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 5.4. Have tools been safety-checked before using?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 5.5. Are the proper tools provided?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 5.6. Are they stored properly?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 5.7. Are tools being used for the intended purpose?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 5.8. Is the policy for repair/replacement of damaged tools known to all?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

6. Heavy Equipment/Materials Handling

  • Applicable for this project

  • 6.1. Are operators maintaining adequate distance from other workers?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 6.2. Is the equipment in good repair?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 6.3. What about footholds, handholds, windshields, seats, tires, hydraulic equipment, backup alarms, rollover protection, lights?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 6.4. Are trenches properly sloped, shielded, and barricaded?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 6.5. Are materials properly tied down during transport?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

7. Ergonomics Note: "Ergonomics" refers to the scientific discipline concerned with understanding the interactions among humans and other elements in the environment around them with the goal of creating a healthy work environment compatible with the needs, abilities, and limitations of people.

  • Applicable for this project

  • 7.1. Does the nature of the work require highly repetitive movements?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 7.2. Are workers required to use excessive force or to place themselves in awkward positions or postures?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 7.3. Are workplaces and job layouts designed to prevent undue stress on wrists, knees, and shoulders?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 7.4. Are workers on highly routine jobs rotated periodically to maintain alertness?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 7.5. Do workers obtain sufficient rest, or are they overly fatigued?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

8. Personal Safety/Passersby Hazards

  • Applicable for this project

  • 8.1. Do trip hazards or dangers from sharp objects exist?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 8.2. Is there sufficient overhead clearance?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 8.3. Are railings, "Warning" signs, or "Danger" signs needed?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 8.4. Are flagmen needed?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 8.5. Are dangerous areas barricaded or roped off?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 8.6. Is anything loose on parapets or ledges?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 8.7. Are restraining devices needed?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 8.8. Are tiebacks in place?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 8.9. Are sidewalks and private roadways in good repair?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 8.10. Are pedestrians alert to moving vehicles?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

9. Hazards (chemical, electrical, environmental, fire, etc.)

  • Applicable for this project

  • 9.1. Is there excessive dust, noise, fumes, heat, or vibration?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.2. Is there adequate ventilation and illumination?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.3. Is the physical environment in the work area acceptable?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.4. Are respiratory protection write-ups posted or readily available?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.5. Are fire extinguishers charged and in good condition?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.6. Are they serviced in accord with local fire codes and tagged with proof of service?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.7. Are rags and other combustibles stored properly?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.8. Is there a danger of spontaneous combustion?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.9. Are flammable or explosive materials used?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.10. Is their use controlled?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.11. Are personnel trained to handle special hazard exposures?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.12. Are emergency procedures understood?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.13. Is eyewash station nearby?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.14. Are MSDS sheets accessible?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.15. Is all electrical equipment properly grounded?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.16. Are all panels readily accessible and identified?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 9.17. Is the wiring in good condition?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

10. Emergency Response

  • Applicable for this project

  • 10.1. Are emergency phone numbers posted (on a wall or other known location) for first aid, fire, chemical, and electrical emergencies?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 10.2. Do workers know whom to call?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 10.3. Are any needed supplies on hand?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

11. Fall Prevention

  • Applicable for this project

  • 11.1. Is scaffolding level?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.2. Are all legs bearing a load, with none floating?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.3. Are levelling jacks being used?<br>(No unsecured wood, concrete blocks, or other debris are permitted as substitutes.)

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.4. Do dangers exist for persons below?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.5. Is safety netting needed?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.6. Are toeboards needed?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.7. Are baseplates or casters used?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.8. Are casters locked?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.9. Are safety pins installed?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.10. Are outriggers needed?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.11. Should staging be tied into the building?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.12. Are decks/planks tied down?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.13. Are there any gaps in the working platform?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.14. Is the platform free of trip hazards?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.15. Are safety rails attached?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.16. Are safety gates being used?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.17. Are floor openings covered?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.18. Are catwalks and elevated walkways in good condition?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.19. Are handrails sturdy?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.20. Is everything secured from wind?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.21. Is there sufficient lighting?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 11.22. Are safety lines and harnesses needed?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

12. Ladders

  • Applicable for this project

  • 12.1. Are they in good condition?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 12.2. Is the top being used for standing or for holding materials?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 12.3. Is anyone overreaching or carrying materials that should be hoisted?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 12.4. Are stepladders of adequate height?<br>(Extension ladders must lean with the extension side out. No metal ladders can be used for electrical work. Stationary ladders must extend 900 mm above the roof.)

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 12.5. Are safety belts needed if both hands need to be free?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

13. Housekeeping/Storage Methods

  • Applicable for this project

  • 13.1. Are areas free of clutter, dirt, and spills?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 13.2. Do they reflect orderliness, with a place for everything and everything in its place?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 13.3. Are materials stacked and stored properly?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 13.4. Are heavy objects on lower shelves?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 13.5. Are aisles, catwalks, and walkways well defined and in obstructed?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 13.6. Are storage piles stable?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 13.7. Are they too high?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 13.8. Is there any unusual congestion?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 13.9. Is the pallet storage acceptable?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 13.10. Are items exposed to weather?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

14. Building Integrity

  • Applicable for this project

  • 14.1. Is the building in good condition?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 14.2. Is the use of the building consistent with its design?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 14.3. Is there any unusual erosion or corrosion?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 14.4. Is there unusual buildup of dust/debris?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 14.5. Are any collapse hazards evident?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 14.6. Are coping and facades in good condition?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 14.7. Are all exits locked?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 14.8. If work is being performed, is the door under surveillance?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 14.9. Are designated brothers contacted if needed?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

  • 14.10. Is there an arrangement in place to keep the building secure?

  • Specific Location

  • Describe Unsafe Condition and Recommended Solution

  • Date Corrected

Sign Off

  • Coordinator

  • Assisted by

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.