Residential Safety Inspection

• Inspector Name:

  Select Levi Schrock Josh Spink Cole Mitchell

  • Levi Schrock
  • Josh Spink
  • Cole Mitchell

• Date of Inspection:

  Date

• Builder:

• Project Number:

• Subdivision:

• undefined

  Select Layout Excavation Footings Gravel Panel Delivery Walls Stem Walls Panel Pick-Up Waterproofing Gravel Backfill Slab Dirt Backfill Service Jaco

  • Layout
  • Excavation
  • Footings
  • Gravel
  • Panel Delivery
  • Walls
  • Stem Walls
  • Panel Pick-Up
  • Waterproofing
  • Gravel Backfill
  • Slab
  • Dirt Backfill
  • Service
  • Jaco

• Lot/BLDG Number:

• Jobsite Location:
  Address

• Jobsite Crew Leader

Safety:

• Is sufficient PPE being used?

  Yes

  No

  N/A

• PPE being used:

  Select Hard Hat Shirt Pants Boots Gloves Safety Glasses High-Vis Vest Dust Mask Respirator Tyvec Suit

  • Hard Hat
  • Shirt
  • Pants
  • Boots
  • Gloves
  • Safety Glasses
  • High-Vis Vest
  • Dust Mask
  • Respirator
  • Tyvec Suit

• PPE not used:

  Select Hard Hat Shirt Pants Boots Gloves Safety Glasses High-Vis Vest Dust Mask Respirator Tyvec Suit

  • Hard Hat
  • Shirt
  • Pants
  • Boots
  • Gloves
  • Safety Glasses
  • High-Vis Vest
  • Dust Mask
  • Respirator
  • Tyvec Suit

• Names of those without proper PPE:

• Caution tape being used?

  Yes

  No

  N/A

• Any unique hazards on this jobsite?

Tools

• Are all tools and cords in good condition?

  Yes

  No

  N/A

• Are all hand tools in a safe and usable condition?

  Yes

  No

  N/A

• Are all power tools in a safe and usable condition?

  Yes

  No

  N/A

• Are all cords in good condition (excluding power tools)?

  Yes

  No

  N/A

EPA

• Were all EPA guidelines followed?

  Yes

  No

• Is the street dirty from the job?

  Yes

  No

  N/A

• Is there excessive concrete on the ground?

  Yes

  No

  N/A

• Is the jobsite cleared of excessive trash?

  Yes

  No

• Is the slit fence present and/or in good condition?

  Yes

  No

  N/A

• Is the water pump being filtered correctly?

  Yes

  No

  N/A

• Was anything spilled?

  Yes

  No

Vehicle info:

• Are Custom Concrete trucks present?

  Yes

  No

• Was pre-trip inspection filled out?

  Yes

  No

• Name of driver:

• Is the box/bed damage?

  Yes

  No

• Is the cab damage?

  Yes

  No

• Does the truck have cones?

  Yes

  No

  N/A

• Are the cones being used?

  Yes

  No

  N/A

• Vehicle(s) ID Number:

Excavation Conditions

• Excavation okay?

  Yes

  No

• Proper sloping/benching?

  Yes

  No

  N/A

• What is wrong with sloping/benching?

• Ramp and/or stairs in good condition?

  Yes

  No

  N/A

• Enough room between wall and excavation?

  Yes

  No

  N/A

• How wide is the path?

• Is spoils pile at least 2' away from edge of excavation?

  Yes

  No

  N/A

• Name of excavator:

• Soil Type?

  A

  B

  C

• Any potential cave-offs?

  Yes

  No

  N/A

• Conditions of drive onsite?

  Good

  Not good

• Does driveway onsite have enough room for full outrigger extension (27')?

  Yes

  No

  N/A

• Photo of jobsite:

  Media

Sanitation:

• Is a portable toilet at jobsite?

  Yes

  No

• Do workers have water onsite?

  Yes

  No

  N/A

• Anything else needing to be noted about jobsite?

• Photo?

  Media

• Anything else needing to be noted about jobsite?

• Photo?

  Media

• Anything else needing to be noted about jobsite?

• Photo?

  Media

• Anything else needing to be noted about jobsite?

• Photo?

  Media

• Anything else needing to be noted about jobsite?

• Photo?

  Media