Information

  • Project Name

  • Conducted on

  • Prepared by

  • Location
  • Supervisor

  • Subcontractors

Site safety items

  • Are records of toolbox talks on site?

  • Material Safety Data Sheets

  • OSHA Postings

  • First Aid Kit available in the Supervisor truck

  • Housekeeping was good on site.

  • Safety Cans used for all fuel containers? (No plastic)

Personal Protective Equipment

  • Is head protection being worn by all employees exposed to overhead hazards?

  • Are safety glasses being worn by all employees?

  • Are sturdy work boots being worn?

  • Are cut resistant gloves available on site for all employees?

  • Is hearing protection available on site?

  • Are all employees dressed appropriately for the weather?

  • Is high visibility clothing worn by all employees exposed to traffic or moving equipment?

Traffic Control

  • Temporary traffic control Required?

  • Written traffic control plan onsite? (Take Picture)

  • Advance warning signs in place?

  • Warning Signs & Cones

  • Channelizers clean & reflective

  • Dust Control

Flagging

  • Flagger Required

  • Flagger In Place

  • Proper PPE

  • Correct Hand signals in use

  • Flagger located appropriately

Night Work

  • Working at Night?

  • Proper PPE, including Class III?

  • Adequate Lighting

  • Lighting Protected from damage from other equipment?

Electrical

  • Electrical sources on site?

  • GFCI in Use and Tested on generators

  • Extension Cords in good condition, with no exposed inner wiring?

  • Hand & Portable Tools in good condition with guards installed and cords with no exposed inner wires.

  • Generators are Properly Grounded

Motor Vehicles & Equipment

  • Outriggers are fully extended when necessary?

  • Windows are in good condition to allow visibility?

  • Warning/Flashing Lights in good working order?

  • Seat Belts worn by all Equipment drivers and passengers? (Means no riding on steps)

  • Fire Extinguishers available and charged on all equipment?

  • Backup Alarms are audible on all mobile equipment?

Trenching & Excavation

  • Trenches over 4' deep?

  • Spoils Pile - 2 feet back

  • Trenches Properly Sloped or shored

  • Shoring Materials adequate?

  • Competent Person Log Maintained

  • Egress Ladders within 25 feet

Dust and Respiratory Protection

  • Notes on Dust

Confined Space

  • Confined Space on Site?

  • Entry Permit

  • Atmosphere Tested & Documented

  • Continuous Monitoring

  • Confined Space Training

  • Tripod, Retrieval & Harness

Miscellaneous

  • Compressed Gas Cylinders

  • Burning, Welding & Cutting

  • Cranes, Hoists & Slings

  • Scaffolds & Platforms

  • Fall Protection

  • Working Over Water Precautions

Confirmation

  • Notes

  • Completed by

  • Site Supervisor

  • Additional Representative

  • Signature
  • Additional rep

  • Company and Title

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.