Information
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Project Name
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Conducted on
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Prepared by
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Location
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Supervisor
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Subcontractors
Site safety items
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Are records of toolbox talks on site?
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Material Safety Data Sheets
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OSHA Postings
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First Aid Kit available in the Supervisor truck
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Housekeeping was good on site.
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Safety Cans used for all fuel containers? (No plastic)
Personal Protective Equipment
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Is head protection being worn by all employees exposed to overhead hazards?
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Are safety glasses being worn by all employees?
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Are sturdy work boots being worn?
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Are cut resistant gloves available on site for all employees?
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Is hearing protection available on site?
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Are all employees dressed appropriately for the weather?
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Is high visibility clothing worn by all employees exposed to traffic or moving equipment?
Traffic Control
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Temporary traffic control Required?
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Written traffic control plan onsite? (Take Picture)
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Advance warning signs in place?
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Warning Signs & Cones
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Channelizers clean & reflective
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Dust Control
Flagging
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Flagger Required
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Flagger In Place
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Proper PPE
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Correct Hand signals in use
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Flagger located appropriately
Night Work
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Working at Night?
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Proper PPE, including Class III?
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Adequate Lighting
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Lighting Protected from damage from other equipment?
Electrical
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Electrical sources on site?
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GFCI in Use and Tested on generators
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Extension Cords in good condition, with no exposed inner wiring?
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Hand & Portable Tools in good condition with guards installed and cords with no exposed inner wires.
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Generators are Properly Grounded
Motor Vehicles & Equipment
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Outriggers are fully extended when necessary?
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Windows are in good condition to allow visibility?
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Warning/Flashing Lights in good working order?
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Seat Belts worn by all Equipment drivers and passengers? (Means no riding on steps)
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Fire Extinguishers available and charged on all equipment?
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Backup Alarms are audible on all mobile equipment?
Trenching & Excavation
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Trenches over 4' deep?
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Spoils Pile - 2 feet back
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Trenches Properly Sloped or shored
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Shoring Materials adequate?
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Competent Person Log Maintained
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Egress Ladders within 25 feet
Dust and Respiratory Protection
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Notes on Dust
Confined Space
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Confined Space on Site?
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Entry Permit
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Atmosphere Tested & Documented
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Continuous Monitoring
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Confined Space Training
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Tripod, Retrieval & Harness
Miscellaneous
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Compressed Gas Cylinders
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Burning, Welding & Cutting
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Cranes, Hoists & Slings
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Scaffolds & Platforms
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Fall Protection
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Working Over Water Precautions
Confirmation
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Notes
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Completed by
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Site Supervisor
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Additional Representative
Signature
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Additional rep
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Company and Title