Roth Technician Safety Inspection

• Employee Name

• Vehicle Number

• Client / Site Location

• Conducted on

  Date

• Prepared by

Tech

• Did tech check in with customers?

  Yes

  No

  N/A

• Was tech wearing seatbelt while driving?

  Yes

  No

  N/A

• Opportunity taken to talk about lessons learned regarding safety?

  Yes

  No

  N/A

• Does the tech have proper training for tasks performed during this inspection?

  Yes

  No

  N/A

Equipment

• Tools not in use kept in place?

  Yes

  No

  N/A

• If required is PPE available?

  Yes

  No

  N/A

• Are all equipment compartments stocked?

  Yes

  No

  N/A

Ladders

• Are ladders in safe condition?

  Yes

  No

  N/A

• Do ladders extend 3' above the landing

  Yes

  No

  N/A

• Are ladders secured to prevent slippage?

  Yes

  No

  N/A

• Are ladders away from electrical conductors and power lines?

  Yes

  No

  N/A

• Is the ladder set up at proper 4:1 ratio?

  Yes

  No

  N/A

• Are step ladders used in safe manner?

  Yes

  No

  N/A

Fall Protection

• Is the worker protected from falls of 6' or greater?

  Yes

  No

  N/A

• Was the worker using proper fall restraint? Describe restraint.

  Yes

  No

  N/A

• Did the tech use a hand line to get materials to the roof in place of carrying material up the ladder?

  Yes

  No

  N/A

• Was the tech protected from falls while pulling up material?

  Yes

  No

  N/A

• Does worker have proper training in fall protection ?

  Yes

  No

  N/A

Electrical

• Any plugs, sockets or switches damaged or unsafe?

  Safe

  At Risk

  N/A

• Electrical cords free from cuts or crushing damage?

  Safe

  At Risk

  N/A

• Are cords equipped with ground pin?

  Yes

  No

  N/A

• Are all portable power tools in good condition?

  Yes

  No

  N/A

• Is lock out/ tag out used?

  Yes

  No

  N/A

Personal Protective Equipment (was the following PPE in use during inspection?)

• Safety Glasses

  Yes

  No

  N/A

• Face Shield/ Goggles

  Yes

  No

  N/A

• Gloves- proper type?

  Yes

  No

  N/A

• Hard Hat

  Yes

  No

  N/A

• Respirator

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Full Body Harness

  Yes

  No

  N/A

• Shock Absorbing Lanyard or Self Retracting Lifeline

  Yes

  No

  N/A

• Rope Grab

  Yes

  No

  N/A

• Arc Flash Rated Clothing

  Yes

  No

  N/A

Chemical Safety

• Safety Data Sheets available for all chemicals?

  Yes

  No

  N/A

• Workers trained in the use of hazardous substances?

  Yes

  No

  N/A

Fire Prevention

• Are Extinguishers easily accessible and location known by all employees?

  Yes

  No

  N/A

• Is the fire extinguisher within 50' of flammable liquids?

  Yes

  No

  N/A

Vehicle Condition

• Tires in safe condition?

  Yes

  No

  N/A

• Safe brake performance?

  Yes

  No

  N/A

• Do all lights function properly? (Check operation of brake, indicator and reversing lights)

  Yes

  No

  N/A

• Is the steering wheel and dash clean?

  Yes

  No

  N/A

• Are compressed gas bottles secured and regulators removed?

  Yes

  No

  N/A

• Is windshield free from cracks?

  Yes

  No

  N/A

• Is there easy access to the first aid kit?

  Yes

  No

  N/A

• Are ladders properly secured to ladder rack

  Yes

  No

  N/A

• Is the vehicle kept in neat & orderly condition?

  Yes

  No

  N/A

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