Information
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Document No.
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Crew Leader / Foreman
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Client / Site
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Weather Conditions
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Conducted on
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Location
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Prepared by
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Personnel
A. Personal Protective Equipment
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Hard Hats in use by all personnel <br>
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Eye protectin in use by all personnel
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Reflective vest worn by all personnel
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Hearing protection in use when required
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Proper Foot Wear ?
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Proper clothing ( FR if applicable )
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Fall protection in use
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Respirator / face mask when required
B. Tools and Equipment
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Tools and Equipment in good condition
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All equipment properly guarded
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Electrical equipment connected properly, grounded and in good condition. GFCI; automatic magnetic cut-off for woodworking tools.
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Machine guards / pinch points identified / protected
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Rigging / lifting equipment in good condition and inspected
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Ladders in good condition; tied back; extended 3 ft beyond landing
C. Heavy equipment
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Daily inspection completed
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Fire extinguisher mounted and in good condition
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Seatbelt worn during operation
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Perimeter around equipment clear
D. Work site
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Warning devices ( signs and cones ) properly placed according to MUTCD
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Safety cones in good condition and placed correctly
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Traffic taper correctly positioned
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Brakes set on truck / Chock on unhitched trailers
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Equipment properly secured on truck / trailer
E. General
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Safe access to work site
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Good housekeeping and material storage
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Barricades / Debris / Warning signs in place around pot holes
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Excavations / trenches properly protected , spoil pile 2 feet away from excavation
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Shoring properly installed / tabulated Data on site
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First aid kit / Eye wash available
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Utilities located / properly identified
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Per-task cards reviewed by work crews
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Fire extinguisher: good condition; current inspection tag; within 50 ft
F. D.O.T.
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Lights / reflectors / beacons operational
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Truck inspection completed
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Truck cab neat / vehicle clean
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Trailer properly mounted and free of debris
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Tires with in acceptable tread depth
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