Information

  • Document No.

  • Crew Leader / Foreman

  • Client / Site

  • Weather Conditions

  • Conducted on

  • Location
  • Prepared by

  • Personnel

A. Personal Protective Equipment

  • Hard Hats in use by all personnel <br>

  • Eye protectin in use by all personnel

  • Reflective vest worn by all personnel

  • Hearing protection in use when required

  • Proper Foot Wear ?

  • Proper clothing ( FR if applicable )

  • Fall protection in use

  • Respirator / face mask when required

B. Tools and Equipment

  • Tools and Equipment in good condition

  • All equipment properly guarded

  • Electrical equipment connected properly, grounded and in good condition. GFCI; automatic magnetic cut-off for woodworking tools.

  • Machine guards / pinch points identified / protected

  • Rigging / lifting equipment in good condition and inspected

  • Ladders in good condition; tied back; extended 3 ft beyond landing

C. Heavy equipment

  • Daily inspection completed

  • Fire extinguisher mounted and in good condition

  • Seatbelt worn during operation

  • Perimeter around equipment clear

D. Work site

  • Warning devices ( signs and cones ) properly placed according to MUTCD

  • Safety cones in good condition and placed correctly

  • Traffic taper correctly positioned

  • Brakes set on truck / Chock on unhitched trailers

  • Equipment properly secured on truck / trailer

E. General

  • Safe access to work site

  • Good housekeeping and material storage

  • Barricades / Debris / Warning signs in place around pot holes

  • Excavations / trenches properly protected , spoil pile 2 feet away from excavation

  • Shoring properly installed / tabulated Data on site

  • First aid kit / Eye wash available

  • Utilities located / properly identified

  • Per-task cards reviewed by work crews

  • Fire extinguisher: good condition; current inspection tag; within 50 ft

F. D.O.T.

  • Lights / reflectors / beacons operational

  • Truck inspection completed

  • Truck cab neat / vehicle clean

  • Trailer properly mounted and free of debris

  • Tires with in acceptable tread depth

  • Add signature

  • Select date

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.