Title Page

  • Document No.

  • Job Site

  • Foreman

  • Conducted On

  • Conducted By

  • Location

Safety Topics

Ladder Safety (1926 Subpart X, 1926.1050 - 1926.1060, 1926 Subpart X App A)

  • Is a ladder being used?

  • Does the ladder meet the 1/4 ratio?

  • Is the ladder tied off?

  • Is the ladder being used properly?

  • Are rungs and steps free of any substance that would make it slippery.

  • Areas at top/bottom of ladder are clear.

  • 3 points of contact maintained at all times?

  • Ensure nothing is carried up the ladder.

  • Employees face ladder when climbing up/down?

  • Is ladder on a level/firm footing?

  • Are there any openings/doors near the ladder?

  • Is the traffic diverted away from the area with the ladder?

  • Are openings protected with proper cover?

Fall Protection (1926 Subpart M, 1926.500 - 1926.503, 1926 Subpart M App A - E)

  • Are guardrails being used? (1926 subpart M App B)

  • Positioning device system (1926 subpart M App D)

  • Personal fall arrest system (1926 subpart M App C)

  • Is every aspect of fall arrest present?

  • Full Body Harness

  • Web Lanyard (1926.104)

  • Shock Absorber

  • Locking snap hooks

  • Lifeline or Retractable (1926.104)

  • Is the rope being adjusted as needed during use?

  • Rope Grab

  • Adequate anchor point

Personal protection equipment (PPE) (1926 Subpart E, 1926.95 - 1926.107)

  • Is PPE being used?

  • Hand protection

  • Foot protection (1926.96)

  • Head Protection (1926.100)

  • Hearing protection (1926.101)

  • Eye/Face protection (1926.102)

  • Respiratory protection (1926.103)

General Safety Topics

Tools and Equipment

  • Are power tools in good working order?

  • Is PPE used when operating power tools when needed?

  • Are all cords in good working order

  • Are hand tools used properly and in good working condition?

  • Is PPe used during hand tool use when needed?

  • Are generators being used?

  • Is fire extinguisher at a safe and accessible distance? (no more than 25 feet)

  • Are the proper amount of cords being used, not overloaded?

  • Is the generator maintenance records up to date?

Hot Work

  • Is there a kettle being used?

  • Material staging and safety (minimum 25 feet away)

  • Is kettle taped off from unwanted entry?

  • Are pipes leading to roof secured?

  • Is the egress unobstructed (10 foot minimum)

  • Are fire extinguishers provided and kept nearby? ( 2-20 lb no more then 25 feet away)

  • Is there a working thermometer?

  • Propane containers (minimum 10 feet away when being used)

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