Information

  • Document No.

  • Contractor

  • Client

  • Site number

  • Photo of structure

  • Conducted on

  • Aaron Steeneck

  • Location
  • Site Number(s)

  • Add media

Jobsite documentation

  • Daily safety tailgate meetings taking place? (JSA)

  • Posting OSHA and other regulatory posters?

  • Current competent climbing cards up-to-date and available?

  • Are competent rigging cards available and up to date?

  • Has climbing harness been inspected and documented prior to use?

  • Does foreman have minimum OSHA 30 hr?<br>

  • Do all crew members have minimum OSHA 10 hr?

  • Is there a minimum of 2 personnel certified in CPR/first aid?

  • First aid kit available?

  • Is an MSDS book onsite?

  • Additional comments/remarks

  • Photos

Fall protection

  • Ground person present for crew on tower?

  • 100% fall protection used

  • Is work being done at ground level when crew is on tower?

  • Does crew have rescue kit/first aid at base of tower?

  • Additional comments/remarks

  • Photos

Personal protective equipment

  • Head protection?

  • Proper work clothing including but not limited to long pants and shirts with sleeves and boots?

  • Eye protection in accordance to ANSI Z 87.1?

  • Additional comments/remarks

  • Photos

  • Rigging and equipment

  • Is a rigging plan in place?

  • Has a 150% load test been preformed and documented prior to any lifts?

  • Is rope that is used for personnel inspected and documented prior to use?<br>

  • Is rope or cable used for tools and equipment being inspected and documented prior to use?

  • Are blocks of adequate size and capacity for the job?

  • Is cathead in good working order?

  • Slings that are being used of adequate size in working order with all tags legible?

  • Are carabiners being used on load line?

  • Additional photos

Latter's

  • Is step latter fully open and locked before climbing?

  • Latter is a least 1ft away for every 4ft of height?

  • Latter rails should extend at least 3ft above top landing?

  • Not climbing past the top 3 rungs or steps from the top?

  • Is latter securely fastened or ground stakes used to prevent slipping?

Fire protection

  • Fire blankets in use and are 3000 degree NFPA 701?

  • Designated fire watchers are on site?

  • Is welding being done at base of structure while Ariel work is being done?

  • Fire watcher signature

  • Proper sized Waterwagon on site minimum 300 gallons?

  • Proper size and quantity fire extinguishers present with current inspection tags minimum five #4?

  • Interior of structure cleaned out and free of debris?

  • No more than one person welding at a time

  • Was monopole scope done?

  • Cutting and welding plan on site and filled out?

  • Additional comments/remarks

  • Photos

Job site conditions

  • Worksite clean and free of debris?

  • Are open holes barricaded?

  • All chemical flammable and combustible items identified?

  • Are proper gas cans being used? No plastic cans.

  • Are Overhead electrical lines present?

  • Additional comments/remarks

  • Photos

  • Signature of foreman being audited

  • Signatures of General contractors being audited

  • Signatures of General contractors being audited

  • Signatures of General contractors being audited

  • Customer signature

  • Signature of auditor

  • Additional comments/remarks

  • Additional photos

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.