• Date and Time:

Contractors

  • Contractors On-Site

  • Other company name?

  • Comments:

Work Activities

  • Hot Work

  • Permit issued

  • Permit number and description of work being done.

  • Take Pictures

  • Immediately stop work and contact Plant Engineer.

  • Comments:

  • Permit displayed

  • Permits must be displayed in the area Hot Work is being done.

  • Take pictures

  • Comments:

  • Permit procedures followed

  • Immediately stop work and contact Plant Engineer.

  • Comments:

  • Assembly

  • Overhead work

  • Hard hats worn

  • Proper PPE must be worn

  • Comment:

  • Work at heights

  • Fall protection in place

  • Immediately stop work until proper PPE is worn.

  • Comment:

  • Other

  • Comments:

Equipment

  • Fork Trucks

  • Hoist

  • Crane

  • Scissor Lift

  • Fall protection worn

  • Immediately stop work until proper PPE is worn.

  • Comments:

Training

  • All personnel trained

Personal Protective Equipment

  • Hard hats worn

  • Proper PPE must be worn at all times.

  • Comments:

  • Eye protection worn

  • Proper PPE must be worn at all times.

  • Comments:

  • Hearing protection worn

  • Proper PPE must be worn at all times.

  • Comments:

  • Foot protection-steel toes

  • Proper PPE must be worn at all times.

  • Comments:

  • Hair nets/beard nets

  • Proper PPE must be worn at all times.

  • Comments:

Other

  • Signage in place

  • Comments:

  • All work completed in safe manner

  • Comments:

Corrective Actions

  • Comments:

General Observations

  • Comments:

  • Approvals

  • Inspector

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