Mission Task Analysis

  • MTA completed for activities being performed

  • MTA signed by coworkers

Fall Protection

  • Guard/ Safety rails on place

  • Rails installed in good condition

  • Guard/safety rails are at correct height (top rail 42+/-, mid rail 21+/-)

  • Toe boards on place and secured

  • Floor/ground openings covered or barricaded

  • Hole covers secured and marked "HOLE"

  • Personal fall arrest system in use

  • Fall protection equipment installed and used properly

  • proper tie-off points being used.

  • Debris netting installed (if required)

  • Is netting in good condition

  • Leading edge work barricaded or guard rails installed

  • Rebar impalement protection in place

Hand and Power Tools

  • Data plate on tools legible

  • Double insulated or grounded

  • Drill handles in place (if equipped)

  • All guards in place and properly working

  • Power cords in good condition

  • Wooden handles free of splinters/cracks

  • Impact tools free from mushroomed heads

  • Tools being inspected and used properly for the task

  • Safety whip cables in place on air compressors

Personal Protective Equipment

  • Hard Hats

  • Proper footwear

  • Tarsal guards being used (during required task)

  • Hearing protection

  • Eye protection

  • Face shields

  • Was PPE inspected.

Chemical Safety HAZCOM/SDS

  • Site specific SDS on file

  • All chemical containers labeled

  • chemicals storage in the designated area.


  • Proper cords being used and in good shape

  • Extension cords being suspended correctly

  • Extension cords inspected daily.

  • Danger signs around high voltage areas

  • GFCI's used at the receptacle

  • Equipment at least 10 feet from power lines


  • All work areas in orderly condition

  • Walking / working surface free from tripping hazards.

  • Aisle-ways and emergency routes clean of material and debris.

  • Material on upper floors secured to prevent displacement.

  • Regular site clean up and trash disposal

  • Protruding nails removed

  • Trash box used correctly (not overfilled)


  • Rigging equipment in proper condition

  • Is the Rigging appropriate for the lift.

  • Tag lines being used

  • Whistles being used

  • Crane yearly inspections current

  • Daily equipment inspections completed

  • Can crane operator see the signal person

  • Are the ANSI approve hand signals being used.

  • Are two way radios being used to communicate with the operator

  • crane located at a safe distance from power lines

  • Is weather conditions adequate for lifts.

  • Back up alarms properly working

  • Seat belts worn in equipment and vehicles

  • copy of the crane operator's qualification /certifications on file


  • Proper shoring, sloping, shielding for soil type and depth

  • Underground utilities located prior to digging

  • Proper access/egress to trench

  • Spoil piles properly located

First Aid and Health

  • Drinking water readily available

  • First Aid kits stocked and available

  • Eye wash stations available

  • Toilets available and clean

Work Zone

  • Traffic control correctly laid out per plan

  • Flaggers performing duties adequately

  • Adequate lighting for night work


  • Properly erected-(fully planked, footings secured, cross-bracing, tied to structure, etc.)

  • Ladder access provided

  • Fall protection in place (guardrails or tied off)

  • Inspection completed by competent person

  • Rolling scaffolds moved correctly (not being surfed from platform)


  • Handrails/Stair rails in place

  • Sides and edges of stairway landings protected by guardrail systems

  • stacked materials kept at a safe distance from the toe boards

Fire Safety

  • Fire extinguisher readily available and in proper order

  • No smoking signs posted where needed

  • Flammables/combustibles properly stored

  • Containers clearly identified/labeled

  • SDS available


  • Ladders in good condition

  • Spreaders on the step ladder locked

  • Are ladders being used properly

  • job made ladder built properly (no double head nails)

  • Are ladders being used at the proper angle (1-4)

  • Manufacturer's label affixed and legible

  • Ladders extend 3' above surface

  • Ladders tied off

  • Proper access/egress on elevated decks

  • Access provided at 19"

Oxy-Acetylene Torch

  • Cylinders properly stored

  • Proper PPE worn

  • Cables, hoses, regulator, torches in good condition

  • Hot work permit completed

  • is there at least one 10 lb extinguisher withing 50 feet of oxygen and acetylene storage areas.

  • Fire watch in place for cutting

  • Is cutting torch in good working condition.

Aerial Lifts

  • Are coworkers using proper fall protection

  • coworkers remaining on the platform at all times

  • the gate or chain closed when occupied

  • Lift st on level ground, per manufacturer's recommendations

  • Operator has been trained

  • Tools and materials secured from displacement

  • Has the equipment been inspected prior to use.

  • Are lanyards/retractable attached to proper anchorage points.

  • is the lift capacity visible and appropriate for the task


  • Weekly tool box safety talk completed

  • BCC required safety postings in place

  • OSHA 5-in-1 poster in place

  • Emergency numbers posted

  • Overall Comments

  • Add signature

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