Title Page

  • Site Inspected?

  • Conducted on

  • Prepared by

  • Location

Perimeter Check

  • Does the site have perimeter fence in place?

  • Does the site have security to prevent unauthorized access?

  • How is the site secured from unauthorized personnel?

  • Does the site have a SWPPP in place?

  • Is the SWPPP being maintained accordingly?

  • Have you reported this issue to the person in charge of SWPPP?

  • Is there any work being done around the sites permiter?

  • Describe the work being done.

  • Are employees wearing proper PPE?

  • What PPE is not being used?

  • Specify the PPE not being used.

  • Site Work
  • Area?

  • Have all employees in this area been through Site Specific Training?

  • How did the employee/s get to site without training?

  • Have you reported this to the appropriate supervisor?

  • Has a Job Safety Analysis been completed for the work being observed?

  • Why has a JSA not been completed?

  • Has an equipment inspection form been completed for the equipment being observed?

  • Why was it not completed?

  • If a permit is required for the work being done, was it completed and approved?

  • Why was it not completed and approved?

  • Fall Protection/Prevention
  • Area?

  • Is fall protection selected based on a hazard analysis of the planned work, known hazards and specific work location?

  • Has the work area been isolated to prevent unauthorized access and limit the exposure to potential falling objects through the use of barricades?

  • Does the barricade have proper tags identifying the hazards that comply with 29 CFR 1926.200?

  • Has equipment, anchorage points and access methods been inspected; rated; and are appropriate for the load?

  • Are employees required to work at heights been provided with adequate information, instruction and training for the work being performed?

  • Have you notified the supervisor?

  • Have potential or existing hazards been identified and the risks assessed of anyone falling from heights?

  • Have alternative ways of carrying out the work been considered?

  • Have all practical steps been taken to prevent falls?

  • Is the ladder appropriate for the task or would another device such as a platform ladder / scaffold/elevated work platform be more appropriate?

  • Can three points of contact be maintained when using a ladder?

  • Are fall prevention systems required and in place?

  • In setting up a fall injury prevention system is it inspected to ensure sharp edges, pinch points, and sources of heat, which could damage the system are identified and rectified?

  • Has it been assessed whether a fall will be arrested before hitting the ground/other structure?

  • Is there a safe means of access/egress to the work being performed at heights? ex: stairs, walkways, ladders, mechanical lifts etc. and are they free from obstructions?

  • Scaffold
  • Scaffold Identification #?

  • Scaffolds designed by a qualified person?

  • Scaffolds are capable of supporting 4 times the intended load?

  • Competent person supervised erection of scaffold?

  • Casters are proper size and locking mechanism functioning correctly?

  • Supporting surface is level and solid with no settling?

  • Scaffold frames plumb and braced?

  • All brace connections secured?

  • Diagonal braces or hood planks used to prevent racking?

  • Platform on all working levels fully decked?

  • Each platform at least 18" wide?

  • Ends of platforms cleated for a minimum of 6" past support?

  • Wallboards overlap over support with at least 12" of overlap?

  • Ladders are provided to access scaffold platform?

  • Guardrails in place where workers could fall 10' or more?

  • Guardrails in place can support 200lb?

  • Top rai is between 38" -45" with mid rail midway between top rain and platform?

  • Toe Boards, screens or barricades are in place when objects could fall from scaffold platforms?

  • Scaffolds stacked more then 4 times the minimum base width are tied, guyed or braced to prevent tipping.

  • Scaffold is erected at least 10' from electrical power lines?

  • Workers are NOT riding scaffold if height is more than 2 times the minimum base width?

  • Force to move scaffold is within 5' of floor?

  • Workers are locking scaffold when worker is using stationary position?

  • Employees trained before working on scaffold?

  • Hot Work Activites
  • Area?

  • Is a competent person, trained for hot works going to undertake these works?

  • Has a JSA been completed?

  • Have all flammables / combustible materials been removed or protected?

  • Fire protection systems are present and in working order?

  • Equipment and machinery to be used has been inspected and verified to be in good condition?

  • Floor and ground has been cleared of combustible materials and wet down if applicable?

  • Is a fire watch present?

  • Does the fire watch have the proper Fire Extinguisher for the task?

  • Are nearby personnel aware of the hot work activity?

  • Do the employees conducting Hot Work have all the proper PPE for the task. Ex: Face Shield if grinding.

  • Are employees aware to remove PPE that could potentially catch on Fire unless FR? Ex: Class 2 vest that are not FR.

  • Excavation Safety
  • Area?

  • Underground utilities marked/identified before digging?

  • Digging around underground utilities performed under active permit?

  • Hand digging performed within 2' of marked lines, or hand digging performed until marked utilities are identified before machine digging?

  • Excavations, adjacent areas and protective systems inspected by a "competent" person daily prior to the start of work and after each rain event?

  • Excavations over 5' deep have proper protective measures in place? ex: sloping, benching, or trench box.

  • If trench box is used is the tabulated data onsite?

  • Workers working within the trench box at all times?

  • Ladders placed within 25' of workers?

  • Spoil piles at a minimum of 2' back from the edge of the excavation? Note: the edge is the furthest part of the disturbed soil. Ex: if a trench is dug vertical to 6 feet deep then sloped at the 1:11/2 angle the edge of the excavation is where the slope ended.

  • Barriers/Barricades installed on unattended excavations?

  • Class 2 vest worn by all workers exposed to vehicular traffic?

  • Audible alarms functioning properly on excavation equipment?

  • Does the excavation have any visible signs of damage? Ex: Ruts caused by rain events, cracks showing potential cave ins.

  • Are the safety measures used in accordance with the classification of soil? Ex: Benching is not allowed on Type C soil.

  • Behavioral Based Safety
  • Area?

  • Are employees aware of the safety program and its objectives?

  • Do employees understand the behaviors expected of them?

  • Are employees trained to identify and report unsafe behaviors?

  • Are employees encouraged to report unsafe behaviors without fear of retaliation?

  • Are employees recognized for safe behaviors?

  • Are employees involved in the development and implementation of the safety program?

  • Are employees provided with feedback on their safety performance?

  • Are employees provided with opportunities to improve their safety performance?

  • Is the safety program regularly reviewed and updated to reflect changes in the workplace?

  • undefined

  • Confined Space
  • Area?

  • Workplace been evaluated to determine if any spaces are permit-required confined space? {OSHA 1910.146(c)(1)}

  • Is the written confined space program complete?

  • Is the program reviewed and updated regularly by qualified staff?

  • The training of employees and entrants complete and documented?

  • Has periodic survey of canceled permits been performed and documented?

  • Has the evaluation of confined spaces been completed?

  • Have effective measures been taken to prevent employees from entering the permit spaces?

  • Has entry procedures been established and documented for: a. permit required confined spaces, b. alternate procedures for permit spaces, c. non-permit required confined spaces?

  • Have signs been posted at confined spaces?

  • Have confined space hazards been identified, evaluated, and documented?

  • Have appropriate atmospheric tests been performed prior to confined space entry?

  • Are confined spaces thoroughly emptied and rinsed of corrosive and hazardous substance before entry?

  • Are all lines to a confined space entry secured?

  • Have the protective equipment and materials been provided and maintained?

  • Has adequate ventilation been provided prior to and during confined space entry?

  • Is a rescue and emergency services available, ready and aware of entry?

  • Are accurate facility maps, descriptions, and locations readily available to emergency personnel if needed?

  • Procedures established for work performed by contractors in confined spaces?

  • Are entry permits reviewed prior to work being performed by qualified personnel and posted at the site?

  • LOTO
  • Area?

Additional Inspection Items

    Additional Items
  • Additional Findings

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.