Title Page

  • Date

  • Site Name

  • Contractor

  • Carrier

  • Location
  • Can The Site Safety Observation Be Performed? Crew present/work being performed?

  • Crewmembers On Site

Safety Paperwork

  • JSA Is Thorough and Complete?

  • Crew Taking Appropriate Hazard Mitigation Steps Identified In JSA?

PPE

  • Hard Hats

  • High Vis

  • Safety Glasses

  • Gloves

  • Work Attire

Equipment

  • First Aid Kit Readily Accessible?

  • First Aid Kit Fully Stocked?

  • Fire Extinguisher Readily Accessible?

  • Fire Extinguisher Inspected?

  • GFCI Utilized?

  • Extension Cords Are Free From Trip Hazards or Properly Marked?

  • Have underground Utilities been located?

  • Is Bore Rig/Vac Truck set up in a safe location? (Traffic control, level ground, etc.)

  • Does Bore Rig/Vac Truck appear to be in good condition?

  • Are controls functioning properly?

  • Are there any fluid leaks?

  • Has the Strike Alert sensor been deployed?

  • Site/Job Specific PPE Available and in use?

Site

  • Adequate Warmth or Shade Accessible?

  • Water Available For Entire Crew?

  • Traffic Cones or Barricades Used When Necessary?

  • Appropriate Cert Cards Avaliable? EX: Authoroized/Competent Climber, Rigging, First-Aid/CPR, RF, Crane, Aerial Lift, etc.

  • Housekeeping, Site Free From Excessive Debris/Trash?

Signatures

  • Inspector

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.