Title Page
-
Date
-
Site Name
-
Contractor
-
Carrier
-
Location
-
Can The Site Safety Observation Be Performed? Crew present/work being performed?
-
Remote Audit?
-
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 heavy equipment set up in a safe location? (Traffic control, level ground, etc.)
-
Does heavy equipment 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?
-
Housekeeping, Site Free From Excessive Debris/Trash?
-
Appropriate Cert Cards Avaliable? EX: Authoroized/Competent Climber, Rigging, First-Aid/CPR, RF, Crane, Aerial Lift, etc.
Signatures
-
Inspector