Safety Inspection Report

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

PROGRAM ADMINISTRATION

• OSHA POSTINGS

  Yes

  No

  N/A

• Emergency numbers / contacts posted

  Yes

  No

  N/A

• Safety manual - The Hagerman Group

  Yes

  No

  N/A

• Safety manual -subcontractors

  Yes

  No

  N/A

• Weekly toolbox talks - The Hagerman Group

  Yes

  No

  N/A

• Weekly toolbox talks - subcontractors

  Yes

  No

  N/A

• First aid kits - job trailer

  Yes

  No

  N/A

• First aid kits - field

  Yes

  No

  N/A

• Emergency action plan posted / up to date

  Yes

  No

  N/A

• Fire extinguisher - trailer

  Yes

  No

  N/A

HOUSEKEEPING

• Work areas orderly

  Yes

  No

  N/A

• Adequate lighting

  Yes

  No

  N/A

• Job site free of slips, trips and fall hazards

  Yes

  No

  N/A

• Stairways / walkways clear

  Yes

  No

  N/A

• Trash picked up

  Yes

  No

  N/A

• Break areas orderly

  Yes

  No

  N/A

ELECTRICAL / UTILITY

• Insulation intact on cords and wiring

  Yes

  No

  N/A

• Temporary lighting guarded

  Yes

  No

  N/A

• Electrical panels labeled HOT and covered

  Yes

  No

  N/A

• GFCI protection utilized

  Yes

  No

  N/A

• Underground electrical lines marked

  Yes

  No

  N/A

• Underground gas lines marked

  Yes

  No

  N/A

• Lockout procedures utilized

  Yes

  No

  N/A

HAND AND POWER EQUIPMENT

• Hand tools in good working order

  Yes

  No

  N/A

• Electrical cords in good working order

  Yes

  No

  N/A

• All mechanical safeguards in use

  Yes

  No

  N/A

• Handles not broke / splinter free

  Yes

  No

  N/A

EQUIPMENT

• Breaks, lights, signals and alarms operative

  Yes

  No

  N/A

• Daily log book filled out

  Yes

  No

  N/A

• Seat belts worn - LULL

  Yes

  No

  N/A

• Aerial lift - PPE being used

  Yes

  No

  N/A

• Cranes- swing radius protected - level

  Yes

  No

  N/A

• Rigging equipment inspected - tag showing

  Yes

  No

  N/A

BARRICADES AND FENCING

• Roadways and sidewalks protected

  Yes

  No

  N/A

• Floor openings planked or barricaded

  Yes

  No

  N/A

• Wall, roof openings covered or barricaded

  Yes

  No

  N/A

• Leading edges guarded

  Yes

  No

  N/A

EXCAVATION

• Necessary ladders provided

  Yes

  No

  N/A

• Spoil set back at least 2 feet

  Yes

  No

  N/A

• Rebar impalement protection

  Yes

  No

  N/A

LADDERS

• Ladders in good condition

  Yes

  No

  N/A

• Side rails extend 36 inches above landing

  Yes

  No

  N/A

• Proper for job and secure

  Yes

  No

  N/A

• Step ladders fully open when in use

  Yes

  No

  N/A

• Placement of ladder safe

  Yes

  No

  N/A

INFECTION CONTROL

• Daily inspection checklist completed

  Yes

  No

  N/A

• ILSM current

  Yes

  No

  N/A

• Debris covered

  Yes

  No

  N/A

• Walk off mats in place / in use

  Yes

  No

  N/A

SCAFFOLDING

• All scaffolds plumbed and leveled as erection proceeds

  Yes

  No

  N/A

• Are adequate sills and base plates being used

  Yes

  No

  N/A

• If electrical power lines are near the scaffold, are necessary precautions being taken

  Yes

  No

  N/A

• Do scaffold planks extend past their end supports not less than 6 inches and no more than 12 inches

  Yes

  No

  N/A

• Are guardrails and end rails in place

  Yes

  No

  N/A

• To protect from falling objects, are toe boards or area barricaded below

  Yes

  No

  N/A

• Are frames and panels braced by cross, horizontal or diagonal braces

  Yes

  No

  N/A

• Are scaffolds with a (4:1) base to height ratio

  Yes

  No

  N/A

• Is fall protection being used in areas where required

  Yes

  No

  N/A

• Are scaffolds securely anchored at lease every 30 feet of length and 25 feet in height

  Yes

  No

  N/A

• Is their an assess ladder, steps or equivalent safe access to scaffold

  Yes

  No

  N/A

• Is the scaffold within its weight capacity

  Yes

  No

  N/A

ENVIRONMENTAL CONTROLS

• Silt fence installed and maintained

  Yes

  No

  N/A

• Hazardous materials properly stored

  Yes

  No

  N/A

• Spill containment kit adequate / on site

  Yes

  No

  N/A

FIRE PREVENTION

• Are safety cans being used and properly labeled

  Yes

  No

  N/A

• Propane tanks - barricade installed - labeled -( flammable,no smoking, fuel type)

  Yes

  No

  N/A

• Compressed gas cylinders secured- upright- protected from damage

  Yes

  No

  N/A

• Fire extinguishers immediately available and inspection current

  Yes

  No

  N/A

PPE

• Hard hats worn

  Yes

  No

  N/A

• Gloves available - cut resistant for demo

  Yes

  No

  N/A

• Face shields being used - mason saw or other operations

  Yes

  No

  N/A

• Eye protection

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

• Safety harness and lanyards utilized with adequate anchorage points

  Yes

  No

  N/A

• Respirators and masks utilized

  Yes

  No

  N/A

• High visible clothing in use

  Yes

  No

  N/A

The Hagerman Group VIOLATIONS

• Notes

  Safe

  At Risk

  N/A

• Notes

  Yes

  No

  N/A

SUBCONTRACTOR VIOLATIONS

• Notes

  Yes

  No

  N/A

• Notes

  Yes

  No

  N/A