SAFETY INSPECTION

• Conducted on

  Date
• MAP ADDRESS
  Address

• JOB ADDRESS

• # of workers on jobsite

• Safety Inspection Performed by

Hot work kettle and torch

• Does every propane tank and torch have a charged and compliant fire extinguisher next to it?

  Yes

  No

  N/A

• Is a working and compliant fire extinguisher next to kettle?

  Yes

  No

  N/A

• Is kettle 25 feet away from propane tanks?

  Yes

  No

  N/A

• Is propane tank for kettle tied off?

  Yes

  No

  N/A

• Is operator within 25 feet of kettle?

  Yes

  No

  N/A

• Is the kettle pump pipe tied down securely?

  Yes

  No

  N/A

• Is kettle temperature under 400 degrees Fahrenheit?

  Yes

  No

  N/A

• Is operator wearing hard hat, face shield, long sleeve gloves, and proper clothing?

  Yes

  No

  N/A

• Is a felt machine being operated properly?

  Yes

  No

  N/A

• Is everybody working forward and/or tied off?

  Yes

  No

  N/A

• Are the workers carrying hot tar wearing compliant clothes and gloves?

  Yes

  No

  N/A

Personal Fall Arrest System ( PFAS)

• Is PFAS being worn while working above a lower level of 15' or more on residential roofs?

  Yes

  No

  N/A

• If it's a commercial building at 20' or higher, are workers within 6' of edge of roof using PFAS?

  Yes

  No

  N/A

• If skylights or other holes larger than 12" x 12" are present, is there a protective barrier surrounding it, or a piece of plywood marked hole covering it ? Is the roofer working inside of barrier using PFAS?

  Yes

  No

  N/A

• If workers are not using their PFAS at the edge, is there a parapet wall at least 36" present? ( If wall is present, fall protection is not mandatory at roof edge)

  Yes

  No

  N/A

• Does job require stansions and caution tape at edges?

  Yes

  No

  N/A

• Anchor, harness and/or lifeline in good working condition?

  Yes

  No

  N/A

• Harness date is compliant? (Not expired)

  Yes

  No

  N/A

• Are all anchors properly secured per manufacturers specs? (If installed into a truss, at least 2" screws are required in all center holes).<br>If installed into the field all 32 holes require 2" screws.<br>

  Yes

  No

  N/A

• Is PFAS properly attached to anchors and harness?

  Yes

  No

  N/A

• Pictures of anchors secured and roofers wearing fall PFAS.

  Media

Personal Protective Equipment (PPE)

• Is correct foot wear, long pants, long sleeved Midwest shirt, gloves, and safety glasses being worn correctly?

  Yes

  No

  N/A

• Are hard hats are worn correctly?

  Yes

  No

  N/A

• Saw and saw blade guards are being used correctly?

  Yes

  No

  N/A

• Is all equipment, tools, and electrical cords in proper working condition?

  Yes

  No

  N/A

• Picture of roofer wearing personal protective equipment.

  Media

Ladder

• Ladder placed on level surface, away from all doorways, and high traffic areas?

  YES

  NO

• Does Ladder conform to applicable standards?

  YES

  NO

• Are we using our ladder extensions?

  Yes

  No

  N/A

• If ladder extensions are not possible, is the ladder tied to roof and extended at least 3' above eave?

  Yes

  No

  N/A

• Picture of ladder tied to roof 3' above eave.

  Media

• Is there safe passage to and from the access point?

  YES

  NO

Any special or miscellaneous notes about job site or crew.

• Final observation

• Drawing if needed

  Drawing

• Misc. pictures of job site or crew

  Media

• COMMENTS & CORRECTIVE ACTIONS TAKEN by Superintendent (not a warning, just recognizing and correcting possible dangerous situations).

• Signature here affirms that possible dangerous situations will be corrected by foreman. Failure to correct the possible dangerous situation after the situation has been recognized will result in a written warning. Only foreman is required to sign.

  Sign

• Safety Directors Review & Actions Taken

• Signature of employee being warned. If multiple or repeated offenses occur, employee may be asked to exit job site and will not be payed for the remainder of the work day. Three or more violations may be cause for termination.

  Sign