SAFETY INSPECTION

• Conducted on

  Date

• JOB ADDRESS

• CREW NAME

• # of workers on jobsite

• Safety Inspection Performed by

• INITIAL OBSERVATION<br>Are there any immediate hazards observed?

  Yes

  No

  N/A

LADDER

• Does Ladder conform to applicable standards?

  YES

  NO

• Ladder secured to roof and extended at least 3' above eave?

  YES

  NO

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

  Media

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

  YES

  NO

PERSONAL FALL ARREST SYSTEM (PFAS)

• PFAS worn while working 6' or more above a lower lever?

  YES, to Code

  NO

• Picture of worker wearing PFAS.

  Media

• Is PFAS safely attached to anchors and harness?

  YES, to Code

  NO

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

  YES

  NO

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

  YES, to Code

  NO

• Are all anchors properly secured per manufactures specifications?<br>If installation into truss using screw/nail in center row of holes.<br>If installation into field using screw/nail in every rows of holes.<br>

  YES, to Code

  NO

• Picture of PFAS anchored to truss.

  Media

OTHER IMPORTANT SAFETY POINTS & PERSONAL PROTECTIVE EQUIPMENT (PPE)

• Are Hard Hats properly utilized as required?

  YES

  NO

• Are Safety Glasses properly utilized as required?

  YES

  NO

• If safety can is present, is it a Metal Can?

  YES

  NO

• Is Fire Extinguisher present and charged as required?

  YES

  NO

• Is First Aid Kit present?

  YES

  NO

• Are all other equipment, tools, and cords in good condition?<br>

  YES

  NO

• COMMENTS & CORRECTIVE ACTIONS TAKEN by Superintendent