Title Page
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Project:
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Project Address:
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Project Permit Number:
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Date & Time:
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Weather:
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Safety Manager:
Subcontractor Manpower
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What subcontractors are on site?
Job Safety Orientations/ Refresher
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Was a job safety orientation or refresher orientation conducted / held?
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Date and Time:
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Contractors in attendance:
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Has the job safety orientation log been updated?
Site Specific Safety Manual
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Is the AECOM Tishman Site Specific Safety Manual located on site?
Safety Documentation
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Are pre-shift safety meetings (daily pre task plans) being conducted and submitted by the subcontractors prior to the start of the shift?
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Are pre-shift safety meetings (daily pre task plans) being conducted and submitted by the controlling contractors Foremen prior to the start of the shift?
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Are weekly toolbox box talks being conducted and submitted by the subcontractors?
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Are weekly toolbox box talks being conducted and submitted by the controlling contractors Foreman or Safety Manager? (Date? Topic? Attendance?)
Daily Inspections of Site Activities With Corrective Actions and Safety Violations
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What site activities were observed?
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Safety inspection locations that were spot checked?
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Unsafe actions, conditions, notification, stop work orders, summonses, and location of each: (See LifeGuard for additional observations )
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Corrected unsafe actions, conditions, notifications, orders: (See LifeGuard for additional observations )
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Any safety violations administered?
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If yes, please list and see the attached safety violation.
Positive Safety Practices Observed
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Positive Safety Practices observed (See LifeGuard Observations)
Incidents, Accidents, Near Miss', Property Damage
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Did an incident, accident, near miss or property damage occur?
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If yes, please list and see the attached incident report.
Regulatory Inspections
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Did a regulatory inspection occur?
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Type of regulatory inspection
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Date of the regulatory inspection
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Location of the regulatory inspection
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What was the outcome of the regulatory inspection?
Safety Managers Signatures
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Date & Time:
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Primary Site Safety Coordinator Signature
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Date & Time:
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Alternate Site Safety Coordinator Signature
