Title Page

  • Job Number

  • Supervisor

  • Project

  • Conducted on

  • Prepared by

Administration

  • Safety Manual

  • Site Specific SDS Sheets

  • Labor Law Poster

  • Visitor PPE Available

  • Weekly Safety Meeting Completed (Tool Box Talk)

  • Weekly Safety Audit Completed

  • Emergency Response Plan Posted

Electrical

  • Cords in good condition

  • Cords protected from traffic

  • GFCI's being used

  • LO/TO Procedures in place

  • Energized Parts Protected

Fire Protection

  • Fire Extinguisher Inspected Monthly and Annually

  • Proper Fuel Containers Used

  • Combustibles have been removed from the hot work area

Hand and Power Tool

  • Cords in good condition

  • Ground Prongs in Place

  • Guards in place

  • Handles in good condition

  • Proper Tool for the job

  • Tool in good condition

Housekeeping

  • Clear Access to Building or Site

  • Rebar Caps in place for any protruding metal 5' or less in height

  • Materials Stored Properly

  • Slip, Trip, and Fall Hazards

  • Trash in Proper container

  • Walkways Clear

Ladders

  • Extension ladders are 3' above landing and secured

  • No step greater than 19 inches in height

  • Extension set up on a 4 to 1 pitch

  • Not defects

  • Step ladders fully opened when in use

  • Proper use of the ladder

PPE

  • Hard Hats

  • Safety Glasses

  • Gloves when necessary

  • Hearing Protection

  • Proper Clothing

  • Work Boots

  • Face Shields

  • Respirators/Dust Masks

Motorized Equipment

  • Back up alarm functioning

  • Horn Functioning

  • Inspected

  • Seat belts being used

Scaffolding

  • Bracing and Pins in place

  • Guardrails in place

  • Inspected Daily

  • Proper Access

  • Sill plates, leveling jacks, wheels installed properly

Scissor and Aerial Lifts

  • Gate or Chain Secured

  • Harness while in boom lift

  • Inspected

  • Not standing on top or mid rails

  • Ground Conditions

Site and Public Protection

  • Adequate Lighting

  • Barricades Installed Properly

  • Company Rep Present

  • Falling Object Protection

Silica

  • Are there any activities being conducted that would produce silica dust

  • Are Exposure Control Plans submitted

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.