Title Page
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Job Number
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Supervisor
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Project
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Conducted on
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Prepared by
Administration
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Safety Manual
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Site Specific SDS Sheets
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Labor Law Poster
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Visitor PPE Available
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Weekly Safety Meeting Completed (Tool Box Talk)
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Weekly Safety Audit Completed
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Emergency Response Plan Posted
Electrical
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Cords in good condition
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Cords protected from traffic
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GFCI's being used
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LO/TO Procedures in place
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Energized Parts Protected
Fire Protection
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Fire Extinguisher Inspected Monthly and Annually
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Proper Fuel Containers Used
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Combustibles have been removed from the hot work area
Hand and Power Tool
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Cords in good condition
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Ground Prongs in Place
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Guards in place
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Handles in good condition
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Proper Tool for the job
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Tool in good condition
Housekeeping
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Clear Access to Building or Site
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Rebar Caps in place for any protruding metal 5' or less in height
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Materials Stored Properly
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Slip, Trip, and Fall Hazards
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Trash in Proper container
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Walkways Clear
Ladders
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Extension ladders are 3' above landing and secured
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No step greater than 19 inches in height
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Extension set up on a 4 to 1 pitch
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Not defects
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Step ladders fully opened when in use
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Proper use of the ladder
PPE
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Hard Hats
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Safety Glasses
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Gloves when necessary
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Hearing Protection
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Proper Clothing
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Work Boots
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Face Shields
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Respirators/Dust Masks
Motorized Equipment
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Back up alarm functioning
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Horn Functioning
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Inspected
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Seat belts being used
Scaffolding
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Bracing and Pins in place
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Guardrails in place
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Inspected Daily
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Proper Access
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Sill plates, leveling jacks, wheels installed properly
Scissor and Aerial Lifts
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Gate or Chain Secured
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Harness while in boom lift
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Inspected
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Not standing on top or mid rails
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Ground Conditions
Site and Public Protection
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Adequate Lighting
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Barricades Installed Properly
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Company Rep Present
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Falling Object Protection
Silica
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Are there any activities being conducted that would produce silica dust
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Are Exposure Control Plans submitted
