Title Page
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Site Name:
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Project Number:
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Conducted on
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Prepared by
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Location
Job Site Inspection
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Daily Safety Meeting Conducted today?
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Why was the meeting not conducted?
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JHA reviewed and discussed with team?
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Why was this not discussed?
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HASP Available and Up To Date
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Not Available?
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Not up to date?
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Emergency Procedures / SRS discussed during safety meeting?
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Vehicle available on-site for transportation to hospital?
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Why is the vehicle not available?
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Proper PPE being worn as specified in the HASP and/or JHA?
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Level being worn?
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Why is it not being worn?
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PPE adequate for work conditions?
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If not, Give reason?
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Monitoring equipment calibrated?
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Vehicle and Equipment inspections completed?
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Why are the inspections not completed?
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Wheel Chocks on site and being used?
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Kill switches operable on all pieces of equipment?
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What needs to be fixed?
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Is equipment Out of Service?
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Work zones set up properly?
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What can be done differently?
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First Aid and Eye Wash on site and in good working order?
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Why are no first aid measures established?
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Is a spill kit present?
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Why is no spill kit present?
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In good condition?
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Proper cleaning fluids being used for known contaminants?
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What needs to be changed or obtained?
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Proper decon procedures being used?
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Why are decon procedures not being followed?
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Decon personel wearing proper PPE?
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Why is the proper PPE not being worn?
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Equipment being decontaminated?
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Why is the equipment not being decon'd?
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Disposal items changed twice a day or as needed?
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Why is this not being done?
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Proper collection and disposal of PPE?
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Why is this not being done?
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Proper collection and disposal of decon fluids?
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How were these fluids disposed of?
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Is the buddy system being used?
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Kneeling or sitting on drums or ground is prohibited? (unless needed)
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What is the necessity of doing this?
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Adequate illumination provided at night or in dark areas?
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Explain why not properly illuminated
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Smoking, Eating, or Drinking in the EZ or CRZ prohibited?
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Entry into excavations prohibited unless properly shored or sloped?
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Is excavation shored or sloped?
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Why not properly shored or sloped?
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All unusual situations on-site listed in the HASP?
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What was unusual?
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What actions were taken?
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Was the HASP revised?
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Reason for not revising?
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All confined spaces identified?
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If not, list confined spaces:
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Confined Space Permits used?
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Why was the permit not used?
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Work zones free from trip and fall hazards?
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What are the Trip/Fall hazard?
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Work zones free of litter and trash and cleaned on a daily basis?
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Why is the work zone not free of trash?
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Are 2-20lb. fire extinguishers on site?
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Check fire extinguisher tag for up to daily initials on inspections
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inspections must be completed on monthly basis and signed off on tag.
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On-Site personnel utilizing good hygiene practices?
Discrepancies
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Any other safety issues?
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Name of person authenticating:
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Signature:
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Date and Time:
