Title Page
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Site conducted
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Conducted on
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Prepared by
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Client Name
- S'n'S Erectors
- Grout Tech Inc.
- Alpha Painting and Decorating
- Yates Construction
- Clayco Construction
- Cherry Coatings
- MK Marlow
- Kovach Enclosure Systems
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Foreman / Project Manager
General Safety
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Are posters and safety signs or warnings in place?
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Has site management been made aware of this issue?
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Are daily safety meetings being held? (Ex. Toolbox talks, as- needed safety stand downs, etc.)?
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Is there a valid reason a brief safety meeting could not be held on this day?
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Is a first-aid kit available and adequately stocked?
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Has site management been made aware of this issue?
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Are emergency telephone numbers posted?
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Has site management been made aware of this issue?
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Has an accident reporting procedure been established?
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Has site management been made aware of this issue?
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Has job-related safety training been completed?
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Have training needs been identified and brought to the attention of site management?
Housekeeping and Sanitation
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Are work area(s) generally neat and clean?
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Please list the area in- need and the next steps needed to remedy this issue.
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Are passageways and walkways clear?
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Please list the area in- need and the next steps needed to remedy this issue.
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Are waste containers provided and used?
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Please list the area in- need and the next steps needed to remedy this issue.
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Is the work area well lighted?
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Please list the area in- need and the next steps needed to remedy this issue.
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Is there an adequate potable water supply?
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Please list the area in- need and the next steps needed to remedy this issue.
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Have nails, boards, and debris been removed?
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Please list the area in- need and the next steps needed to remedy this issue.
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Are eye-flushing facilities available?
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Please list the area in- need and the next steps needed to remedy this issue.
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Are emergency showers available?
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Please list the area in- need and the next steps needed to remedy this issue.
Hazard Communication
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Is there a written program?
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Has site management been made aware of this issue?
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Are employees trained?
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Has training been scheduled or coordinated with site management?
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Are safety data sheets on file and readily available?
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Are material(s) properly stored and labeled?
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Is a log of all chemicals on site available?
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Are labels legible?
PPE
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Have hazard evaluations been performed?
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Has site management been notified?
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Is protective equipment adequate for exposure?
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Please identify the inadequate equipment.
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Are employees issued PPE where needed?
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Are inspections being conducted before and after use of PPE?
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Is PPE being used in the field?
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Identify the at- risk behavior and solutions needed to remedy.
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Are employees trained in the use of PPE?
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Has site management been notified and training scheduled?
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Are inspections being conducted before and after use of PPE?
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If not, please list the suggested remedies for this at- risk condition.
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Is adequate fall protection provided?
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If not, please list the suggested remedies for this at- risk condition.
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Is eye protection available?
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If not, please list the suggested remedies for this at- risk condition.
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Is face protection (glasses, goggles, shields) available?
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If not, please list the suggested remedies for this at- risk condition.
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Are respirators and masks provided?
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If not, please list the suggested remedies for this at- risk condition.
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Are respirators used to protect against harmful dust, asbestos, sand blasting, and welding (lead, paint, and galvanized zinc or cadmium)?
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If not, please list the suggested remedies for this at- risk condition.
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Is head protection available?
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If not, please list the suggested remedies for this at- risk condition.
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Is hand and foot protection available?
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If not, please list the suggested remedies for this at- risk condition.
Power Tools
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Is proper housekeeping conducted where tools are used?
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If not, please list the suggested remedies for this at- risk condition.
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Are inspections and proper maintenance of tools performed?
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If not, please list the suggested remedies for this at- risk condition.
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Are tool guards in place and used correctly?
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If not, please list the suggested remedies for this at- risk condition.
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Are damaged or malfunctioning tools tagged out until repaired or replaced?
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If not, please list the suggested remedies for this at- risk condition.
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Is competent instruction and supervision provided?
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If not, please list the suggested remedies for this at- risk condition.
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Are cords included in electrical inspection?
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If not, please list the suggested remedies for this at- risk condition.
Ladders
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Are ladders inspected and in good condition?
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If not, please list the suggested remedies for this at- risk condition.
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Are ladders used properly?
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If not, please list the suggested remedies for this at- risk condition.
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Are ladders secured to prevent slipping, sliding, or falling?
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If not, please list the suggested remedies for this at- risk condition.
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Do siderails extend 36 inches above top of landing?
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If not, please list the suggested remedies for this at- risk condition.
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Are ladders properly maintained and stored?
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If not, please list the suggested remedies for this at- risk condition.
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Is fall protection provided for fixed ladders in excess of 20 feet long?
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If not, please list the suggested remedies for this at- risk condition.
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Are aluminum ladders being used where they could make contact with live electrical equipment?
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If not, please list the suggested remedies for this at- risk condition.
Electrical
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Is electrical equipment properly maintained?
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If not, please list the suggested remedies for this at- risk condition.
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Is equipment properly grounded?
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If not, please list the suggested remedies for this at- risk condition.
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Are proper fire extinguisher(s) provided?
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If not, please list the suggested remedies for this at- risk condition.
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Are cords staged where they could pose a hazard or become damaged?
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If not, please list the suggested remedies for this at- risk condition.
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Is electrical equipment being used in wet areas or conditions?
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If not, please list the suggested remedies for this at- risk condition.
Fire Prevention
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Are an adequate number and types of fire extinguisher(s) available?
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If not, please list the suggested remedies for this at- risk condition.
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Is fire prevention/extinguisher training performed?
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Has site management been notified and training scheduled?
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Are inspections of fire extinguishers performed periodically?
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If not, please list the suggested remedies for this at- risk condition.
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Are flammable liquids stored in approved containers and correctly labeled?
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If not, please list the suggested remedies for this at- risk condition.
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Flammable Liquids and Materials
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Are only approved containers being used?
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If not, please list the suggested remedies for this at- risk condition.
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Are containers stored in approved and appropriate area(s)?
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If not, please list the suggested remedies for this at- risk condition.
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Are cylinders stored or secured in an upright position?
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If not, please list the suggested remedies for this at- risk condition.