Site Health and Safety Inspection

• Audit Title

• Project Name

• Project Number

• Project Location
  Address

• Project Supervisor

• Conducted on

  Date

• Weather

  Sunny / Warm

  Cloudy / Cool

  Rain

  Snow

  Windy

• Subcontractors onsite?

  Yes

  No

  N/A

• List names

Previous HSE Inspection

• Has the last inspection been reviewed?

  Yes

  No

  N/A

• Have all safety issues from this inspection been corrected?

  Yes

  No

  N/A

1.0 Jobsite General

• 1.1 Is a "Site Specific Health and Safety Plan" required, and if so, is it available for review?

  Yes

  No

  N/A

• 1.2 Are posting requirements prominently displayed on the bulletin board i.e. OSHA posters, Davis-Bacon Wages, Emergency Phone Numbers, etc.?j

  Yes

  No

  N/A

• 1.3 Are permits maintained onsite?

  Yes

  No

  N/A

• 1.4 Is the OSHA 300 Summary posted onsite? (February 1st thru April 30th)

  Yes

  No

  N/A

• 1.5 Are toolbox safety meetings held weekly?

  Yes

  No

  N/A

• 1.6 Are First Aid kits available and adequately stocked?

  Yes

  No

  N/A

• 1.7 Are stretch and flex exercises performed daily?

  Yes

  No

  N/A

2.0 Housekeeping and Sanitation

• 2.1 Are floors and/or ground free from trash and debris?

  Yes

  No

  N/A

• 2.2 Are waste containers provided and used?

  Yes

  No

  N/A

• 2.3 Are sanitary facilities (male/female) adequate and clean?

  Yes

  No

  N/A

• 2.4 Is there an adequate supply of potable water onsite?

  Yes

  No

  N/A

• 2.5 Is there adequate lighting for work being done?

  Yes

  No

  N/A

• 2.6 Are minor spills reported and cleaned up promptly?

  Yes

  No

  N/A

• 2.7 Are passageways and exits clear?

  Yes

  No

  N/A

• 2.8 Is dirt and debris removed from streets and sidewalks to help prevent public injury?

  Yes

  No

  N/A

• 2.9 If there is a maintenance yard, are parts (cutting edges, teeth, etc.) stored in an orderly fashion?

  Yes

  No

  N/A

3.0 Construction Area - Site Security

• 3.1 Are warning signs in place?

  Yes

  No

  N/A

• 3.2 Are open ditches and drop-offs protected?

  Yes

  No

  N/A

• 3.3 Are ladders lowered and secured when not in use?

  Yes

  No

  N/A

• 3.4 Are sidewalks protected?

  Yes

  No

  N/A

• 3.5 Is construction fence maintained onsite?

  Yes

  No

  N/A

• 3.6 Is the fence locked at end of shift?

  Yes

  No

  N/A

• 3.7 Are holes and/or openings protected and marked appropriately?

  Yes

  No

  N/A

• 3.8 Are adequate warning signs of detours and obstructions in place?

  Yes

  No

  N/A

• 3.9 Are personal vehicles controlled onsite?

  Yes

  No

  N/A

• 3.10 Is GPS equipment secured at end of shift?

  Yes

  No

  N/A

• 3.11 Are keys removed from equipment and doors locked when shift is over?

  Yes

  No

  N/A

• 3.12 Is equipment parked and secured in a well lit area?

  Yes

  No

  N/A

• 3.13 Are light plants, generators, trailers etc. protected from theft?

  Yes

  No

  N/A

4.0 Hazard Communication

• 4.1 Is a written HAZCOM program onsite?

  Yes

  No

  N/A

• 4.2 Are the employees trained in the "Global Harmonized System" (GHS)?

  Yes

  No

  N/A

• 4.3 Are employees informed of how to retrieve a Safety Data Sheet (SDS) on the company website?

  Yes

  No

  N/A

• 4.4 Are materials properly stored and labeled?

  Yes

  No

  N/A

• 4.5 Are the labels legible?

  Yes

  No

  N/A

• 4.6 Is there a spill kit available onsite and is it adequately stocked?

  Yes

  No

  N/A

5.0 Fire Prevention

• 5.1 Are there an adequate number of fire extinguishers available onsite?

  Yes

  No

  N/A

• 5.2 Have practices and procedures been established to control potential fire hazards and ignition sources?

  Yes

  No

  N/A

• 5.3 Are employees aware of the fire hazards of the materials and processes to which they are exposed?

  Yes

  No

  N/A

• 5.4 Are fire extinguishers inspected monthly by the company and annually by an outside source?

  Yes

  No

  N/A

• 5.5 Are employees trained in the use of fire extinguishers?

  Yes

  No

  N/A

• 5.6 Are flammables and combustibles labeled and properly stored ?

  Yes

  No

  N/A

• 5.7 Is equipment shut down prior to fueling?

  Yes

  No

  N/A

• 5.8 Is smoking prohibited within 50 feet of any fueling operations?

  Yes

  No

  N/A

• 5.9 Are gasoline engines allowed to cool down before fueling?

  Yes

  No

  N/A

6.0 Flammable and Combustible Materials

• 6.1 Are there flammables or combustibles onsite? (If no, hit N/A on all and proceed to Section 7)

  Yes

  No

  N/A

• 6.2 Are combustible scrap, debris and waste materials (oily rags) stored in covered metal receptacles and removed from the project site promptly?

  Yes

  No

  N/A

• 6.3 Are proper storage methods used to minimize the risk of fire and spontaneous combustion?

  Yes

  No

  N/A

• 6.4 Are approved containers being used for the storage and handling of flammable and combustible liquids?

  Yes

  No

  N/A

• 6.5 Are all connections tight on drums and combustible liquid piping (vapor and liquid)?

  Yes

  No

  N/A

• 6.6 Are all flammable liquids kept in closed containers when not in use?

  Yes

  No

  N/A

• 6.7 Are bulk drums of flammable liquids grounded or bonded to containers during dispensing?

  Yes

  No

  N/A

• 6.8 Are safe practices followed when gasoline, diesel, or liquid petroleum gas (propane) is stored, handled and used?

  Yes

  No

  N/A

• 6.9 Are all solvent wastes and flammable liquids kept in fire-resistant, covered containers until they area removed from the worksite ?

  Yes

  No

  N/A

• 6.10 Are fuel-gas cylinders and oxygen cylinders separated by distance, fire resistant barriers or other means while in storage?

  Yes

  No

  N/A

• 6.11 Are fire extinguishers provided for the type of materials they will extinguish and placed in areas where they are to be used?<br> <br> CLASS A: Ordinary combustible material<br> CLASS B: Flammable liquids, gas or grease<br> CLASS C: Energized electrical equipment

  Yes

  No

  N/A

• 6.12 Are appropriate fire extinguishers mounted within 75 feet of outside areas containing flammable liquids and within 10 feet of any inside storage area for such materials?

  Yes

  No

  N/A

• 6.13 Are fire extinguishers mounted so that employees do not have to travel more than 75 feet for Class A fires or 50 feet for a Class B fire?

  Yes

  No

  N/A

• 6.14 Are all fire extinguishers serviced, maintained and tagged at least annually?

  Yes

  No

  N/A

• 6.15 Are fire extinguishers inspected monthly and removed from service if not fully charged?

  Yes

  No

  N/A

• 6.16 Are "NO SMOKING" signs posted in areas where flammable and combustible materials are used or stored?

  Yes

  No

  N/A

• 6.17 Are safety cans used for dispensing flammable and combustible liquids?

  Yes

  No

  N/A

7.0 Fuel Operations

• 7.1 How is equipment being fueled onsite?

  Aboveground Storage Tank

  Fuel Truck (Company)

  Fuel Truck (3rd Party)

• 7.2 Is it prohibited to fuel an internal combustion engine with a flammable liquid while the engine is running?

  Yes

  No

  N/A

• 7.3 Are fueling operations done in such a manner that the likelihood of spillage will be minimal?

  Yes

  No

  N/A

• 7.4 When spillage occurs during fueling operations, is the spilled fuel washed away completely, evaporated, or other health and safety guidelines followed to control vapors before restarting the engine?

  Yes

  No

  N/A

• 7.5 Are fuel tank caps replaced and secured before starting the engine?

  Yes

  No

  N/A

• 7.6 In fueling operations, is there always metal contact between the container and the fuel tank?

  Yes

  No

  N/A

• 7.7 Are fueling hoses of a type designed to handle the specific type of fuel?

  Yes

  No

  N/A

• 7.8 Is it prohibited to handle or transfer gasoline in open containers?

  Yes

  No

  N/A

• 7.9 Are open lights, open flames, sparking, or arcing equipment prohibited near fueling or transfer of fuel operations?

  Yes

  No

  N/A

• 7.10 Is smoking prohibited in the vicinity of fueling operations?

  Yes

  No

  N/A

• 7.11 If using an Aboveground Storage Tank (AST) is it placarded with appropriate signs i.e. Gasoline (1203), Diesel (1993), No Smoking, etc.?

  Yes

  No

  N/A

• 7.12 If using an Aboveground Storage Tank (AST) are fire extinguishers located between 25' - 75 feet away from tank?

  Yes

  No

  N/A

8.0 Electrical

• 8.1 Are preliminary inspections performed by employees to determine what conditions exist prior to starting work on electrical equipment or lines?

  Yes

  No

  N/A

• 8.2 Are lockout/tagout procedures being performed when electrical equipment is being serviced?

  Yes

  No

  N/A

• 8.3 Are all portable hand-held electrical tools and equipment either grounded or double-insulated?

  Yes

  No

  N/A

• 8.4 Are ground fault circuit interrupters used to protect employees?

  Yes

  No

  N/A

• 8.5 If not, is an assured equipment grounding program in place?

  Yes

  No

  N/A

• 8.6 Are live electrical parts guarded against accidental contact?

  Yes

  No

  N/A

• 8.7 Are extension cords protected from damage?

  Yes

  No

  N/A

• 8.8 Are extension cords removed from service when cut, worn, frayed or missing prongs?

  Yes

  No

  N/A

• 8.9 Are conductors entering boxes, cabinets or fittings protected from abrasion?

  Yes

  No

  N/A

• 8.10 Are all unused openings (including conduit knockouts) of electrical enclosures and fittings closed with appropriate covers, plugs, or plates?

  Yes

  No

  N/A

• 8.11 Are portable generators grounded?

  Yes

  No

  N/A

• 8.12 Are signs being used to warn workers of electrical dangers (above and below ground)?

  Yes

  No

  N/A

• 8.13 Are temporary lights equipped with guards to prevent accidental contact with bulb?

  Yes

  No

  N/A

• 8.14 Is the circuit breaker panel clearly labeled and secured?

  Yes

  No

  N/A

• 8.15 Is there sufficient access and working space around junction boxes? (36" minimum)

  Yes

  No

  N/A

9.0 Personal Protective Equipment (PPE)

• 9.1 Have levels of personal protection been established?

  Yes

  No

  N/A

• 9.2 Are employees instructed on the proper use of the PPE?

  Yes

  No

  N/A

• 9.3 Are protective goggles or face shields provided and worn where there is any danger of flying particles or corrosive materials?

  Yes

  No

  N/A

• 9.4 Are approved safety glasses (ANSI Z87-1) being worn at all times in areas where there is a risk of eye injury?

  Yes

  No

  N/A

• 9.5 Are high visibility vests provided and worn by all personnel?

  Yes

  No

  N/A

• 9.6 Are hardhats provided and worn where danger of flying or falling objects exists?

  Yes

  No

  N/A

• 9.7 Are hardhats inspected periodically for damage to the shell and suspension system?

  Yes

  No

  N/A

• 9.8 Is appropriate foot protection being worn, as required by policy?

  Yes

  No

  N/A

• 9.9 Are air contaminants present i.e. paint, solvents, dust, etc. that would require the use of respirators or dust masks?

  Yes

  No

  N/A

• 9.10 Are eyewash bottles and/or stations located in the vicinity of employees who are working in a potentially hazardous area?

  Yes

  No

  N/A

• 9.11 Is there a designated area for eating and drinking where there is no exposure to dust, fumes, toxic materials or other health hazards?

  Yes

  No

  N/A

• 9.12 Is hearing protection available to all employees when sound levels exceed 90 decibels in an 8 hour day?

  Yes

  No

  N/A

10.0 Hand and Power Tools

• 10.1 Are tools and cords inspected prior to each use?

  Yes

  No

  N/A

• 10.2 Are tools and cords in good condition?

  Yes

  No

  N/A

• 10.3 Are tools and cords stored properly when not in use?

  Yes

  No

  N/A

• 10.4 Are the right tools being used for the task at hand?

  Yes

  No

  N/A

• 10.5 Are tools properly grounded or double insulated?

  Yes

  No

  N/A

• 10.6 Are guards and/or attachments being used on equipment or tools that require them?

  Yes

  No

  N/A

• 10.7 Are damaged or malfunctioning tools tagged out and not used until repaired or replaced?

  Yes

  No

  N/A

• 10.8 Are whip-checks being used on air hoses exceeding a 1/2" inside diameter?

  Yes

  No

  N/A

• 10.9 Are employees instructed not to use electrical power tools near flammable gases/vapors?

  Yes

  No

  N/A

• 10.10 Is proper PPE being worn by employees?

  Yes

  No

  N/A

11.0 Portable Ladders

• 11.1 Are portable ladders being used onsite? (If no, hit N/A on all and proceed to Section 12)

  Yes

  No

  N/A

• 11.2 Are all ladders maintained in good condition? (rungs, side rails, hardware and fittings securely attached, moveable parts operating freely without binding or undue play)

  Yes

  No

  N/A

• 11.3 Are non-slip safety feet provided on each ladder?<br>

  Yes

  No

  N/A

• 11.4 Are ladder rungs and steps free of mud, grease and oil?

  Yes

  No

  N/A

• 11.5 Are ladders setup correctly (not on boxes, barrels or other unstable bases to obtain additional height)?

  Yes

  No

  N/A

• 11.6 Are employees facing the ladder when ascending or descending?

  Yes

  No

  N/A

• 11.7 Are employees prohibited from using ladders that are missing labels, broken, missing steps, rungs or cleats, broken side rails or other faulty equipment?

  Yes

  No

  N/A

• 11.8 When portable ladders are used to gain access to elevated platforms, roofs, etc., does the ladder extend 3' above the elevated surface?

  Yes

  No

  N/A

• 11.9 Are employees instructed not to use the top step of portable ladders, including stepladders, as a step?

  Yes

  No

  N/A

• 11.10 Are ladders prohibited from being placed in front of door openings except when the door is blocked open, locked or guarded?

  Yes

  No

  N/A

• 11.11 Are ladders placed at appropriate angle (1 foot away from the wall for every 4 foot of length)?

  Yes

  No

  N/A

• 11.12 Are portable ladders secured at the base to prevent ladder from moving?

  Yes

  No

  N/A

• 11.13 If using portable metal ladders are they legibly marked with signs reading "CAUTION" - Do Not Use Around Electrical Equipment or equivalent wording?

  Yes

  No

  N/A

• 11.14 When using a stepladder, is the side braces and cross braces locked?

  Yes

  No

  N/A

12.0 Hoisting and Rigging

• 12.1 Are hoisting and rigging activities being conducted onsite? (If no, hit N/A on all and proceed to Section 13)

  Yes

  No

  N/A

• 12.2 Is rigging equipment inspected prior to each use and periodically thereafter?

  Yes

  No

  N/A

• 12.3 Are ropes, slings, chains, hooks, cables, clevises and chokers in good condition?

  Yes

  No

  N/A

• 12.4 Are damaged slings, chains and other rigging equipment removed from service?

  Yes

  No

  N/A

• 12.5 Are slings padded and protected from sharp corners?

  Yes

  No

  N/A

• 12.7 Are U - bolts (crosby clips) being used and are they placed and spaced correctly?

  Yes

  No

  N/A

• 12.6 If provided, are safety latches on hooks operable?

  Yes

  No

  N/A

• 12.8 Are employees instructed not to stand or walk underneath the load?

  Yes

  No

  N/A

• 12.9 Are tag-lines being used to prevent the load from swinging?

  Yes

  No

  N/A

• 12.10 Is barricade tape placed around the swing radius to prevent unauthorized access?

  Yes

  No

  N/A

• 12.11 Is there an identification tag on the sling or lifting chain and is it legible?

  Yes

  No

  N/A

13.0 Trenching and Excavations

• 13.1 Are trenching or excavation activities being conducted onsite? (If no, hit N/A on all and proceed to Section 14)

  Yes

  No

  N/A

• 13.2 Has a "Competent Person" been designated to oversee excavation activities?

  Yes

  No

  N/A

• 13.3 Have utilities been located and properly marked prior to excavation?

  Yes

  No

  N/A

• 13.4 Are utilities refreshed every 30 days as required?

  Yes

  No

  N/A

• 13.5 Has the trench been inspected by a competent person prior to work and have they completed the trench log?

  Yes

  No

  N/A

• 13.6 Is the trench inspected by the competent person after every rainstorm or other hazard-increasing occurrence to determine if additional protection against slides and cave-ins is necessary?

  Yes

  No

  N/A

• 13.7 Has a visual and manual test been performed on the soils and documented on the trench log?

  Yes

  No

  N/A

• 13.8 Are materials, spoil piles and equipment at least 2' away from the edge of excavation - If not, are they kept in place by retaining devices?

  Yes

  No

  N/A

• 13.9 Is the sloping or benching system configured correctly to the soil type? (B-1 Maximum Allowable Slopes)

  Yes

  No

  N/A

• 13.10 Are adjacent roads, sidewalks and utilities supported and protected?

  Yes

  No

  N/A

• 13.11 If a trench box is being used, is the tabulated data onsite and available for review?

  Yes

  No

  N/A

• 13.12 Is the trench box extended at least 18" above grade to prevent loose debris from falling or rolling into the trench (if sloping is used to protect workers)?

  Yes

  No

  N/A

• 13.13 If trench box is not extended above top of excavation, is it at ground level?

  Yes

  No

  N/A

• 13.15 If the trench is greater than 4 feet deep has the atmosphere been tested when there is a possibility of oxygen deficiency or build-up of hazardous gases?

  Yes

  No

  N/A

• 13.14 Does the trench box sit no more than 2 feet above bottom of trench (or less if soil collapsing behind or below trench box) ?

  Yes

  No

  N/A

• 13.16 Are ladders or ramps being used in in trenches greater than 4 feet deep?

  Yes

  No

  N/A

• 13.17 Are ladders placed every 25 feet of lateral movement for employees?

  Yes

  No

  N/A

• 13.18 Are ladders properly secured and extend 3 feet above lower level?

  Yes

  No

  N/A

• 13.19 Are ladders placed inside the trench box?

  Yes

  No

  N/A

• 13.20 If used, are equipment ramps adequate?

  Yes

  No

  N/A

• 13.21 Are precautions taken to protect employees from water accumulating inside the trench?

  Yes

  No

  N/A

• 13.22 Is surface water or runoff diverted and/ or controlled to prevent water accumulating inside the trench?

  Yes

  No

  N/A

• 13.23 If trench is greater than 20 feet deep has it been approved by a registered PE?

  Yes

  No

  N/A

• 13.24 Are open trenches or excavations onsite protected by berms, fence, etc.?

  Yes

  No

  N/A

• 13.25 If using berms onsite, are they constructed correctly? (good course material and at mid-axle height of the largest piece of equipment onsite)

  Yes

  No

  N/A

• 13.26 Are barriers or a fence placed around open excavations near pedestrian or vehicle thoroughfares?

  Yes

  No

  N/A

• 13.27 Are personnel onsite maintaining a minimum of 6 feet away from edge of excavation?

  Yes

  No

  N/A

• 13.28 Is equipment kept a safe distance away from the edge of excavation?

  Yes

  No

  N/A

• 13.29 Are employees prohibited from working on the faces of sloped or benched excavations above other employees?

  Yes

  No

  N/A

14.0 Cranes

• 14.1 Are cranes being used onsite? (If no, hit N/A on all and proceed to Section 15)

  Yes

  No

  N/A

• 14.2 Are annual inspections completed and available for review?

  Yes

  No

  N/A

• 14.3 Are inspections performed prior to use and as needed by operator?

  Yes

  No

  N/A

• 14.4 Are all safety devices working properly (alarms, level indicator, brakes, seat belt, etc.)?

  Yes

  No

  N/A

• 14.5 Are the outriggers extended and working properly?

  Yes

  No

  N/A

• 14.6 Are supporting materials being used (blocking, mats, pads, cribbing, etc.)?

  Yes

  No

  N/A

• 14.7 Are power lines deactivated or are warning signs placed to worn employees of overhead clearance?

  Yes

  No

  N/A

• 14.8 Is the cranes swing radius barricaded or demarked?

  Yes

  No

  N/A

• 14.9 Are rated load capacities posted on the crane?

  Yes

  No

  N/A

• 14.10 Is the crane on level ground and is it capable of holding the load?

  Yes

  No

  N/A

• 14.11 Is the boom angle indicator available and working properly?

  Yes

  No

  N/A

15.0 Heavy Equipment

• 15.1 Has a pre/post trip inspection been completed on equipment?

  Yes

  No

  N/A

• 15.2 Are equipment inspection books available for review?

  Yes

  No

  N/A

• 15.3 Are lights, horn and backup alarm functioning properly?

  Yes

  No

  N/A

• 15.4 To save on idle time, is equipment being turned off after 15 minutes?

  Yes

  No

  N/A

• 15.5 Are haul roads well maintained and laid out properly?

  Yes

  No

  N/A

• 15.6 Are haul roads inspected for steep grades, sharp curves, limited site distance, slippery surfaces, etc.?

  Yes

  No

  N/A

• 15.7 Are traffic patterns established and safe?

  Yes

  No

  N/A

• 15.8 Are equipment speeds established according to site conditions?

  Yes

  No

  N/A

• 15.9 Are fire extinguishers located on equipment and inspected at least monthly?

  Yes

  No

  N/A

• 15.10 Are seat belts being worn by employees?

  Yes

  No

  N/A

• 15.11 Are seat belts in good condition and not expired?

  Yes

  No

  N/A

• 15.12 Are windows clean and free of obstructed views i.e. mud, grease, etc.?

  Yes

  No

  N/A

• 15.13 Are windows free of cracks or breaks?

  Yes

  No

  N/A

• 15.14 Are floors of equipment free from debris (bottles, pop cans, etc.)?

  Yes

  No

  N/A

• 15.15 Are employees using three points of control when mounting and dismounting equipment?

  Yes

  No

  N/A

• 15.16 Are cell phones, MP3 players, etc. being used by employees while operating equipment?

  Yes

  No

  N/A

• 15.17 Are all attachments on equipment lowered when approached and when shift ends?

  Yes

  No

  N/A

• 15.18 Are wheels chocked or turned towards berm when parked?

  Yes

  No

  N/A

• 15.19 Are employees riding in equipment without proper seating?

  Yes

  No

  N/A

16.0 Motor Vehicles

• 16.1 Has a pre/post trip Inspection been completed on tractor and/or trailer?

  Yes

  No

  N/A

• 16.2 Are inspection books (DVIR) available for review?

  Yes

  No

  N/A

• 16.3 Are drivers qualified to drive truck or tractor?

  Yes

  No

  N/A

• 16.4 Have tie down chains been inspected prior to use (lowboy trailer)?

  Yes

  No

  N/A

• 16.5 Is the deck of the lowboy trailer in good condition?

  Yes

  No

  N/A

• 16.6 Are lights, horn, brakes and backup alarm functioning properly?

  Yes

  No

  N/A

• 16.7 Do drivers check for rocks lodged in the duals before pulling onto roadway?

  Yes

  No

  N/A

• 16.8 Are fire extinguishers located on water truck or tractor?

  Yes

  No

  N/A

• 16.9 Are fire extinguishers inspected monthly and annually as required?

  Yes

  No

  N/A

• 16.10 Are seat belts being worn correctly by driver?

  Yes

  No

  N/A

• 16.11 Are seat belts in good condition and not expired?

  Yes

  No

  N/A

• 16.12 Are windows clean and free of obstructed views?

  Yes

  No

  N/A

• 16.13 Are floors free from debris (bottles, pop cans, etc.)?

  Yes

  No

  N/A

• 16.14 Did the driver of the water truck complete a DVIR (if applicable)

  Yes

  No

  N/A

• 16.15 Are employees using three points of control when mounting and dismounting?

  Yes

  No

  N/A

• 16.16 Are cell phones, MP3 players, etc. being used by employees while driving truck?

  Yes

  No

  N/A

17.0 Fall Protection

• 17.1 Are employees either walking and/or working 6 feet above a lower level? (If no, hit N/A on all and proceed to Section 18)

  Yes

  No

  N/A

• 17.2 Guardrails - are top rails a minimum of 42 inches above the leading edge of the tread or walking surface?

  Yes

  No

  N/A

• 17.3 Guardrails - are mid rails between the top rail and the walking/working surface?

  Yes

  No

  N/A

• 17.4 Guardrails - are toe boards 4 inches nominal in vertical height from its top edge to the level of the floor, platform, runway, or ramp?

  Yes

  No

  N/A

• 17.5 Guardrails - are top rails capable of holding 200 lbs. of force?

  Yes

  No

  N/A

• 17.6 Guardrails - are mid rails capable of holding 150 lbs. of force?

  Yes

  No

  N/A

• 17.7 Guardrails - are guardrail systems surfaced to prevent injury to an employee from punctures or lacerations, and to prevent snagging of clothing.

  Yes

  No

  N/A

• 17.8 Personal Fall Arrest - is a body belt being worn for personal fall arrest? (only permitted as a positioning device)

  Yes

  No

  N/A

• 17.9 Personal Fall Arrest - is harness and lanyard inspected before each use?

  Yes

  No

  N/A

• 17.10 Personal Fall Arrest - have employees been properly trained on inspection procedures?

  Yes

  No

  N/A

• 17.11 Personal Fall Arrest - do employees know appropriate anchorage points for each task?

  Yes

  No

  N/A

• 17.12 Personal Fall Arrest - is the anchorage point capable of holding 5,000 lbs.?

  Yes

  No

  N/A

• 17.13 Personal Fall Arrest - are all anchorage points of body harness located at shoulder height?

  Yes

  No

  N/A

• 17.14 Personal Fall Arrest - has the free-fall distance been considered, so that the employee doesn't hit the lower level?

  Yes

  No

  N/A

• 17.15 Personal Fall Arrest - if using fall restraint system (retractable) has It been inspected before use?

  Yes

  No

  N/A

• 17.16 Personal Fall Arrest - is there a plan to get the employee down safely in the event of a fall?

  Yes

  No

  N/A

18.0 Welding / Cutting

• 18.1 Are welding/cutting activities being performed onsite? (If no, hit N/A on all and proceed to Section 19)

  Yes

  No

  N/A

• 18.2 Is proper PPE being worn?

  Yes

  No

  N/A

• 18.3 Is a fire extinguisher present during welding/cutting operations?

  Yes

  No

  N/A

• 18.4 Are hoses and cords controlled and out of the way?

  Yes

  No

  N/A

• 18.5 Are cables protected and in good condition?

  Yes

  No

  N/A

• 18.6 Are screens and shields in place?

  Yes

  No

  N/A

• 18.7 Are cylinders transported vertically and with caps on?

  Yes

  No

  N/A

• 18.8 Are oxygen cylinders and fittings kept away from oil and grease?

  Yes

  No

  N/A

• 18.9 Are oxygen and acetylene stored properly i.e. vertically, secured?

  Yes

  No

  N/A

• 18.10 Are bottles not being used secured with caps in place?

  Yes

  No

  N/A

• 18.11 Are "Hot Work" permits completed and posted in areas requiring such permit?

  Yes

  No

  N/A

• 18.12 Are valves shut off and regulators backed off after use?

  Yes

  No

  N/A

• 18.13 Are flash back arrester placed on hoses (O2 and fuel gas)?

  Yes

  No

  N/A

• 18.14 Are areas inspected for fire hazards prior to welding/cutting operations?

  Yes

  No

  N/A

19.0 Confined spaces

• 19.1 Are there any confined spaces onsite? (If no, hit N/A on all and proceed to Section 20)

  Yes

  No

  N/A

• 19.2 If yes, has the "Confined Space Analysis" form been completed to identify and evaluate the space?

  Yes

  No

  N/A

• 19.3 Are danger signs posted (or other equally effective means of communication) to inform employees about the existence, location and dangers of confined spaces?

  Yes

  No

  N/A

• 19.4 Has anyone surveyed the surrounding area for other potential hazards including drifting vapors and/or gases outside the space?

  Yes

  No

  N/A

• 19.5 Is the written confined space program onsite and available to employees?

  Yes

  No

  N/A

• 19.6 Have guardrails and/or temporary barriers been installed to protect employees from falls and from foreign objects entering the space?

  Yes

  No

  N/A

• 19.7 Has the atmosphere in the confined space been tested, using a calibrated direct-reading instrument, prior to entry?

  Yes

  No

  N/A

• 19.8 Has the atmosphere been tested at multiple levels and recorded in the Confined Space Entry Form?

  Yes

  No

  N/A

• 19.9 Have all physical hazards been eliminated and/or isolated without entering the space?

  Yes

  No

  N/A

• 19.10 Before entry operations begin, has the entry permit been signed by the entry supervisor?

  Yes

  No

  N/A

• 19.11 Has the entry permit been made available at the time of entry to all authorized entrants so they can confirm that pre-entry preparations have been completed?

  Yes

  No

  N/A

• 19.12 If using a ventilation system, is it in good working condition and capable of supplying clean fresh air to the space?

  Yes

  No

  N/A

• 19.13 Is the atmosphere in the space being continuously monitored while workers are in the space?

  Yes

  No

  N/A

• 19.14 Do the entrants, attendants and entry supervisor know their respective duties and responsibilities?

  Yes

  No

  N/A

• 19.15 Is necessary personal protective equipment (PPE) available and being used?

  Yes

  No

  N/A

• 19.16 Is lighting equipment that meets the minimum illumination requirements and one that is explosion proof available and being used?

  Yes

  No

  N/A

• 19.17 Is all portable electrical equipment used inside the confined space equipped with ground-fault protection?

  Yes

  No

  N/A

• 19.18 Has equipment, such as ladders, needed for safe ingress and egress by authorized entrants been provided?

  Yes

  No

  N/A

• 19.19 Is communication equipment available to allow the attendants to communicate with authorized entrants, as necessary, to monitor their status and alert them of the need to evacuate the permit space?

  Yes

  No

  N/A

• 19.20 Is non-entry rescue equipment available and being used?

  Yes

  No

  N/A

• 19.21 If using local emergency services (fire dept.), have they been informed of the entry and will they give us advance notice if they are unable to respond?

  Yes

  No

  N/A

20.0 Environmental Controls

• 20.1 Is stormwater compliance under our contract? (If no, hit N/A on all and proceed to Section 21)

  Yes

  No

  N/A

• 20.2 Has a stormwater permit been filed and onsite for review?

  Yes

  No

  N/A

• 20.3 Are waterways and Inlets protected?

  Yes

  No

  N/A

• 20.4 Is the silt fence being maintained?

  Yes

  No

  N/A

• 20.5 Does the silt fence need any repairs?

  Yes

  No

  N/A

• 20.6 Is the vehicle tracking pad effective and working properly?

  Yes

  No

  N/A

• 20.7 Is there a concrete washout and Is it working properly?

  Yes

  No

  N/A

• 20.8 Is dust being controlled onsite?

  Yes

  No

  N/A

• 20.9 Are there any BMP's in need of repair?

  Yes

  No

  N/A

• 20.10 Are dewatering activities being performed onsite?

  Yes

  No

  N/A

• 20.11 Is the dewatering permit onsite for review?

  Yes

  No

  N/A

• 20.12 Is there an above ground storage tank onsite and is it protected?

  Yes

  No

  N/A

21.0 Traffic Controls for Roadway/Highway Construction

• 21.1 Are roadway or highway activities being conducted onsite? (If no, hit N/A on all and proceed to Section 22)

  Yes

  No

  N/A

• 21.2 Is the accumulation of sand, gravel, debris, dust, oil, etc. cleaned from the intersections as needed?

  Yes

  No

  N/A

• 21.3 Is dust controlled on unpaved surfaces?

  Yes

  No

  N/A

• 21.4 Are equipment crossings well maintained?

  Yes

  No

  N/A

• 21.5 Are signs posted designating right-of-way at equipment crossings?

  Yes

  No

  N/A

• 21.6 Are unpaved roadway surfaces maintained by frequent grading/compaction?

  Yes

  No

  N/A

• 21.7 Are supplemental signs or other warning devices used to slow traffic on high speed roads prior to flagger station?

  Yes

  No

  N/A

• 21.8 Are police officers used for traffic control?

  Yes

  No

  N/A

• 21.9 Are supervisors and flaggers properly trained and certified?

  Yes

  No

  N/A

• 21.10 Are flaggers wearing high visibility clothing and proper PPE?

  Yes

  No

  N/A

• 21.11 Is distance from sign to flagger kept current?

  Yes

  No

  N/A

• 21.12 Are radios or other acceptable forms of communication used when flaggers are out of the line of sight at either end of traffic?

  Yes

  No

  N/A

• 21.13 Do flaggers have an adequate escape path?

  Yes

  No

  N/A

• 21.14 Do flaggers maintain eye contact until vehicles are stopped?

  Yes

  No

  N/A

• 21.15 Are flaggers relieved periodically?

  Yes

  No

  N/A

• 21.16 Are flagger stations well lit at night?

  Yes

  No

  N/A

• 21.17 Are lane closures or changes clearly marked?

  Yes

  No

  N/A

• 21.18 Is there a Method of Handling Traffic (MHT) onsite and is it current?

  Yes

  No

  N/A

• 21.19 Area traffic patterns in place and controlled?

  Yes

  No

  N/A

• 21.20 Are barricades or fences well marked and lighted?

  Yes

  No

  N/A

• 21.21 Are there ample warning signs for bumps, unpaved surfaces, low shoulders, etc.?

  Yes

  No

  N/A

22.0 Miscellaneous Hazards

• 22.1 Have protective caps or other protective devices been placed on all impalement hazards?

  Yes

  No

  N/A

• 22.2 Have all protruding nails and/or other sharp objects been bent over or removed?

  Yes

  No

  N/A

• 22.3 Have all trip hazards been eliminated?

  Yes

  No

  N/A

23.0 Comments

Inspected By

• Signature of Inspector:

  Sign

• Signature of Supervisor:

  Sign