Site Safety Plan

  • Written safety plan on-site.

  • Safety plan is:

  • JHA/AHA/POD on-site.

  • JHAs/AHAs/PODs are:

  • JHA/AHA/PODs appear to address tasks, hazards, and safety measures being performed.

  • JHA/AHA/POD appear to contain sufficient detail.

  • JHA/AHA/PODs have been reviewed with crew.

  • Temporary traffic control plan in place.

  • Plan developed by state-certified Traffic Control Supervisor (TCS).

  • Plan in writing and on-site for review.

  • Permit obtained from authority having jurisdiction (CDOT, county, city).

  • Plan reviewed with crew prior to work.

  • Work zone appears to be set up per MUTCD standards.

  • Work zone appears to be set up per Method of Handling Traffic (MHT).

  • Flaggers are state-certified, wearing appropriate PPE, and using proper STOP/SLOW paddles.

General and Emergency Safety Provisions

  • Water and restroom facilities available.

  • Adequate lighting.

  • First-aid-trained personnel on-site if medical services are not available within 4 minutes.

  • In the absence of a clinic, hospital, or physician, that is reasonably accessible to the worksite, federal safety standards and industry best practices require a first-aid trained person to be available at the worksite. OSHA considers "reasonably available" to mean within 3-4 minutes. Training must be confirmed by a valid certificate from a recognized organization such as the American Red Cross or the American Heart Association. Though not required by federal safety standards, additional training in CPR is also recommended.

  • First-aid kits available and stocked.

  • Federal safety standards and industry best-practices require first-aid supplies to be easily accessible at the worksite. First-aid contents should be checked before being sent out on each job and at least weekly to ensure that expended items are replaced.

  • Fire extinguishers are available on each floor.

  • Federal safety standards and industry best-practices require a fire extinguisher to be readily available on site for every 3000 square feet of work area and on each floor of the building.

  • Fire extinguishers appear functional, free of damage, and tagged to confirm annual inspection within the last 12 months.

  • Fire extinguishers are available 25 to 75 feet from outdoor flammable liquid storage areas.

  • Federal safety standards and industry best-practices require a fire extinguisher to be located 25 to 75 feet from any outdoor flammable liquid storage area.

  • Fire extinguishers appear functional, free of damage, and tagged to confirm annual inspection within the last 12 months.


  • Debris picked up. Work area free of trip hazards.

  • Floor holes guarded or provided with secure labeled covers.

  • Potential impalement hazards from protruding rebar, form stakes, pipe stubs and nails capped or covered.

  • Materials properly stored.
    - Materials clear of stairways and exit routes
    - 4:1 maximum stack height-to-base ratio

  • Other housekeeping observations or comments.

  • Fire extinguishers appear functional, free of damage, and tagged to confirm annual inspection within the last 12 months.

Hazard Communication

  • Chemical containers properly labeled.

  • SDSs on-site for chemicals present.

  • Chemicals properly stored (appropriate containers, flammables clear of ignition sources, etc.).

  • Fire extinguishers are provided within 50 feet of flammable or combustible liquids in quantities of over five gallons.


  • Electrical panels and equipment is fully enclosed, including face plates on switches and receptacles.

  • Circuit breakers labeled.

  • Temporary power GFCI protected.

  • Temporary lighting protected from damage by guards or adequate distance.

  • Temporary lighting circuits separate from non-lighting receptacle circuits.

  • Extension cords appear to be in serviceable condition.

  • Other electrical observations or concerns.

Personal Protective Equipment

  • Eye protection

  • Eye protection usage policy.

  • Eye protection worn as required.

  • Eye protection appears to meet ANSI Z87 requirements and is in serviceable condition.

  • Head Protection

  • Head protection usage policy.

  • Head protection worn as required.

  • Head protection appears to be in serviceable condition.

  • Head protection is worn correctly (suspension in the proper direction, no ball caps under hard hats, etc.)

  • High-Visibility Clothing

  • High-visibility clothing usage policy.

  • ANSI rating

  • High-visibility clothing worn as required.

  • High-visibility clothing appears to be in serviceable condition (clean, zipped up, etc.)

  • Hand Protection

  • Hand protection usage policy.

  • Hand protection worn as required.

  • Hearing Protection

  • Hearing protection usage policy.

  • Noise monitoring assessment has been performed to determine worker exposure.

  • Assessment found noise exposures to be:

  • Hearing protection appears to be appropriate for the exposure and worn properly.

  • Employees have been trained on when and how to use hearing protection.

  • Respiratory Protection

  • Respirator usage is voluntary.

  • Air monitoring has been conducted to assess the need, or lack of need, for mandatory respiratory protection.

  • Air monitoring should be performed to assess average exposures to workers over an 8-hour time-weighted average in order to determine whether respiratory protection should be required or left optional. Pinnacol Assurance can provide this service at no cost to you. To request air monitoring or other safety and industrial hygiene services, please contact Pinnacol's Safety on Call line at 303.361.4700.

  • Voluntary respirator use limited to filtering face piece respirators (disposable dust masks).

  • Voluntary use of tight-fitting respirators (half-mask and full-mask respirators) other than filtering facepiece respirators (dust masks) requires implementation of those elements through a written respiratory protection program necessary to ensure that the employee using a respirator voluntarily is medically able to use that respirator and that the respirator is cleaned, stored, and maintained so that its use does not present a health hazard to the user.

  • Voluntary use respirators are NIOSH-approved.

  • Workers who wear filtering face piece respirators voluntarily have received Appendix D of OSHA's respiratory protection standard.

  • Workers who voluntarily wear filtering face piece respirators (dust masks) should be provided with a copy of the information below.

    29 CFR 1910.134 - Appendix D - Information for Employees Using Respirators When Not Required

    Respirators are an effective method of protection against designated hazards when properly selected and worn. Respirator use is encouraged, even when exposures are below the exposure limit, to provide an additional level of comfort and protection for workers. However, if a respirator is used improperly or not kept clean, the respirator itself can become a hazard to the worker. Sometimes, workers may wear respirators to avoid exposures to hazards, even if the amount of hazardous substance does not exceed the limits set by OSHA standards. If your employer provides respirators for your voluntary use, or if you provide your own respirator, you need to take certain precautions to be sure that the respirator itself does not present a hazard.

    You should do the following:

    1. Read and heed all instructions provided by the manufacturer on use, maintenance, cleaning and care, and warnings regarding the respirator's limitations.

    2. Choose respirators certified for use to protect against the contaminant of concern. NIOSH, the National Institute for Occupational Safety and Health of the U.S. Department of Health and Human Services, certifies respirators. A label or statement of certification should appear on the respirator or respirator packaging. It will tell you what the respirator is designed for and how much it will protect you.

    3. Do not wear your respirator in atmospheres containing contaminants that your respirator is not designed to protect against. For example, a respirator designed to filter dust particles will not protect you against gases, vapors, or very small solid particles of fumes or smoke.

    4. Keep track of your respirator so that you do not mistakenly use someone else's respirator.

  • Respirator use is mandatory.

  • Respiratory hazard requiring protection:

  • Air monitoring has been conducted to assess and quantify hazard and to select appropriate respiratory protection.

  • Air monitoring should be performed to assess average exposures to workers over an 8-hour time-weighted average in order to determine whether respiratory protection is required and, if so, what type. Pinnacol Assurance can provide this service at no cost to you. To request air monitoring or other safety and industrial hygiene services, please contact Pinnacol's Safety on Call line at 303.361.4700.

  • Written respiratory protection program in place.

  • If company operations expose employees to atmospheres containing potentially dangerous concentrations of airborne contaminants (dust, chemical vapors/mists, fumes, etc.), respiratory protection may be required. If so, the company should develop and implement a formal respiratory protection program containing the following elements:

    - Procedures for selecting respirators for use in the workplace.
    - Medical evaluations of employees required to use respirators.
    - Fit testing procedures for tight-fitting respirators.
    - Procedures for proper use of respirators in routine and reasonably foreseeable emergency situations.
    -Procedures and schedules for cleaning, disinfecting, storing, inspecting, repairing, discarding, and otherwise maintaining respirators.
    -Procedures to ensure adequate air quality, quantity, and flow of breathing air for atmosphere-supplying respirators.
    -Training of employees in the respiratory hazards to which they are potentially exposed during routine and emergency situations.
    -Training of employees in the proper use of respirators, including putting on and removing them, any limitations on their use, and their maintenance.
    -Procedures for regularly evaluating the effectiveness of the program.

    A sample respiratory protection program can be obtained by contacting Pinnacol’s Safety on Call line at 303.361.4700 or by visiting Pinnacol's Safety Services resources at

  • Workers required to wear respirators have been medically evaluated.

  • Workers required to wear respirators have been fit-tested.

  • All respirators are NIOSH-approved.

  • Respirators in use:

  • Respirators in use: N99 - Non-oil particulate - 99% efficient

  • Respirators in use: N95 - Non-oil particulate - 95% efficient

  • Respirators in use: R95 - Up to 8 hours with oil based particulates - 95% efficient

  • Respirators in use: R99 - Up to 8 hours with oil based particulates - 99% efficient

  • Cartridges in use: Magenta - HEPA (P100 - 99.97% efficient)

  • Cartridges in use: Black - organic vapor

  • Cartridges in use: White - acid gas

  • Cartridges in use: Yellow - organic vapor and acid gas

  • Cartridges in use: Olive - mercury vapor and chlorine

  • Cartridges in use: Green - ammonia and methylamine

  • Cartridges in use: Other

  • Other cartridges in use:

  • Respirators and cartridges (if applicable) are appropriate for the hazard.

  • Other PPE concerns or comments.

Ladders and Stairs

  • Ladders on-site.

  • Ladders are of appropriate duty rating for the task.

  • For construction operations, all ladders should be either Type 1, Type 1A, or Type 1AA

    Ladder Type Rated Capacity Duty Rating Description

    Type IAA Ladder 375 lb. Extra-heavy-duty industrial ladder
    Type IA Ladder 300 lb. Heavy-duty industrial ladder
    Type I Ladder 250 lb. Heavy-duty industrial ladder
    Type II Ladder 225 lb. Medium-duty commercial ladder
    Type III Ladder 200 lb. Light-duty household ladder

  • Ladders are of proper type and size for the task.

  • Ladders appear to be in serviceable condition.

  • Ladders set up correctly (4:1 ratio, 36" extension past upper landing, etc.).

  • Other ladder concerns.

  • Stairs on-site.

  • Points of access where there is a break in elevation of 19 inches or more are provided with a stairway, ramp, or ladder.

  • Stairs with four or more risers are equipped with at least one handrail and one stair rail system on each open side. The top surface of a stair rail system may also be a "handrail."

  • Handrails are between 30 and 37 inches high from the face of the riser at the forward edge of the tread.

  • Midrails, screens, or intermediate vertical members are provided between the handrail and steps.

  • Where doors open into a stairway, platforms are provided and the swing of the door does not reduce the effective width of the platform to less than 20 inches.

  • Other stairway concerns or comments.


  • Scaffolds on-site.

  • Firm footing, mud sills, and base plates in place.

  • Casters (if used) are locked while scaffold is in use.

  • Scaffold is plumb, square, and level.

  • Cross braces are complete.

  • Working levels are fully planked.

  • Planks either overlap support 6-12" or are cleated to restrain from sliding (6-18" if planks are over 10').

  • Plank deflection does not exceed 1/60 of the plank length, indicating overload. (1" deflection per 5' feet of plank length).

  • Planking is in serviceable condition (free of checks, notches, saw cuts, excessive splits, etc.).

  • Front edge of platforms are no further than 14" from face of wall (18" for plastering operations).

  • Scaffold access and egress is provided and adequate where platform is more than two feet above or below access point.

  • If height is over 4 times the narrowest base dimension, scaffold is tied/braced to the wall.

  • Scaffold ties installed per manufacturer spec or every 26 feet vertically and every 30 feet horizontally.

  • Scaffolds with cantilevered work platforms are tied, braced, or outrigged to prevent tipping.

  • Cantilevered work platforms are used to support workers only and not to store/stage materials.

  • Fall protection over 10 feet is provided via guardrails or PFASs.

  • Other scaffold concerns.

Powered Mobile Scaffolds (Scissor Lifts)

  • Powered Mobile Scaffolds (Scissor Lifts) on-site.

  • Lift operators have received training on proper operation and capacity.

  • Working platform is clear of trip hazards.

  • Access gate/chain is closed while lift is in use.

  • Other scissor lift comments or observations.

Working at Heights

  • Workers more than 6' above a lower level.

  • PFAs

  • Anchors appear adequate and/or properly installed.

  • Lifelines in good condition and adjusted to restrain or limit free fall to 6 feet.

  • Lanyards in good condition and properly connected.

  • Harnesses in good condition and properly adjusted.

  • Guardrails

  • Rails are complete along fall hazard.

  • Rails appear to be installed to withstand 200 pounds downward and outward force.

  • 42" top rails (+/-3 ") and mid rails approximately halfway between the working surface and the top rail.

  • Toe boards are in place as needed to protect workers below from falling objects.

  • Wall openings less than 39 inches high are guarded.
    ("openings" are more than 18" wide and more than 30" high).

  • Warning lines (For roofing operations on low-slope (4:1) roofs only)

  • Warning lines complete around unprotected roof edge.

  • Warning lines no closer than 6 feet from roof edge.
    (10 feet if mechanical equipment is used perpendicular to warning line).

  • Access point is blocked off by rope, chain, or other barricade, or the path is offset to avoid walking directly into the work area.

  • Lines between 34 and 39 inches.

  • Warning line stanchions appear capable of resisting 16-pound force applied 30 inches up.

  • Workers between line and roof edge protected by PFAS or safety monitor.

  • Safety monitor (Roofing operations or as part of a site-specific Fall Protection Plan only).

  • Monitor is on same working level as workers, within sight distance, and close enough to communicate.

  • Monitor warns workers when back is to roof edge or worker is piling material in direction of roof edge.

  • Monitor has no other duties to distract from monitoring workers.

  • Controlled Access Zone (Overhand bricklaying or as part of a site-specific Fall Protection Plan only)

  • General operations - Control line is 6 - 25 feet from unprotected edge.

  • Precast Erection Operations - Control line is 6 - 60 feet or 1/2 the length of the member being erected.

  • Overhand Bricklaying - Control line is 10 - 15 feet from unprotected edge.

  • Control line extends along entire length of unprotected edge and connects to guardrails or walls.

  • Control line is flagged every 6 feet and has at least 200-pound breaking strength.

  • Control line is 39 - 45 inches high.

  • Site-specific Fall Protection Plan (For leading-edge, precast concrete, and residential construction only)

  • Conventional fall protection methods have been demonstrated to be infeasible and documented in safety plan.

  • Plan is in writing and on site for review.

  • Plan includes discussion of measures to be taken to protect workers who cannot use conventional fall protection methods.

  • Plan includes names of workers included under the plan.

  • Plan lists each location that conventional fall protection cannot be used. Locations are classified as Controlled Access Zones.

  • Steel erection fall protection.

  • Steel erectors protected at heights more than 15 feet.

  • Connectors protected at heights more than 30 feet.

  • Controlled Decking Zone (CDZ) in use.

  • Used in area between 15 and 30 feet above lower level where leading-edge decking is being installed.

  • Access to CDZ limited to leading-edge workers.

  • CDZ boundaries designated and marked.

  • CDZ is no more than 90 feet wide and no more than 90 feet from leading edge.

  • Other fall protection concerns or comments.

Hand and Power Tools

  • Hand and power tools in use.

  • Hand tools in serviceable condition.

  • Power tools properly guarded and free of damage.

  • Power tools either grounded or double insulated.

  • Powder-actuated tools in use.

  • Powder-actuated tools and loads properly used and/or stored.

  • Powder-actuated tool operators trained on make and model of tool in use.

  • The company's tool and fastener supplier may be able to provide this training. Often at no cost to the company.

  • Powder-accuated tool operators wear head, eye, and hearing protection.

  • Powder-actuated tool operators familiar with misfire procedure.

  • If a powder-actuated tool misfires, the user must hold the tool in the operating position for at least 30 seconds before trying to fire it again. If it still will not fire, the user must hold the tool in the operating position for another 30 seconds and then carefully remove the load in accordance with the manufacturer’s instructions. This procedure will make the faulty cartridge less likely to explode. The bad cartridge should then be put in water immediately after removal.

    Lack of familiarity with this procedure may indicate a need for tool operator retraining.

  • Other tool observations or comments.


  • Workers near excavations.

  • Excavations protected by guardrails, fences, or barricades if not readily seen due to plant growth or other visual barriers.

  • Workers in excavations.

  • Utility locates have been conducted prior to start of excavation operations.

  • Competent person familiar with excavation hazards, pertinent OSHA regulations, and soil analysis.

  • Excavation inspected daily by a competent person before workers enter.

  • Soil type determined by competent person.

  • Spoil at least 2 feet from edge.

  • Means of access provided within 25 feet if more than 4 feet deep.

  • Excavation is over 5 feet deep or otherwise in need of safeguarding as determined by competent person.

  • Excavation is a residential basement and contractor is using alternative safeguarding measures as specified in OSHA's 1995 letter of interpretation by James Stanley. If so, each of the following seven conditions must be met.

  • Basement excavation is less than 7.5 feet deep or is benched at least 2 feet horizontally for every 5 feet or less of vertical height.

  • The minimum horizontal width (excavation face to formwork/wall) at the bottom of the excavation is at least 2 feet.

  • There is no water, surface tension cracks, nor other environmental conditions present that reduce the stability of the excavation.

  • There is no heavy equipment operating in the vicinity that causes vibration to the excavation while employees are in the excavation.

  • All soil, equipment, and material surcharge loads are no closer in distance to the top edge of the excavation than the excavation is deep.

  • Work crews in the excavation are the minimum number needed to perform the work.

  • Work had been planned and is carried out in a manner to minimize the time employees are in the excavation.

  • Excavation safeguarding is in place.

  • Excavations more than 5 feet deep that workers enter require safeguarding to protect workers from excavation collapse hazards. Excavations less than 5 feet deep also require safeguarding if determined necessary by the competent person. Recognized methods of excavation safeguarding include:

    -sloping (slope angle depends on current soil conditions)
    -benching (bench configurations depend on current soil conditions)
    -shielding (often referred to as “trench boxes”)
    -shoring (typically pneumatic or hydraulic systems)
    -design by a registered professional engineer

    Additional information on excavation safeguarding can be obtained by calling Pinnacol’s Safety on Call line at 303-361-4700 or by visiting OSHA’s website at

  • Sloping

  • Sloping appropriate for soil type.
    - 3/4:1 for class A (53 degrees or less)
    - 1:1 for class B (45 degrees or less)
    - 1 1/2:1 for class C (34 degrees or less)

  • Benching (A or B soils only)

  • Benching configuration is appropriate for soil type.
    - 3/4:1 for class A (53 degrees or less)
    - 1:1 for class B (45 degrees or less)
    - Width of the first bench is twice the bench height
    - Maximum bench height is 4"

  • Shielding (trench box)

  • Shield is level with or above excavation edge.

  • Shield protects from all exposed vertical walls.

  • Shield fits tight in excavation to minimize movement during collapse.

  • Excavation extends no more than 2 feet below bottom of shield.

  • Shoring

  • Tabulated data for proper use of shoring system on site for review.

  • Shoring system installed per manufacturer specs for soil type and depth. (sheeting, spanning, depth, etc.).

  • Combination shielding and sloping

  • Sloping appropriate for soil type.
    - 3/4:1 for class A (53 degrees or less)
    - 1:1 for class B (45 degrees or less)
    - 1 1/2:1 for class C (34 degrees or less)

  • Shield extends at least 18" above bottom of slope.

  • Shield protects from all exposed vertical walls.

  • Shield fits tight in excavation to minimize movement during collapse.

  • Excavation extends no more than 2 feet below bottom of shield.

  • Custom-engineered design.

  • Engineered by licensed P.E.

  • Plans on-site for review.

  • Other excavation observations or comments.

Cranes and Rigging

  • Crane set up on-site.

  • Pre-shift crane inspection completed by competent person.

  • Monthly crane inspection conducted, documented, and on file.

  • Annual crane inspection conducted, documented, and on file.

  • Ground conditions appear adequate.

  • Swing radius of counterweight barricaded off to avoid striking workers and equipment.

  • Outriggers pads are solid, sturdy, and appear at least 3 times the area of the outrigger plates.

  • Outriggers are fully extended.

  • Crane is designed for partial outrigger extension and outriggers are extended to the minimum reduced extension.

  • Crane is designed for "on rubber" lifting with reduced load chart.

  • Crane operated per proper load chart (full extension, partial extension, on rubber, etc.).

  • Maximum crane radius at least 20 feet from overhead power lines.

  • Power lines have been de-energized, locked-out, and visibly grounded by utility owner.

  • The crane’s work zone has been defined, is at least 20 feet back from the power line, and has been demarcated with an elevated high-visibility marking (warning line, barricades, signs, etc.).

  • Operator has been instructed against operating crane past established work zone boundaries.

  • Complete requirements for cranes operating near overhead power lines are specified in OSHA Construction safety standard 1926.1408 which can be viewed at Operators, riggers, and signal persons should be familiar with this standard.

  • Any other risk concerns involving crane or setup or operation.

  • Company Performing Rigging Operations.

  • Riggers are trained in safe rigging principles.

  • Riggers have reasonable idea of load weights (shipping docs, mfg specs, raw material calculations, etc.).

  • Signal person has been trained and evaluated by the employer or qualified third party and understands how to give and read signals, has a basic understanding of equipment limitations, understands relevant OSHA crane standard requirements, and has demonstrated qualification via oral, written, or practical testing.

  • Documentation of signal person qualification on-site.

  • Rigging equipment is in serviceable condition (capacities labeled, free of damage, kinks, stains, etc.).

  • Observed rigging practices appear effective and safe.
    - Tag lines used where appropriate
    - No workers under suspended loads
    - Loads appear stable
    - Rigging equipment appears to be used per intended use and within its capacity

  • Other rigging comments or observations.

Aerial Lifts

  • Aerial lifts in use.

  • Aerial lift operators trained and authorized.

  • Aerial lift controls clearly marked.

  • Fall protection used in aerial lift.

  • Type of fall protection used in aerial lift:

  • To ensure proper function of the SRL in the event of a fall, SRL should be rated by the SRL manufacturer for use in an inverted position as the anchor point in the aerial lift is below the worker's D-ring.

  • Total fall distance of the lanyard may result in worker hitting the ground before the fall is fully arrested. Company should consider using lanyards adjusted short enough to restrain workers from being ejected over the lift's guardrail or use self-retracting lanyards (SRLs) rated by the manufacturer for inverted use due to the anchor points in the lift being located below the workers' D-ring.

  • Other aerial lift comments or observations.

Heavy Equipment

  • Heavy equipment on-site.

  • Equipment with obstructed view to the back is equipped with backup alarms.

  • Equipment appears to be free of significant damage, leaks, and other safety concerns.

  • Parked equipment has brakes set and all buckets, blades, and other implements grounded.

  • Operators have been trained, evaluated, and authorized by employer to operate equipment.

  • Training documented and on file.

  • Employer claims training has been provided but has no records for verification.

  • Machine-specific evaluation and authorization documented and on file.

  • Employer claims evaluation has been conducted but has no records for verification.

  • Operators wear seat belts while operating.

  • Operators maintain 3 points of contact while dismounting equipment.

  • Other heavy equipment observations or comments.


  • Add drawing

  • Evaluator's signature:

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