Information
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Jobsite
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Foreman
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GC or owner
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# of Employees
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Prepared by
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Conducted on
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Location
Rate each area by checking the appropriate box. Describe the hazard and corrective action. Document positive responses by "tapping" the left edge of the box.
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1. Housekeeping
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2. Confined Space
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3. Working at Heights
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a. Floor/Wall Openings
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b. Guardrails
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c. Ladders
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d. Aerial Lifts
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e. Scaffolding
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4. Excavations/Duct Bank
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5. Electrical
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a. GFCI
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b. Cords/Assured Grounding
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c. Lockout Tagout
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d. Temporary Lights & Power
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6. Signs/Barricades
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7. Access/Egress
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8. Material Storage
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9. Compresses Gases
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10. Personal Protective Equipment
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a. Hard Hats
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b. Safety Glasses
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c. Fall Protection Gear
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d. Gloves
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e. NFPA 70E Gear
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f. Hearing Protection
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g. Respirators
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11. Fire Prevention/Extinguishers
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12. Equipment Inspection
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a. Tools/Machines
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b. Aerial Lifts/Fork Lifts
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c. Vehicles
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14. Is an MSDS Book available?
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15. Is a Health & Safety Manual available?
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16. First Aid Kit/Emergency Information
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17. Other
Other Jobsite Comments
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Any good things to note about the jobsite?
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Any General Contractor comments or concerns?
Are the following being completed on this jobsite?
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Daily Pre-Task Plans
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Weekly Safety Talks
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Daily Stretching
