Title Page

  • Site conducted

  • Conducted on

  • Prepared by

  • Location
  • Crew(s) at Location

Safety:

  • Is appropriate PPE being used?

  • If no, list what pieces of PPE are not being used correctly:

  • Has this issue been resolved?

  • Is proper sloping/benching being used for all excavations?

  • What is the severity of this risk?

  • Was this issue resolved?

  • Is a guardrail or fall arrest system being used?

  • Was this issue resolved?

  • Are stakes/rebar capped?

  • Is vacuum being used a HEPA vac?

Tools/Equipment:

  • Are all tools, cords, and equipment in good condition?

  • If no, what equipment needs to be repaired/replaced:

  • Was this issue resolved?

  • Is equipment free of excessive mud/concrete buildup?

  • Are all high valued tools stored in a safe location while not in use?

  • Are all storage containers properly labelled?

  • Are all fuel cans stored in a safe location and properly labelled?

Vehicles:

  • Are company vehicles on-site?

  • What vehicle/equipment numbers are on-site?

  • Are company vehicles free of any new damage?

  • If no, which vehicle shows new damage:

  • Is pre-use inspection filled out?

  • If no, which vehicles do not have pre-use inspection filled out:

  • Is skid steer emergency exit accessible?

  • Are company vehicles free of trash?

  • If no, which vehicle(s) have excessive trash:

Jobsite:

  • Is construction entrance satisfactory for all equipment and vehicles?

  • Does the jobsite have sufficient room for working space and traffic?

  • Are all EPA guidelines being followed?

  • If no, which guidelines are not being followed:

  • Is jobsite cleared of excessive trash?

  • Is there a portable toilet on site?

  • Is the portable toilet close and easily accessible?

Comments

  • List any items that require a follow-up or corrective action that are not addressed above:

  • List any items that may be included in the Safety Recognition Program:

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