Site Safety Evaluation

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Crew(s) at Location

• Is appropriate PPE being used?

  Yes

  No

  N/A

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

• Has this issue been resolved?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• What is the severity of this risk?

  Low Severity

  High Severity

• Was this issue resolved?

  Yes

  No

  N/A

• Is a guardrail or fall arrest system being used?

  Yes

  No

  N/A

• Was this issue resolved?

  Yes

  No

  N/A

• Are stakes/rebar capped?

  Yes

  No

  N/A

• Is vacuum being used a HEPA vac?

  Yes

  No

  N/A

Tools/Equipment:

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

  Yes

  No

  N/A

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

• Was this issue resolved?

  Yes

  No

  N/A

• Is equipment free of excessive mud/concrete buildup?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are all storage containers properly labelled?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

Vehicles:

• Are company vehicles on-site?

  Yes

  No

  N/A

• What vehicle/equipment numbers are on-site?

• Are company vehicles free of any new damage?

  Yes

  No

  N/A

• If no, which vehicle shows new damage:

• Is pre-use inspection filled out?

  Yes

  No

  N/A

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

• Is skid steer emergency exit accessible?

  Yes

  No

  N/A

• Are company vehicles free of trash?

  Yes

  No

  N/A

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

Jobsite:

• Is construction entrance satisfactory for all equipment and vehicles?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are all EPA guidelines being followed?

  Yes

  No

  N/A

• If no, which guidelines are not being followed:

• Is jobsite cleared of excessive trash?

  Yes

  No

  N/A

• Is there a portable toilet on site?

  Yes

  No

  N/A

• Is the portable toilet close and easily accessible?

  Yes

  No

  N/A

• 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: