Site Safety Inspection Report - Lake States Tree Service

• Job Site Name

• Customer

• Location
  Address

• Conducted on

  Date

• Prepared by

• Crew Foreman

• General Foreman

Safety and Personal Protective Equipment Compliance

• Employee Name

• Hearing Protection

  Safe

  At Risk

  N/A

• Eye Protection

  Safe

  At Risk

  N/A

• Chainsaw Protection

  Safe

  At Risk

  N/A

• Reflective Vest

  Safe

  At Risk

  N/A

• Head Protection

  Safe

  At Risk

  N/A

• Lanyard(s)

  Safe

  At Risk

  N/A

• Fall Protection

  Safe

  At Risk

  N/A

• Rubber Gloves

  Safe

  At Risk

  N/A

• Long Sleeve Shirt

  Safe

  At Risk

  N/A

• Employee Name

• Hearing Protection

  Safe

  At Risk

  N/A

• Eye Protection

  Safe

  At Risk

  N/A

• Chainsaw Protection

  Safe

  At Risk

  N/A

• Reflective Vest

  Safe

  At Risk

  N/A

• Head Protection

  Safe

  At Risk

  N/A

• Lanyard(s)

  Safe

  At Risk

  N/A

• Fall Protection

  Safe

  At Risk

  N/A

• Rubber Gloves

  Safe

  At Risk

  N/A

• Long Sleeve Shirt

  Safe

  At Risk

  N/A

• Employee Name

• Hearing Protection

  Safe

  At Risk

  N/A

• Eye Protection

  Safe

  At Risk

  N/A

• Chainsaw Protection

  Safe

  At Risk

  N/A

• Reflective Vest

  Safe

  At Risk

  N/A

• Head Protection

  Safe

  At Risk

  N/A

• Lanyard(s)

  Safe

  At Risk

  N/A

• Fall Protection

  Safe

  At Risk

  N/A

• Rubber Gloves

  Safe

  At Risk

  N/A

• Long Sleeve Shirt

  Safe

  At Risk

  N/A

• Employee Name

• Hearing Protection

  Safe

  At Risk

  N/A

• Eye Protection

  Safe

  At Risk

  N/A

• Chainsaw Protection

  Safe

  At Risk

  N/A

• Reflective Vest

  Safe

  At Risk

  N/A

• Head Protection

  Safe

  At Risk

  N/A

• Lanyard(s)

  Safe

  At Risk

  N/A

• Fall Protection

  Safe

  At Risk

  N/A

• Rubber Gloves

  Safe

  At Risk

  N/A

• Long Sleeve Shirt

  Safe

  At Risk

  N/A

General

• First Aid Kit

  Compliant

  Missing Items

  No Kit Available

• Spill Kit

  Compliant

  Missing Items

  No Kit Available

• Material Safety Data Sheets / Safety Data Sheets

  Yes

  No

  N/A

• Equipment Inspection

  Compliant

  Not all equipment

  No inspections

• Daily Job Briefing

  Excellent

  Meets Expectations

  None / Below Expectations

• Tailgate Safety

  Excellent

  Meets Expectations

  None / Below Expectations

• Traffic / Site Control

  Safe

  At Risk

  N/A

Vehicles

• Vehicle #

• DOT Log Book

  Yes

  No

  N/A

• Outrigger Pads

  Safe

  At Risk

  N/A

• Dielectric Date

  Date

• Signs

  Safe

  At Risk

  N/A

• Cones

  Safe

  At Risk

  N/A

• Flagman/Spotter

  Safe

  At Risk

  N/A

• Fire Extinguisher

  Safe

  At Risk

  N/A

• Pre/Post Trip Inspections

  Yes

  No

  N/A

• Triangles

  Yes

  No

  N/A

• Vehicle #

• DOT Log Book

  Yes

  No

  N/A

• Outrigger Pads

  Safe

  At Risk

  N/A

• Dielectric Date

  Date

• Signs

  Safe

  At Risk

  N/A

• Cones

  Safe

  At Risk

  N/A

• Flagman/Spotter

  Safe

  At Risk

  N/A

• Fire Extinguisher

  Safe

  At Risk

  N/A

• Pre/Post Trip Inspections

  Yes

  No

  N/A

• Triangles

  Yes

  No

  N/A

• Vehicle #

• DOT Log Book

  Yes

  No

  N/A

• Outrigger Pads

  Safe

  At Risk

  N/A

• Dielectric Date

  Date

• Signs

  Safe

  At Risk

  N/A

• Cones

  Safe

  At Risk

  N/A

• Flagman/Spotter

  Safe

  At Risk

  N/A

• Fire Extinguisher

  Safe

  At Risk

  N/A

• Pre/Post Trip Inspections

  Yes

  No

  N/A

• Triangles

  Yes

  No

  N/A

Comments

• Inspector Name

• Inspector Signature

  Sign

• Crew Foreman Name

• Crew Foreman Signature

  Sign