Information

  • Project Name:

  • Project Number:

  • Site Owner:

  • Weather:

  • Conducted on

  • Prepared by

  • Superintendent:

  • Foreman:

Site Inspection:

  • Capture.JPG

Documentation:

  • Daily Safety Meeting Record Completed?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Weekly Toolbox Meeting Record completed and signed by workers?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Site Specific Plan Risk Assessment completed and signed by Safety Coordinator and Project Manager/Superintendent?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Ground Disturbance Permit completed and signed by workers?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Safety Board up to date?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • JOHS meeting minutes up to date?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • All workers completed site specific orientation?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • All workers completed Hall Corporation Safety Orientation?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • WCB inspection minutes posted?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • BC One up to date?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Date of recent BCOne Call:

  • 30M33 completed and posted?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Notice of Project completed and posted?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Site Safety Rules posted?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Site Emergency Preparedness information completed and posted?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • JOHS Committee members posted?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Notice to Workers Posted (PL 9/PL 8)?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Workers Compensation Act/ OHS regulations available (PL 29)?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Traffic/ Pedestrian Management:

  • Traffic Management Plan in place?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Signs, barricades, hoarding, and delineators in place as required?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • TCP's wearing appropriate PPE?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Is the roadways safe for vehicle/ bicycle traffic? (i.e. potholes, saw cuts, etc.)

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • TCP certification available?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Fire Prevention:

  • Fire extinguishers are tagged and checked monthly?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Fire extinguishers are accessible?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Flammable materials are stored away from compressed gas or enclosed areas?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Emergency Preparedness:

  • Air horn, radio or cell phone communication established?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Muster station is established and communicated?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Route to the hospital has been determined and posted?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Emergency exits are clear of obstructions and marked?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

First Aid:

  • First aid attendant is scheduled for adequate level of training?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • First aid room/ dressing station is adequately stocked?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • First aid kit adequately stocked?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • First aid room is clean?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • First aid attendant's certificate is available on site?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

WHMIS

  • Controlled products are labelled properly?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Controlled products are stored as per Safety Data Sheets (SDS)?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • SDS are up to date (within 3 years) and available?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Controlled products are handled properly?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Spill kits are available on site?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Personal Protective Equipment (PPE)

  • PPE requirements have been communicated?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Baisc PPE requirements (hard hat, CSA approved steel toed boots and hi-viz vests) are being worn by all workers?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • PPE is being used and maintained properly?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Housekeeping:

  • Toilets, washing, drinking, and eating facilities are clean and stocked?Work

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Work areas are clean of construction debris?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Pedestrian walk ways are free of tripping hazards (ie string line, wood debris, nails, etc)?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Materials and equipment are parked in a safe and secure manner?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Adequate garbage containers are available on site and being used?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Spilled or leaked liquids are being cleaned up?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Mobile Equipment

  • Daily Pre-Trip Inspections are being completed by operators?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Horns, lights and backup alarms are working properly?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • No hydraulic leaks are notice?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Equipment is being operated at a safe speed and under control?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Seat belts are being worn?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Fire extinguishers are available in the machine?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Spill kits are available in the machine?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Only equipment operators are in moving equipment (ie no riders)?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Equipment is parked in a safe location with all attachments and secured with the transmission in the manufacturer's specific park position?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Tools (Power, Gas, Hand, Pneumatic, Powder Actuated)

  • Electrical cords in good condition?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Compressed air connections secured (ie with pins)?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Equipment is disconnected before repair and adjustments?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Compatible components used?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Guards are in place and used correctly?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Specialized PPE is being worn by operator?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Compressed Gas Cylinders:

  • All cylinders are strapped or otherwise secured?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • All cylinders are being stored away from heat, sparks, or flammable products?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Compressed gas cylinders are not stored in C-cans or enclosed areas?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • All torches (oxy/fuel) are equipped with flash arrests/ suppressors?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Oxygen cylinders are not stored with flammable/ combustible cylinders?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Cylinders are capped when not in use or affixed with a regulator?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Rigging:

  • All rigging has been inspected before use?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Rigging is being used as per lifting ratings?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • All lifting hooks have a safety latch?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Rigging has certification tag attached?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Defective rigging is tagged out?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Fall Protection:

  • All situations where fall protection is required has been identified? (over 3m/ 10ft or; when a hazard exists below work area)

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Workers are instructed to wear fall protection before entering work are where fall hazards exist?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • All fall protection equipment is inspected and maintained?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Type of fall protection being used?

  • Guardrails are installed whenever possible, and are the right type and construction as per OHS Regulation. (125 lb resistance)

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Horizontal lifeline systems are installed as per manufacturer's instructions or OHS Regulation Guideline 11.7?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Vertical lifeline systems are installed correctly as per manufacturer's instructions?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • A written Fall Protection Plan is in place for work over 7.5m/ 25 ft?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Anchor points are the right type and strength for fall protection system? (Fall restraint: 800 lbs or 4 times body weight, Fall Arrest: 5,000 lbs)

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Electrical (Low Voltage)

  • GFCI or Assured Grounding Program is in place?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Cords are intact?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Lock out procedures are in place?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Energized panels and junction boxes are covered if outdoors?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Plugs and prongs are in good condition?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Electrical cords are strung or otherwise protected?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Lighting systems are in place?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Electrical (High Voltage)

  • Limits of approach
    750v to 75kv- 3m/10ft
    75kv to 250kv- 4.5m/15ft
    250kv to 550kv- 6m/20ft

  • Limits of Approach are known and maintained?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Is high voltage overhead/underground power lines guarded?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Ladders

  • Are ladders in good condition with suitable undamaged rungs, rails and feet?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Ladders secured in place when required?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Ladder at a 4:1 ratio and extended 3 feet above upper landing?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • No work is occurring on the last 2 steps of the ladder?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Excavations:

  • Has the location of underground utilities been determined prior to beginning excavations?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Is the BC One call available with the crew?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Has the utility location been clearly identified on the ground through the use of spray paint or other means?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Have utilities been hand exposed within 1m prior to mechanical excavating?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Have all exposed and undermined utilities been adequately supported?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • If the excavation is more than 1.2m/ 4ft deep have the workers been protected through the use of shoring, sloping, benching or by work instructions from a P. Engineer or Geotech?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Is emergency access/egrees maintained at all times?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Is the shotcrete shoring and anchor drawings signed and sealed by a P. Eng or Geotech.

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Is manufactured shoring being used?

  • Does the shoring cage system extend at least 1 foot above the grade, unless in a roadway?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Has the area between the shoring cage and excavation been backfilled or braced?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Has the area between the shoring cage and excavation been backfilled or braced?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Is the shoring cage equipped with a ladder for access/egress?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Is a copy of the shoring cage engineering certificate available on site?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Are you using benching or sloping?

  • Sloping.JPG
  • If sloping: Does it follow the 3V:4H or better sloping requirements?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Capture2.JPG
  • If benching: Does it follow the 3V:4H or better benching requirements?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Is written instruction being used by a Geotch/P.Engineer?

  • Written Instructions for trenching must include:
    -Written and available on site?
    -Specify support and sloping requirements, and the subsurface condition to be expected?
    -Date of issue
    -Site address/location
    -Drawings/ sketches, plan and sections and/or clearly written instructions
    -Geotechnical description of expected soil conditions, or confirmation upon site require
    -Limitations of machinery or equipment being used adjacent to the excavation
    -Time period for which certification applies
    -Influence of changing weather conditions
    -Name of certifying engineer, signature and seal

  • Does it include the above requirements?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Confined Space

  • Confined spaces are identified, warning signs posted, and access points are secured against entry?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • A qualified supervisor is assigned responsibility for supervising entry and issuing entry permits?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Safe work procedures are in place, and based on the hazard assessment prepared by a qualified person?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Procedures used when entering a confined space are consistent with written procedures?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Personnel with confined space entry duties are trained in hazards and safe work procedures?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • There are provisions for rescue of persons inside a confined space, personnel are trained and equipped?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Standby personnel requirements are satisfied?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Ventilation and atmospheric monitoring requirements satisfied?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Personal protective equipment and clothing suited to the hazard are worn/ used by personnel?

  • Risk Level

  • Concern/ Comment:

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Other:

  • Other concern/ Comment:

  • Risk Level

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

  • Other concern/ Comment:

  • Risk Level

  • Corrective Action (include expected completion date/ by whom):

  • Date Corrected/ Initial:

Monthly Tools and Equipment:

Hand Tools

  • Hand Saw

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Sledge Hammer

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Watering Cans

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Shovels, Rakes, Brooms

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

Rigging

  • Slings

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Wire Cables

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Hooks

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Shackles

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Clutches

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

Gas Powered

  • Chop Saw

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Jumping Jack

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Plate Tamper

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Generator

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Chain Saw

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Power Broom

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

Compressed Air

  • Jack Hammer/ Chipping Gun

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Compressed Air Tanks

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

Electrical Tools

  • Pumps

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Coring Equipment

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Electrical Cords

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

Fall Protection

  • Lanyard

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Harness

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Rope Grab

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Life Line

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Anchors

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Self Retracting Lanyards

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

Confined Space

  • Tripod with Winch

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Blower

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Gas Detector

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Harness

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Other:

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

  • Other:

  • Small Tools

  • Risk Level

  • Comment/Concern:

  • Corrective Action (include expected completion date/by whom):

  • Corrected Date/ Initial:

Monthly PPE:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

  • Worker Name

  • PPE Inspected

  • Comment/Corrective Action Required:

  • Correct Date/ By Whom:

Signature:

  • Person Completing Inspection Report

  • Site Supervisor

  • Safety Department

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.