Information

  • Project/Job #

  • Project/Job

  • Conducted on

  • Prepared by

  • Location
  • Personnel

BEHAVIOR

  • B. Job Hazard Analysis for each task?

  • D. Near Miss Reporting

  • E. Hazard Recognition Reporting

  • F. Other

WORK AREAS

  • A. General Housekeeping

  • C. Unprotected Sides or Holes

  • B. Walking - Working Surfaces

  • D. Impalement Hazards

  • E. Sanitary Facilities

  • F. Trash Receptacles

  • G. Material Storage/Lay Down

  • H. Connex, Box 4 U, Gang Box

JOB SITE POSTERS

  • A. All OSHA Required Posters

  • B. Emergency Evacuations

  • C. Emergency Contacts List

HEALTH/FIRST AID

  • A. CPR/First AidTraining

  • B. First Aid Kit.

  • C. Eye Wash Facilities in Field

  • D. Access to Eye Wash

  • E. Other

PERSONAL PROTECTIVE EQUIPMENT

  • A. Hard Hats

  • B. Safety Glasses

  • C. Face Shield / Goggles (If Required)

  • D. Respiratory Protection (If Required)

  • E. Hearing Protection (If required)

  • G. Gloves

  • H. Foot Protection

  • F. Clothing (Fire Resistant Clothing etc. if required)

FALL PROTECTION

  • A. Trained Personnel (Competent Person)

  • B. Worn Properly

  • C. Suitable Anchorage Points

  • E. Stored Properly

  • F. Emergency Rescue Plan

  • G. Guard Rails.

LADDERS

  • A. Base/Footing/Set Up

  • C. Proper Type for Task

TOOLS AND EQUIPMENT

  • A. In Good Condition

  • C. Whip-Checks

  • D. Other:

EXCAVATIONS

  • A. Trained Personnel (Competent Person)

  • B. Access/Egress

  • C. Soil Condition

  • D. Water Accumulating

  • E. Shoring/Shielding/Sloping

  • F. Barricades

  • G. Spoil Pile

  • H. Air Monitoriing

CONFINED SPACE

  • A. Trained Personnel (Competent Person)

  • B. Attendant Trained

  • C. Entrants Trained

  • F. Permit Required

  • G. Permit Followed

  • H. Air Monitoring

  • I. Emergency Rescue Plan

ELECTRICAL

  • A. G.F.C.I.'s

  • C. Power Tools

  • D. Lock Out/Tag Out

  • E. Assured Ground Inspected

  • B. Extension Cords

FIRE SAFETY

  • A. Hot Work Permit (if required)

  • B. Fire Watch Assigned (Competent Person)

  • C. Fire Extinguisher/Inspected

  • D. Combustibles removed/isolated

  • E. Hot Work Barricade (if required)

  • F. Gas Can(s)

RIGGING AND HOISTING

  • B. Hooks and Latches

  • C. Chain falls/Come-a-longs

  • D. Tag Lines

  • A. Capacity Tags

  • F. Designated Qualified Rigger

  • G. Damage

SCAFFOLD

  • A. Trained Personnel (Competent Person)

  • B. Hand and Mid-rails, Toeboards

  • C. Platform Decked/Secured

  • D. Level Footing/Set up

  • E. Access/Egress

  • F. Away from Powerlines

  • G. Barricades

  • H. Inspection/Tagged Correctly

CRANE EQUIPMENT

  • A. Crane Inspection

  • B. Operator Manual

  • C. Crane Setup

  • D. Crane Swing Radius

  • E. Flagman with Vest

  • F. Operator Qualified and Certified

  • G. Designated Qualified Signaller

  • H. Fall Zone Procedures

  • I. Lift Plan (if required)

EQUIPMENT

  • A. Equipment Inspections

  • B. Operator Qualified and Certified

  • C. Operator Manual

  • D. Flagman with Vest

HAZCOM

  • A. Training - Right to Know

  • B. MSDS on Site

  • C. MSDS for all Chemicals on Site

  • D. Proper Storage of Chemicals

  • E. Proper PPE for Handling Chemicals

  • F. Proper setup and use

OTHER

  • A.

  • B.

  • C.

  • D.

Comments/Recommendations

  • Enter any corrective actions that will be undertaken

Sign Off

  • Safety Representative

  • Production Leader

  • Construction Supervisor

  • Field Hourly Rep / Others

  • Field Hourly Rep / Others

  • Field Hourly Rep / Others

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.