Information

  • DATE

  • COMPANY NAME

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Fire Prevention

1. FIRE PREVENTION

  • Adequate number and type of fire extinguisher(s) available

  • Fire extinguisher training accomplished

  • Phone number of fire department posted

  • Fire extinguisher(s) provided on appropriate equipment

  • All flammable liquids in approved containers and correctly labeled

  • Flammable liquids properly stored

  • Fire alarm available/fire evacuation plan established

  • Fuel supplies protected from accidental impact

  • Fuel training to appropriate personnel

  • Equipment shut down prior to refueling

  • Equipment properly grounded to fuel trucks before refueling

  • "No Smoking" signs posted and enforced

Scaffolding

Scaffolding

  • Erection properly supervised

  • All structural members free from defects and meet safety factor

  • All connections secure

  • Scaffolds erected on solid footing

  • Scaffold tied to structure

  • Working areas free of debris, snow, ice, grease, etc

  • Workers protected from falling objects

  • Scaffold plumb and square, with cross bracing

  • Guardrails, intermediate rails, and toe-boards in place

Cranes and Rigging

Cranes and Rigging

  • Rented cranes inspected & all deficiencies corrected

  • Operators properly trained/licensed

  • Crane chart in cab

  • Tag line in use

  • Correct rigging & proper storage

  • Equipment fully supported

  • Outriggers used fully extended

  • Power lines de-energized, clearances maintained

  • Signalmen work as instructed and trained

  • Proper signals and understood & posted

  • Inspection and maintenance logs maintained

  • Swing radius barricades

  • Chokers, chains, slings & shackles inspected and maintained

  • High wind operating restriction level (30 Mph or mfg's limits)

  • Elevator floor gates and signal system

  • Chain fall used correctly

Heavy Equipment

Heavy Equipment

  • Proper operation

  • Regular monthly inspection, maintenance, & service

  • All personnel is seated

  • Correct parking procedures

  • Wheels chocked when necessary

  • Speed limit control

  • Dump bed chocks and tie-downs

  • Back-up alarms

  • Flagmen when needed

  • Fire extinguishers installed on gas fueled equipment

  • Rollover protection and seatbelt use

Concrete/Masonary Construction

Concrete / Masonary Construction

  • Forms properly installed and braced

  • Adequate shoring, plumbed,and cross braced

  • Concrete truck chocked - when required

  • Hands away from chute pinch points

  • Check heating devices; prevent fire and asphyxiation hazards

  • Protection from cement dust and concrete contact

  • Hard hats, foot protection, shirts, splash goggles

  • Waste concrete placement

Excavation/Trenching

Excavation/Trenching

  • Excavation permits executed

  • Adjacent structures properly shored

  • Shoring and sloping for soil type

  • Adjacent roads and sidewalks supported and protected

  • Soil material stored away from edge, minimum 2 feet

  • Excavation barricaded and lighting provided

  • Equipment kept a safe distance from edge of excavation

  • Ladders and ramps every 25 feet

  • Equipment ramps adequate

  • Proper supervision - including competent person designated daily inspection

  • Underground piping and electrical lines died entities - adequate support provided

Welding/Cutting

Welding/Cutting

  • Welding hoses and cords controlled - out of the way

  • Shields and spark catches

  • Appropriate goggles, gloves, clothing, helmets in use

  • Electrical equipment grounded properly

  • Power cables and hoses protected and in good repair

  • Rods not left in holders

  • Fire extinguishers available

  • Hot work permits approved

  • Gas cylinders secured upright

  • Fuel gas and oxygen separation in storage

  • Flow gages and regulators maintained, removed when not in use

  • Cylinder caps as available

Hand and Power Tools

Hand and Power Tools

  • Tool defects

  • Tools and cords in good condition

  • Proper inspection prior to use

  • Mechanical guards in place

  • Tools stored properly

  • Adequate protection for nearby personnel

  • Properly grounded or double insulated

  • Damaged or malfunctioning tools tagged out until repaired or replaced

  • Cords included in electrical inspections

  • Laws and ordinances compiled with

Flammable and Combustible Liquids

Flammable and Combustible Liquids

  • Containers clearly identified

  • Proper storage - fire rated cabinets and approved containers

  • Fire hazards identified and controlled

  • Grounding and bonding systems

  • Fire extinguisher available

  • Carts for moving cylinders - secured upright during moved

Confined Space Entry

Confined Space Entry

  • Signs posted to identify confined spaces

  • Personal protective equipment specified

  • Standby person

  • Emergency equipment for standby person

  • Permit required precautions taken

  • All required signatures for entry/testing

  • Permits posted prior to start of work

Fall Protection

Fall Protection

  • Walking and working surfaces have the strength and structural integrity to support

  • Do covers prevent walking and tripping in or stepping into holes

  • Do covers prevent objects from falling through holes

  • Appropriate anchorage points for each task that requires a fall arrest or restraint system

  • Anchorage points can withstand twice the potential impact energy of the free fall

  • Lifeline, lanyard, or self-retracting lifeline have a minimum breaking strength of 5,000 pounds

  • Inspections performed prior to use of fall protection system

General Duties / Housekeeping

General Duties / Housekeeping

  • Posters and safety signs / warnings posted

  • Safety meetings held periodically

  • First Aid kit available and adequately stocked

  • Substance abuse policy in place

  • Emergency telephone numbers posted

  • Traffic routes identified

  • New employee orientation completed

  • General Orderliness

  • Regular disposal of waste and trash

  • Trash containers

  • Nails removed or bent down

  • Spills cleaned up promptly

  • Drinking water available

  • Sanitary facilities

  • Stability of materials in storage

Personal Protective Equipment

Personal Protective Equipment

  • Adequate maintenance and sanitary storage available / utilized

  • Adequate fall protection, harnesses provided

  • Eye protection

  • Face protection (glasses, goggles, shields)

  • Respirator, Masks

  • Respirators used for harmful dust, asbestos, sand blasting, welding (lead paint & galvanized zinc or cadmium)

  • Hearing protection

  • Foot protection

  • Hand protection (gloves)

  • Head protection (hard hats)

Hazard Communication / Right To Know

Hazard Communication / Right to know

  • Written program

  • SDS Available

  • Material properly stored and labeled

  • Labels legible

  • Log of all chemicals on site available

  • Employees trained in Hazard Communications

Electrical

Electrical

  • No exposed electrical wires

  • No broken insulation on cords

  • Controls are labeled

  • No cracked or broken receptacle covers

  • GFCI's in wet or damp areas

  • No broken or bent ground prongs on plugs

  • Power tools do not have broken or cracked casings

  • Electrical PPE available for "authorized employees"

  • Breaker panels have covers & breakers are labeled

  • Electric utility rooms are posted "Authorized Employees"

  • Each authorized employee has been issued locks and tags

  • Locks & tags are standardized throughout facility

  • Locks & tags are identifiable to a specific employee

  • Locking devices are available for every type isolation device

  • Material used to affix tag rated at 50 pounds or greater

  • All breakers are labeled

  • Only authorized employees may attach / remove a lock & tag

  • Isolation verified before beginning of work

  • "Affected" employees notified before locking out equipment

  • Assured equipment grounding program established

  • Electrical dangers signage posted

  • Terminal boxes equipped with required covers

  • Electrical high voltage identification

  • Terminal boxes covered

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.