Information
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DATE
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COMPANY NAME
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Fire Prevention
1. FIRE PREVENTION
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Adequate number and type of fire extinguisher(s) available
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Fire extinguisher training accomplished
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Phone number of fire department posted
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Fire extinguisher(s) provided on appropriate equipment
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All flammable liquids in approved containers and correctly labeled
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Flammable liquids properly stored
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Fire alarm available/fire evacuation plan established
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Fuel supplies protected from accidental impact
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Fuel training to appropriate personnel
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Equipment shut down prior to refueling
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Equipment properly grounded to fuel trucks before refueling
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"No Smoking" signs posted and enforced
Scaffolding
Scaffolding
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Erection properly supervised
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All structural members free from defects and meet safety factor
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All connections secure
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Scaffolds erected on solid footing
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Scaffold tied to structure
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Working areas free of debris, snow, ice, grease, etc
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Workers protected from falling objects
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Scaffold plumb and square, with cross bracing
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Guardrails, intermediate rails, and toe-boards in place
Cranes and Rigging
Cranes and Rigging
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Rented cranes inspected & all deficiencies corrected
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Operators properly trained/licensed
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Crane chart in cab
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Tag line in use
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Correct rigging & proper storage
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Equipment fully supported
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Outriggers used fully extended
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Power lines de-energized, clearances maintained
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Signalmen work as instructed and trained
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Proper signals and understood & posted
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Inspection and maintenance logs maintained
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Swing radius barricades
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Chokers, chains, slings & shackles inspected and maintained
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High wind operating restriction level (30 Mph or mfg's limits)
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Elevator floor gates and signal system
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Chain fall used correctly
Heavy Equipment
Heavy Equipment
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Proper operation
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Regular monthly inspection, maintenance, & service
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All personnel is seated
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Correct parking procedures
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Wheels chocked when necessary
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Speed limit control
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Dump bed chocks and tie-downs
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Back-up alarms
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Flagmen when needed
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Fire extinguishers installed on gas fueled equipment
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Rollover protection and seatbelt use
Concrete/Masonary Construction
Concrete / Masonary Construction
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Forms properly installed and braced
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Adequate shoring, plumbed,and cross braced
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Concrete truck chocked - when required
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Hands away from chute pinch points
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Check heating devices; prevent fire and asphyxiation hazards
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Protection from cement dust and concrete contact
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Hard hats, foot protection, shirts, splash goggles
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Waste concrete placement
Excavation/Trenching
Excavation/Trenching
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Excavation permits executed
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Adjacent structures properly shored
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Shoring and sloping for soil type
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Adjacent roads and sidewalks supported and protected
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Soil material stored away from edge, minimum 2 feet
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Excavation barricaded and lighting provided
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Equipment kept a safe distance from edge of excavation
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Ladders and ramps every 25 feet
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Equipment ramps adequate
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Proper supervision - including competent person designated daily inspection
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Underground piping and electrical lines died entities - adequate support provided
Welding/Cutting
Welding/Cutting
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Welding hoses and cords controlled - out of the way
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Shields and spark catches
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Appropriate goggles, gloves, clothing, helmets in use
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Electrical equipment grounded properly
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Power cables and hoses protected and in good repair
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Rods not left in holders
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Fire extinguishers available
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Hot work permits approved
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Gas cylinders secured upright
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Fuel gas and oxygen separation in storage
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Flow gages and regulators maintained, removed when not in use
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Cylinder caps as available
Hand and Power Tools
Hand and Power Tools
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Tool defects
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Tools and cords in good condition
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Proper inspection prior to use
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Mechanical guards in place
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Tools stored properly
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Adequate protection for nearby personnel
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Properly grounded or double insulated
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Damaged or malfunctioning tools tagged out until repaired or replaced
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Cords included in electrical inspections
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Laws and ordinances compiled with
Flammable and Combustible Liquids
Flammable and Combustible Liquids
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Containers clearly identified
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Proper storage - fire rated cabinets and approved containers
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Fire hazards identified and controlled
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Grounding and bonding systems
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Fire extinguisher available
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Carts for moving cylinders - secured upright during moved
Confined Space Entry
Confined Space Entry
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Signs posted to identify confined spaces
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Personal protective equipment specified
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Standby person
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Emergency equipment for standby person
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Permit required precautions taken
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All required signatures for entry/testing
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Permits posted prior to start of work
Fall Protection
Fall Protection
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Walking and working surfaces have the strength and structural integrity to support
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Do covers prevent walking and tripping in or stepping into holes
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Do covers prevent objects from falling through holes
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Appropriate anchorage points for each task that requires a fall arrest or restraint system
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Anchorage points can withstand twice the potential impact energy of the free fall
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Lifeline, lanyard, or self-retracting lifeline have a minimum breaking strength of 5,000 pounds
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Inspections performed prior to use of fall protection system
General Duties / Housekeeping
General Duties / Housekeeping
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Posters and safety signs / warnings posted
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Safety meetings held periodically
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First Aid kit available and adequately stocked
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Substance abuse policy in place
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Emergency telephone numbers posted
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Traffic routes identified
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New employee orientation completed
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General Orderliness
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Regular disposal of waste and trash
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Trash containers
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Nails removed or bent down
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Spills cleaned up promptly
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Drinking water available
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Sanitary facilities
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Stability of materials in storage
Personal Protective Equipment
Personal Protective Equipment
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Adequate maintenance and sanitary storage available / utilized
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Adequate fall protection, harnesses provided
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Eye protection
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Face protection (glasses, goggles, shields)
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Respirator, Masks
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Respirators used for harmful dust, asbestos, sand blasting, welding (lead paint & galvanized zinc or cadmium)
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Hearing protection
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Foot protection
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Hand protection (gloves)
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Head protection (hard hats)
Hazard Communication / Right To Know
Hazard Communication / Right to know
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Written program
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SDS Available
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Material properly stored and labeled
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Labels legible
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Log of all chemicals on site available
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Employees trained in Hazard Communications
Electrical
Electrical
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No exposed electrical wires
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No broken insulation on cords
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Controls are labeled
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No cracked or broken receptacle covers
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GFCI's in wet or damp areas
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No broken or bent ground prongs on plugs
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Power tools do not have broken or cracked casings
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Electrical PPE available for "authorized employees"
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Breaker panels have covers & breakers are labeled
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Electric utility rooms are posted "Authorized Employees"
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Each authorized employee has been issued locks and tags
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Locks & tags are standardized throughout facility
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Locks & tags are identifiable to a specific employee
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Locking devices are available for every type isolation device
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Material used to affix tag rated at 50 pounds or greater
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All breakers are labeled
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Only authorized employees may attach / remove a lock & tag
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Isolation verified before beginning of work
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"Affected" employees notified before locking out equipment
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Assured equipment grounding program established
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Electrical dangers signage posted
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Terminal boxes equipped with required covers
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Electrical high voltage identification
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Terminal boxes covered
