Title Page
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Document Number
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Site conducted
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Conducted on
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Prepared by
General Conditions
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Perimeter fence in good condition?
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Project signage posted?
Posting of Notices
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Osha 300 (available Feb.1-Apr. 30th)
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OSHA CITATIONS:
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OSHA POSTERS
WRITTEN SAFETY PROGRAM
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SAFETY PROGRAM AVAILABLE
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SDS MANUALS AVAILABLE
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EMERGENCY EVACUATION PLAN
SIGNAGE
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WARNING SIGNS (WHERE REQUIRED)
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TOOLBOX TOPIC
FIRST AID:
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SUPPLIES ARE CURRENT
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FIRST AID SUPPLIES (REPLENISHED)
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FIRST RESPONDERS ARE EQUIPPED WITH PROPER PPE
PERSONAL PROTECTIVE EQUIPMENT:
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RESPIRATORY PROTECTION (WHERE NEEDED)
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EMERGENCY PHONE NUMBERS POSTED OR AVAILABLE
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FIRST AID CERTIFIED PERSON ON SITE
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PPE WELL MAINTAINED
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EYE AND FACE PROTECTION
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HEAD PROTECTION
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FOOT PROTECTION
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FALL PROTECTION
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EAR PROTECTION
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HAND PROTECTION
FIRE EXTINGUISHERS:
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CONSPICUOUSLY LOCATED AND ACCESSIBLE
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YEARLY RECHARGE AND TAGGED
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GOOD CONDITION
HOUSEKEEPING
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ORDERLY AND FREE OF DEBRIS
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PROPER MATERIAL STORAGE
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PROPER STORAGE OF BRICKS AND BLOCKS
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MINOR SPILLS CLEANED UP
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AISLES CLEAR AND UNCLUTTERED (TRIP HAZARDS)
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MEETINGS AND TOOLBOX MEETINGS
OPENINGS:
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FLOOR OPENINGS GUARDED
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FALL PROTECTION(GUARD RAILS, ETC)
LADDERS:
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PROPER HEIGHT AND TIED OFF
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LADDERS IN USE ARE IN GOOD CONDITION
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LADDERS USED PROPERLY
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ACCESS AVAILABLE
AERIAL LIFTS (MEWP)
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OPERATORS CERTIFIED
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EQUIPMENT IN GOOD CONDITION
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EMPLOYEE TIED OFF (FALL PROTECTION)
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GATES AND GUARDRAILS ACCEPTABLE
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LIFT USED PROPERLY
AIR COMPRESSORS
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EQUIPPED WITH PRESSURE GAUGE
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SAFETY VALVE PROVIDED
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HOSE SECURED TO FITTING
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REDUCER VALVE INSTALLED
WELDING AND CUTTING
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HOT WORK PERMIT ON FILE
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FIRE WATCH AVAILABLE
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WELDING SCREENS AVAILABLE
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CABLES/HOSES IN GOOD CONDITION
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FIRE EXTINGUISHER AT SITE OF WELDING/CUTTING
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SAFE STORAGE LOCATION OF CYLINDERS
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CYLINDERS SECURED
ELECTRICAL
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CORDS PROTECTED FROM TRAFFIC
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TEMPORARY LIGHTS IN GOOD CONDITION
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GFCI'S AVAILABLE OR AEGP
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PROPER GROUNDING AND USE (TOOLS AND CORDS)
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FLEXIBLE CORDS IN GOOD CONDITION
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COVER PLATES, SWITCHES, OUTLETS ARE IN GOOD CONDITION
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ELECTRICAL PANELS ARE CLEAR AND SERVICEABLE
MACHINES, GENERAL
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POINT OF OPERATION GUARDED
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DRILL PRESS
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SKILL SAW GUARDED
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HANDGRINDER GUARDED
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PROPER USE OF HAND TOOLS
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CHOP SAW GUARDED
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TABLE,RADIAL,BAND SAW SAFETY GUARDS
IMPALEMENT HAZARD
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NAILS REMOVED
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REBAR CAPPED
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STAKES CAPPED
MOBILE EQUIPMENT
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DAILY INSPECTIONS COMPLETED
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BACKUP ALARMS IN PLACE OR SIGNAL PERSON USED
FORKLIFTS/TELEHANDLER
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DAILY INSPECTION COMPLETED
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OPERATOR CERTIFIED
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OPERATOR WORKING IN A SAFE MANNER
EXCAVATOR
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DAILY INSPECTION COMPLETED
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OPERATOR CERTIFIED
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OPERATOR WORKING IN A SAFE MANNER
CRANES AND RIGGING
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OPERATOR CERTIFIED
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INSPECTION COMPLETED
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OPERATOR WORKING IN A SAFE MANNER
HOISTING
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STRAPS/ALLOY STEEL CHAIN TAGS
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PROPERLY USED
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WELL MAINTAINED
EXCAVATIONS AND SHORING
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MATERIALS PROPERLY STORED
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SHORING OF ADJACENT STRUCTURES ADEQUATE
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TRENCHES/HOLES SAFE
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SPOILS
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PROTECTIVE STRUCTURES
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COMPETENT PERSON ON SITE
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ACCESS AVAILABLE
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INSPECTIONS PERFORMED
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CROSSOVERS
POWDER ACTUATED TOOLS
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CERTIFIED EMPLOYEE
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PROPER EYE AND FACE PROTECTION AVAILABLE
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MISFIRED CARTRIDGES PROPERLY DISPOSED
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HEARING PROTECTION USED
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WARNING SIGNS POSTED IN AREA
CONFINED SPACE/ MAN HOLE
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RESCUE PLAN EQUIPMENT
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PROPER VENTILATION
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EMPLOYEES PROPERLY TRAINED
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ENTRY SUPERVISOR ON SITE
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ENTRY PERMIT AVAILABLE
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INSPECTION RECORD AVAILABLE
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ALL CONFINED SPACE IDENTIFIED BY COMPETENT PERSON
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BARRICADES/ SIGNS AVAILABLE
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PROPPER PPE AVAILABLE
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GAS TESTING PERFORMED
UNDERGROUND CONSTRUCTION
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CHECK IN/CHECK-OUT PROCEDURES
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CONTROL OF ACCESS AND EGRESS
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GROUND SUPPORT OF PORTAL
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GAS TESTING BEING DONE AND RECORDED
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PROPER VENTILATION
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ILLUMINATION
LINER CAR
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DAILY INSPECTION COMPLETED
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DRIVER CERTIFIED
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FIRE EXTIGUISHER IN PLACE
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AUDIBLE WARNING HORN AND LIGHT
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WHEEL CHOCKS USED WHEN LT IS STOPPED
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PASSENGERS INSIDE LINER CAR WITH SAFETY CHAIN IN USE
SILICA
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ENGINEERING CONTROLS AVAILABLE
Signature and Date
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Date of Inspection
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Signature of Inspector
