Title Page

  • Company Name

  • Job Site Name

  • Foreman

  • Conducted on

  • Prepared by

  • Location

Cranes, Forklifts, Rigging, and Material Handling

  • Is the crane operator NCCCO certified for the crane being operated or is the forklift operator trained?<br>

  • Has the fall zone been barricaded or controlled?

  • Is the crane/forklift maintaining 20 feet of clearance from overhead power lines?

  • Is the ground condition ok and are outrigger pads being used?

  • Are qualified riggers and signal persons being used?

  • Is proper fall protection in place while performing material handling operations?

  • Are trash boxes, hoisting parachutes, and rigging maintained?

  • Has the documented monthly inspection been completed for the crane?<br>

Tanker and Kettle Operations

  • Is the tanker or kettle properly barricaded to prevent unauthorized access?

  • Is a fully charged fire extinguisher located near the tanker or kettle?

  • Is proper PPE worn while working with hot asphalt?<br>

  • Is the hot pipe properly set up and secured?

Ladders and Access

  • Is the ladder properly set up and secured?

  • Are proper steps in place where elevation changes exceed 19 inches?<br>

  • If using a roof hatch, is the hatch area properly protected?

  • Is the general ladder condition ok?

Fall Protection

  • Are the guardrails properly set up?

  • Are warning line systems properly set up?<br>

  • Are safety monitors properly used?

  • Are all roof openings properly protected?

  • Are personal fall arrest systems properly used?

  • Is overhead protection in place?

Fire Safety

  • Is smoking prohibited in the vicinity of flammable operations and is no smoking signage in place?

  • Is an inspected and properly working fire extinguisher within 50 feet of flammables or 100 feet of general work?

  • Are compressed gas cylinders and other flammables properly stored?

Hazard Communication / GHS

  • Are safety data sheets available?

  • Are all employees trained in GHS?

  • Are all product containers properly labeled?

Personal Protective Equipment

  • Is proper PPE being worn by all employees on site?

  • Are there any other PPE issues (respiratory, hearing, body protection)

Electrical Safety

  • Are all cords and tools undamaged and properly grounded <br>

  • Are incoming power lines protected?

  • Is GFCI being used?

General Safety and Health Provisions

  • Is housekeeping sufficient?<br>

  • Are properly stocked first aid kits available onsite?

  • Are on-site rest rooms available

  • Is drinking water available?

  • Are there any silica, asbestos, or lead issues?<br>

Power and Hand Tools

  • Are the proper tools being used for the job?

  • Is proper guarding in place on tools and equipment?

Scaffolding

  • Has scaffolding been properly assembled and secured and is a competent person on site?

  • Have daily inspections been completed by a competent person and is the scaffolding properly tagged?

  • Does the scaffolding have proper access?

  • Are employees properly trained on aerial work platforms?<br>

DOT Compliance

  • Are commercial drivers properly qualified?

  • Have pre-trip and post-trip inspections been completed and any defects repaired?

  • Does the vehicle have proper markings and/or placarding?

  • Is there a fire extinguisher in the cab of a vehicle?

  • Does the commercial vehicle have a valid DOT inspection?

Foreman Review

  • Foreman Name:

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