• Safety Inspection/Observation Title

  • Document No.

  • Client

  • Personnel

  • Location
  • Conducted on

  • Prepared by

Site rules

  • Site safety rules understood and followed

  • Site hygiene rules understood and followed

Emergency Preparedness

  • Site evacuation procedure understood

  • Emergency exit locations known

  • Emergency contacts known

  • First aider contact procedure known

PPE Correct

  • Head Protection

  • Eye/Face Protection

  • Hand/Foot Protection

  • Hearing Protection

  • Clothing

  • Respirator

Manual Handling

  • Correct body position

  • Help for heavy items

  • Hand placement

  • Weight known

  • Use of equipment

Line of Fire

  • Hand/Body position

  • Overhead hazards

  • Rotating equipment

  • Eyes on work or path

  • Sharp edges identified & protected

  • Rushing/Time pressures


  • Waste/Debris control

  • Cord/lead control

  • Protruding items

  • Correct barricades

Fall protection

  • Slip/Trip hazard

  • Fall arrest equipment use

  • Ladder use

Tool Use

  • Correct tool

  • Used correctly

  • Material secured

  • Guards in place

Chemical use

  • Storage and handling

  • Chemical hazards understood

  • PPE available and used

  • Spillage control measures available and understood

Equipment/Vehicle Use

  • Inspection completed

  • Seat belt use

  • Equipment used properly

  • Reversing

Adjacent Work

  • Equipment startup

  • Vehicle/traffic

  • Work scope known

  • Crane/Hoist use


  • Lockout tag out

  • Hot work

  • Confined space

  • Other procedure


  • Item # - What is positive or at risk? / Corrective action or commendation?

  • Item # - What is positive or at risk? / Corrective action or commendation?

  • Item # - What is positive or at risk? / Corrective action or commendation?

  • Add signature

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