Title Page
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Conducted on
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Prepared by
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Branch Location/Job Name/Employee Name
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Client / Site
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Mechanics Name
Safety Documentation:
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Does Employee have a safety manual?
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Is the Daily Jobsite Inspection Checklist documented?
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Has a Job Hazard Analysis been completed and discussed with all Employees on site?
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Are the applicable F.P.P.checked off and incorporated into the JHA<br> Personal Protective Equipment<br> Lock-Out/Tag-Out/Try-Out<br> Jumpers<br> Live Electrical Troubleshooting<br> Mechanical Stored Energy<br> Cartop and Pit Access<br> Barricades<br> Fall Protection<br> False Cars and Running Platforms<br> Hoisting and Rigging<br>
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Are the applicable 5 Behavioral Safety Traps checked off and incorporated into the JHA<br> Lack of Awareness<br> Diminishing the Risk<br> Lack of Concentration<br> Unintentional Pressure<br> Fear Factor<br>
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Have the Running Platform and cable climber checklists been properly documented?
Clothing & Personnel Equipment:
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Are Employees wearing proper footwear?
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Is all required PPE being worn, is it serviceable, and does it fit correctly?
Electrical Safety:
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Are all power cords in use plugged into GFCI?
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Are all cords serviceable and grounded?
Lockout/Tagout:
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Are energy sources locked & tagged out as required by TKE policy?
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Can the employees demonstrate proper Lockout/Tagout procedure?
Fall Protection:
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Are all guardrails of proper construction, in place & in good repair?
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Are employees tying off correctly?
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In the event of a fall, is there a rescue plan?
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Is the proper lanyard being used (retractable preferred)?
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Is all fall protection equipment serviceable?
Fire Protection:
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Are work areas clear of fire hazards?
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Is a Hot-Work permit required (welding or cutting)?
First Aid:
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Are adequate first aid supplies on hand?
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Do employees know the emergency action plan?
Hand & Power Tools:
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Are power tools in good condition & do they have guards if required?
Hazard Communication:
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Are SDS's available on site for all chemicals and cleaners?
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Are all containers and chemicals clearly marked with contents?
Hoisting Equipment:
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Is all hoisting equipment on site marked with, legible, rated capacity?
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Is all hoisting equipment serviceable?
Material Handling:
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Do employees use proper lifting technique? (back vertical & lifting with legs)
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Is all material handling equipment in good condition? (wheels, handles, pins, etc.)
Illumination:
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Does the jobsite have adequate lighting?
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Do the employees have flashlights or headlamps?
Ladders:
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Are ladders in good condition & with non-metal side rails?
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Are ladders being used properly & for all access over 19" when stairs or ramp are not provided?
Slips and Trips:
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Are good housekeeping practices being followed?
Welding, Cutting & Compressed Gasses:
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Are regulators, hoses and torch in good condition?
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Are Oxygen and Acetylene bottles properly stored?
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Are arc welder leads in good condition with no splices within 10' of the end?
Ask questions regarding FPP. -
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Is Employee knowledgeable on FPP
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Have employees demonstrate, at a minimum, proper Lockout/Tagout and Fall Protection procedures.
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Are there any OTHER UNSAFE CONDITIONS, equipment or actions? If yes, explain below. N/A if there are none