Title Page

  • Job

  • Conducted on

  • Prepared by

  • Builder Name

Scope of Work

  • Access Work Areas

  • A-Frame ladder

  • Extension Ladder

  • Fixed Ladder

  • Boom Lift

  • Scissor Lift

  • Scaffold Stairs

  • Fabricated Frame Scaffold

  • Stairwell

  • Loading & Staging

  • Create Controlled Access Zone (CAZ)

  • Load materials to roof

  • Safely Stage Materials on Roof

  • Re-Roof/Demo

  • Remove exposed roof layer

  • Remove underlayment

  • Remove plywood

  • Cut, measure, install new plywood

  • remove existing fixtures (skylights, hatches, A/C units, vents, etc.)

  • Install new underlayment

  • Re-lay tile

  • Dispose of trash and debris

  • TPO/EDPM/PVC

  • Layout insulation

  • Fasten insulation with screws

  • Install new fixtures (skylights, roof hatch, vents, etc)

  • Roll-out roof material and fasten

  • Apply adhesives to material

  • Torch down materials

  • Weld roof material using heat welders

  • Weld roof material using induction welding

  • Material detailing and patching

  • Metal

  • Measure and cut material

  • Install coping

  • Install siding

  • Install fascia

  • Install gutters

  • Install drip edge

  • Install reglet

  • Install flashing

  • Install bird stop

  • Built-up Roof

  • Set up kettle and pipe

  • Transfer hot asphalt to lugger/buckets

  • Layout base layer and fasten to roof

  • Layout material and seal w/ hot asphalt

  • Torch down materials

  • Dry-In

  • Measure and cut underlayment

  • Fasten underlayment to roof

  • Detail for roof penetrations

  • Tile

  • Layout tile on roof

  • Cut tile for penetrations and terminations

  • Install tile on roof

  • Clean Up

  • Clean work are of trash and debris

Fall Hazards and Controls

  • No/Low Parapets (Lower than 39”)

  • Warning Line 6ft from edge or 10ft when operating equipment on roof w/ PFAS

  • PFAS (100% tie-off)

  • Guardrail system

  • Horizontal lifeline system w/ PFAS

  • Roof Openings/Holes (Greater than 2” in diameter)

  • Cover and secure/fasten it

  • Mark cover with "HOLE" and "AGUJERO"

  • CAZ 15' around hole w/ PFAS inside zone

  • PFAS when working around open holes

  • Roof Hatch

  • Kept closed at all times unless in use

  • Guardrails around hatch

  • PFAS used if working around open roof hatch

  • Skylights

  • Barred

  • PFAS when working around/near skylights

  • Guardrails around skylight

  • CAZ 15' around skylight w/ PFAS inside zone

  • Wall Openings (Greater than 30”H x 18”W)

  • Cover and secure/fasten it

  • Mark cover with "HOLE" and "AGUJERO"

  • CAZ 15' around hole w/ PFAS inside zone

  • PFAS when working around wall openings

  • Sloped Roof (4:12 or greater)

  • Non-slip boots

  • Material staged and secured in self-supporting manner or by other means

  • Slips and Trips

  • Non-slip boots

  • Good housekeeping

  • Situational awareness

  • Ladders

  • Portable

  • 3 pts. of contact when climbing

  • Set up 1ft away from landing point for every 4ft of height

  • Ladder reaches 3ft above landing point

  • Ladder secured/tied-off

  • Feet leveled and position adjusted to type of surface

  • A-Frame

  • No leaning ladder unless designed to do so

  • Top 2 steps not used

  • 3 pts. of contact when climbing

  • Ladder placed on level, secure surface

  • Fixed

  • 42" extension above landing point via safety bar, grab rails, etc.

  • Landing platform(s)

  • Ladder clearance between rungs and wall/permanent object behind ladder greater than 7"

  • Ladder cage

  • Leading Edge Work

  • 100% Tie-off when working leading edge at heights greater than 6'

  • Fall protection equipment designed for leading edge work

  • Scaffolding

  • Tool lanyards

  • Tie-off when working at heights greater than 10' without guardrails

  • Use only approved and tagged access points

  • Mobile Elevated Working Platform

  • Tie-off while operating (fall-restraint)

  • Operators are certified

  • Know load ratings and load charts

  • Break of Elevation

  • Used approved step system or ladder to transition elevations

  • Improper Anchor Point

  • Anchors installed per manufacturers specifications

  • Operating Equipment on Roof

  • Warning Line 10ft from edge

  • Situational awareness

  • Equipment operated according to manufacturer's instructions

  • Where are call hazards located?

  • Where do fall hazards exist?

  • Picture(s)

Other Hazards and Controls

  • Overhead Work

  • Hard hat

  • Controlled Access Zone

  • Struck-By

  • Situational awareness

  • hi-visibility clothing

  • Eye contact with equipment operators

  • Electrical

  • Lock-out, Tag-out

  • Proper PPE

  • Cords in good condition and have ground

  • GFCIs are used

  • Metal tools and equipment kept away from electrical sources

  • Silica Exposure

  • Permissible Exposure Limit awareness

  • Dust collection or ventilation equipment

  • Open or well-ventilated area

  • Respirators

  • Excavation

  • Easily visible or warning system around open excavation

  • Properly guarded or covered from falls when greater than 6ft deep

  • Materials kept 2' away from edge

  • Has protective system in place when greater than 5ft

  • Dust Exposure

  • Respirators

  • Safety Glasses

  • Dust collection or ventilation equipment

  • Open or well-ventilated area

  • Skin

  • Proper clothing

  • PPE for the type of materials or chemicals being worked with

  • Cuts

  • Cut-resistant gloves

  • Tools properly guarded

  • Blades are in good condition and changed regularly

  • Moving Machinery

  • Situational awareness

  • hi-vis clothing

  • eye contact with equipment operators

  • Use spotters

  • Pinch Points

  • Situational awareness

  • hi-vis clothing

  • eye contact with equipment operators

  • Improper Access

  • Correct equipment used for access

  • Equipment correctly set up and used

  • Traffic Control

  • Control properly coned off

  • Flaggers

  • Manual on Uniform Traffic Devices (MUTCD) Needed

  • Hazardous Atmosphere

  • Atmosphere testing

  • Proper PPE

  • Confined Space

  • Controlled Access

  • Confined space permit

  • Atmosphere testing

  • Proper PPE

  • Rescue Plan

  • Manual Lifting

  • Stretch before working

  • Practice good ergonomics

  • Material Storage

  • Keep materials 6ft or more away from edge and tile/masonry 3ft or more away from edge

  • Store flammable materials in covered/shaded areas

  • Keep entryways and access points clear

  • Good housekeeping

  • Proper PPE

  • Material Handling

  • Proper PPE

  • SDS easily accessible

  • Fire extinguisher within 50ft of flammable materials

  • Loud Noises

  • Ear plugs

  • Decibel reader

  • Welding/Hot Work

  • Heat-resistant PPE

  • Face Shields

  • Adequate fire extinguisher within 25ft

  • Know material flash points

  • Firewatch

  • Eye/Face

  • Safety glasses

  • Face shield

  • Face covering

  • Respirators

Tools/Small Equipment Required

  • All tools and equipment on-site are to be inspected daily before use.

Hand Tools

  • Tin Snips

  • Pry Bar

  • Utility Knife

  • Pliers

  • Hammer

Power Tools

  • Circular Saw

  • Reciprocating Saw

  • Hammer Drill

  • Impact Drill

Special Tools

  • Heat Gun/Welder

  • Leaf Blower

  • Spray Gun

  • Staple Gun

  • Nail Gun

  • Powder Actuated

Small Equipment

  • Extension Cords

  • Material Carts

  • Small Generator

  • Automatic Welder

  • Rhinobond Welder

  • Portable Ladders

  • A-Frame Ladders

Heavy Equipment

  • Skytrak Forklift

  • Boom lift

  • Towable Generator

  • Trash Boom

  • Crane

  • Towable Kettle

  • Other

Safety Equipment Required

  • All tools and equipment on-site are to be inspected daily before use.

  • Atmospheric monitor

  • Chemical-resistant gloves

  • Class 2 hi-vis vest

  • Confined space rescue equipment

  • Cut-resistant gloves

  • Ear muffs

  • Ear plugs

  • Fall restraint

  • Face shield

  • Fire extinguisher

  • Guardrails

  • Handrails

  • Hard Hat

  • Heat-resistant gloves

  • Lock-out, Tag-out equipment

  • Personal Fall Arrest System equipment

  • PFAS rescue equipment

  • Respiratory protection

  • Safety glasses

  • Safety goggles

  • Safety toed boots

  • Shoring

  • Trench box

  • Ventilation equipment

  • Warning line

  • Other

Review

  • Additional Photos

  • Crew Leader Signature

  • List of Crew Members
  • Name and Signature

  • Superintendent Signature

  • Safety Representative Signature

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.