Title Page
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Job
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Conducted on
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Prepared by
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Builder Name
Scope of Work
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Access Work Areas
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A-Frame ladder
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Extension Ladder
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Fixed Ladder
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Boom Lift
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Scissor Lift
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Scaffold Stairs
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Fabricated Frame Scaffold
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Stairwell
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Loading & Staging
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Create Controlled Access Zone (CAZ)
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Load materials to roof
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Safely Stage Materials on Roof
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Re-Roof/Demo
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Remove exposed roof layer
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Remove underlayment
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Remove plywood
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Cut, measure, install new plywood
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remove existing fixtures (skylights, hatches, A/C units, vents, etc.)
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Install new underlayment
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Re-lay tile
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Dispose of trash and debris
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TPO/EDPM/PVC
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Layout insulation
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Fasten insulation with screws
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Install new fixtures (skylights, roof hatch, vents, etc)
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Roll-out roof material and fasten
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Apply adhesives to material
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Torch down materials
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Weld roof material using heat welders
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Weld roof material using induction welding
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Material detailing and patching
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Metal
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Measure and cut material
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Install coping
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Install siding
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Install fascia
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Install gutters
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Install drip edge
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Install reglet
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Install flashing
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Install bird stop
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Built-up Roof
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Set up kettle and pipe
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Transfer hot asphalt to lugger/buckets
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Layout base layer and fasten to roof
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Layout material and seal w/ hot asphalt
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Torch down materials
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Dry-In
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Measure and cut underlayment
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Fasten underlayment to roof
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Detail for roof penetrations
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Tile
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Layout tile on roof
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Cut tile for penetrations and terminations
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Install tile on roof
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Clean Up
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Clean work are of trash and debris
Fall Hazards and Controls
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No/Low Parapets (Lower than 39”)
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Warning Line 6ft from edge or 10ft when operating equipment on roof w/ PFAS
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PFAS (100% tie-off)
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Guardrail system
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Horizontal lifeline system w/ PFAS
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Roof Openings/Holes (Greater than 2” in diameter)
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Cover and secure/fasten it
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Mark cover with "HOLE" and "AGUJERO"
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CAZ 15' around hole w/ PFAS inside zone
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PFAS when working around open holes
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Roof Hatch
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Kept closed at all times unless in use
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Guardrails around hatch
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PFAS used if working around open roof hatch
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Skylights
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Barred
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PFAS when working around/near skylights
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Guardrails around skylight
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CAZ 15' around skylight w/ PFAS inside zone
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Wall Openings (Greater than 30”H x 18”W)
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Cover and secure/fasten it
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Mark cover with "HOLE" and "AGUJERO"
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CAZ 15' around hole w/ PFAS inside zone
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PFAS when working around wall openings
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Sloped Roof (4:12 or greater)
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Non-slip boots
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Material staged and secured in self-supporting manner or by other means
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Slips and Trips
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Non-slip boots
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Good housekeeping
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Situational awareness
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Ladders
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Portable
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3 pts. of contact when climbing
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Set up 1ft away from landing point for every 4ft of height
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Ladder reaches 3ft above landing point
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Ladder secured/tied-off
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Feet leveled and position adjusted to type of surface
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A-Frame
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No leaning ladder unless designed to do so
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Top 2 steps not used
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3 pts. of contact when climbing
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Ladder placed on level, secure surface
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Fixed
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42" extension above landing point via safety bar, grab rails, etc.
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Landing platform(s)
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Ladder clearance between rungs and wall/permanent object behind ladder greater than 7"
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Ladder cage
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Leading Edge Work
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100% Tie-off when working leading edge at heights greater than 6'
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Fall protection equipment designed for leading edge work
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Scaffolding
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Tool lanyards
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Tie-off when working at heights greater than 10' without guardrails
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Use only approved and tagged access points
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Mobile Elevated Working Platform
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Tie-off while operating (fall-restraint)
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Operators are certified
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Know load ratings and load charts
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Break of Elevation
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Used approved step system or ladder to transition elevations
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Improper Anchor Point
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Anchors installed per manufacturers specifications
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Operating Equipment on Roof
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Warning Line 10ft from edge
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Situational awareness
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Equipment operated according to manufacturer's instructions
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Where are call hazards located?
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Where do fall hazards exist?
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Picture(s)
Other Hazards and Controls
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Overhead Work
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Hard hat
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Controlled Access Zone
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Struck-By
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Situational awareness
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hi-visibility clothing
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Eye contact with equipment operators
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Electrical
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Lock-out, Tag-out
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Proper PPE
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Cords in good condition and have ground
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GFCIs are used
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Metal tools and equipment kept away from electrical sources
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Silica Exposure
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Permissible Exposure Limit awareness
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Dust collection or ventilation equipment
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Open or well-ventilated area
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Respirators
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Excavation
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Easily visible or warning system around open excavation
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Properly guarded or covered from falls when greater than 6ft deep
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Materials kept 2' away from edge
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Has protective system in place when greater than 5ft
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Dust Exposure
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Respirators
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Safety Glasses
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Dust collection or ventilation equipment
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Open or well-ventilated area
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Skin
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Proper clothing
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PPE for the type of materials or chemicals being worked with
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Cuts
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Cut-resistant gloves
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Tools properly guarded
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Blades are in good condition and changed regularly
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Moving Machinery
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Situational awareness
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hi-vis clothing
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eye contact with equipment operators
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Use spotters
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Pinch Points
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Situational awareness
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hi-vis clothing
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eye contact with equipment operators
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Improper Access
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Correct equipment used for access
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Equipment correctly set up and used
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Traffic Control
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Control properly coned off
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Flaggers
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Manual on Uniform Traffic Devices (MUTCD) Needed
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Hazardous Atmosphere
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Atmosphere testing
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Proper PPE
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Confined Space
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Controlled Access
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Confined space permit
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Atmosphere testing
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Proper PPE
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Rescue Plan
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Manual Lifting
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Stretch before working
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Practice good ergonomics
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Material Storage
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Keep materials 6ft or more away from edge and tile/masonry 3ft or more away from edge
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Store flammable materials in covered/shaded areas
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Keep entryways and access points clear
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Good housekeeping
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Proper PPE
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Material Handling
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Proper PPE
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SDS easily accessible
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Fire extinguisher within 50ft of flammable materials
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Loud Noises
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Ear plugs
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Decibel reader
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Welding/Hot Work
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Heat-resistant PPE
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Face Shields
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Adequate fire extinguisher within 25ft
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Know material flash points
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Firewatch
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Eye/Face
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Safety glasses
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Face shield
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Face covering
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Respirators
Tools/Small Equipment Required
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All tools and equipment on-site are to be inspected daily before use.
Hand Tools
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Tin Snips
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Pry Bar
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Utility Knife
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Pliers
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Hammer
Power Tools
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Circular Saw
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Reciprocating Saw
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Hammer Drill
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Impact Drill
Special Tools
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Heat Gun/Welder
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Leaf Blower
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Spray Gun
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Staple Gun
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Nail Gun
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Powder Actuated
Small Equipment
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Extension Cords
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Material Carts
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Small Generator
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Automatic Welder
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Rhinobond Welder
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Portable Ladders
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A-Frame Ladders
Heavy Equipment
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Skytrak Forklift
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Boom lift
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Towable Generator
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Trash Boom
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Crane
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Towable Kettle
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Other
Safety Equipment Required
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All tools and equipment on-site are to be inspected daily before use.
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Atmospheric monitor
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Chemical-resistant gloves
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Class 2 hi-vis vest
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Confined space rescue equipment
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Cut-resistant gloves
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Ear muffs
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Ear plugs
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Fall restraint
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Face shield
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Fire extinguisher
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Guardrails
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Handrails
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Hard Hat
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Heat-resistant gloves
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Lock-out, Tag-out equipment
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Personal Fall Arrest System equipment
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PFAS rescue equipment
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Respiratory protection
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Safety glasses
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Safety goggles
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Safety toed boots
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Shoring
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Trench box
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Ventilation equipment
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Warning line
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Other
Review
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Additional Photos
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Crew Leader Signature
List of Crew Members
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Name and Signature
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Superintendent Signature
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Safety Representative Signature