Information
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Project Name
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Project ID
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Customer
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Inspector
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Conducted on
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Location
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Subcontractor site-specific safety plan/fall protection plan etc. on-site
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OSHA/State required safety postings on-site
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Weekly safety meeting - (topic noted on sign-up sheet & copies submitted to Trane)
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Personnel Attendance Lsit
Name and Company
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Name (first and last)
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Company
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Subcontractor daily inspection by supervisor or safety representative - (On-site and reviewed)
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All accidents/incidents/near misses reported to Trane supervisor and EHS immediately (subcontractor and Trane)
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Proper PPE Use - (Minimum - safety glasses, hard hat, steel toe boots - note additional as required)
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Safe Roof/Mezzanine/Floor access - (List type of access)
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Overhead protection in place for overhead work (crane, helicopter, steel installation, roof openings, roof edge - note additional when applicable)
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Fall Protection system in place for work closer than 15-feet from fall hazard (roof edge, floor openings, etc)
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Proper fall protection used by all exposed employees
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Training per regulator requirements
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Tethered Fall Protection
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Picture of Fall Protection
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One person per tether line (each line is rated for 2000 lbs)
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Full Harness used
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Monitored System Used
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Float or very low pitched roof
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Monitored easily identified (different color vest, hard hat, etc)
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Monitoring/Warning lines or alarms on place and greater than 15 feet from edge
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Picture of Monitoring System
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Trenching
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No Water
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Is Deeper than 36 inches (3 Feet)
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Shoring Installed
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Picture of Shoring
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Proper Slope
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Ladder Access every 50 feet
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Picture of Ladder
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Ladders in Use on Site
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Step Ladders
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Inspected
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Fully Extended
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Proper Height (not stangng on top two rungs)
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Step Ladder Pictures
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Extension Ladders
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Secured at top
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36 inch overlap at landing
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Pictures of Extension Ladders
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Inspected
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4 to 1 ratio
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Scaffolding At use on site
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Inspected Daily (meets all regulator requirements)
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Personnel are Trained for use
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Scaffolding Erectors are specifically trained for erecting scaffolding
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Slips/Trips/Fall Hazards (holes covered, water cleared, trip hazards)
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Description of At Risk Hazard
Hazard Description
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Description
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Picture of At Risk Hazard
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Crane Use
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Trane Use Checklist
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Forklift
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Inspected Daily before use
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Seat belt used
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Trained operator
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Hot Work
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Extinguishers every 75 ft
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Inspected Monthly
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Combustible Materials moved away from Hot Work Areas
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Hot Work Permits Completed
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Fire Watch for 30 mins after hot work complete
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Electrical Safety Work
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Using GFCI on all equipment
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All Extension Cords inspected and less than 50 feet
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Lock Outs Tag Outs per regulations
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Work in Switchgear or Electrical Panel
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Panel Voltage
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How many Cals Required
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Minimum Cals Meet
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Picture of worker in PPE
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NFPA 70E followed
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Good house Keeping Maitained
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Description of Problem Area
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Picture of Cleaning Area
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Hazardous Material
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MSDS onsite
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Proper Storage Area
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Proper PPE when handeling
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Staff/Public Protection
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Issue
Safety Issue
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Description
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Picture of At Risk Area/Issue
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Proper Lighting in Work Areas
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Noise Control Areas
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Weather
- Sunny
- Cold
- Hot
- Windy
- Rainy
- Other
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Weather Description
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Other Issues
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Details about other issues
Other Issues Descriptions
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Additional Notes and Corrective Actions
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Additional General Pictures
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Signature
