Tri-lam Roofing

• Company Name

• Project

• Location
  Address

• Foreman

• Conducted on

  Date

• Prepared by

Documentation

• JHA/ Work Plan filled out

  Yes

  No

  N/A

• Weekly Safety Meeting/Toolbox talk

  Yes

  No

  N/A

• Permit required available

  Yes

  No

  N/A

Personal Protective Equipment

• Hard Hat worn

  Yes

  No

  N/A

• Eye/face protection used

  Yes

  No

  N/A

• Proper footwear worn

  Yes

  No

  N/A

• Gloves used

  Yes

  No

  N/A

• Safety Vest worn

  Yes

  No

  N/A

• Respiratory protection used

  Yes

  No

  N/A

Electrical/Hand tools/Power tools/Equipment

• Proper tool in working conditions

  Yes

  No

  N/A

• Extension cords in working condition

  Yes

  No

  N/A

• GFCI used

  Yes

  No

  N/A

• Proper safety guard in place

  Yes

  No

  N/A

• Tool handles in working conditions

  Yes

  No

  N/A

Fall Protection

• Personal Fall Arrest System being used

  Yes

  No

  N/A

• Safety Harness/Lanyard/Anchor point used properly as required

  Yes

  No

  N/A

• Body harness inspected

  Yes

  No

  N/A

• Anchor adequate for current use

  Yes

  No

  N/A

• Guardrail system set up at hoist area

  Yes

  No

  N/A

• Guardrail system set up as required

  Yes

  No

  N/A

• Warning lines set up as required

  Yes

  No

  N/A

• Safety Monitor following competent requirements

  Yes

  No

  N/A

• Safety Net set up as required

  Yes

  No

  N/A

• Floor openings covered, marked and secured

  Yes

  No

  N/A

First aid, Fire and Hazcom

• First aid kit available and fully stocked

  Yes

  No

  N/A

• Fire extinguishers available and in working conditions

  Yes

  No

  N/A

• SDS labels on containers legible

  Yes

  No

  N/A

• SDS available on site

  Yes

  No

  N/A

• Gas cylinders upright and secured

  Yes

  No

  N/A

• Fuel cans being used

  Yes

  No

  N/A

Housekeeping and Sanitation

• Drinking water and cups available

  Yes

  No

  N/A

• Restrooms clean and maintained

  Yes

  No

  N/A

• Trash and materials disposed off properly

  Yes

  No

  N/A

• Walkways/walk paths kept clear of hoses/ cords/debris

  Yes

  No

  N/A

• Housekeeping maintained

  Yes

  No

  N/A

• Work area proper access available

  Yes

  No

  N/A

Ladder Safety

• Ladder 3ft above and secured

  Yes

  No

  N/A

• Ladder condition and placement

  Yes

  No

  N/A

Heavy equipment

• Heavy equipment inspected

  Yes

  No

  N/A

• Load chart/angle indicator available

  Yes

  No

  N/A

• Power lines clearance kept

  Yes

  No

  N/A

• Back up alarm in working conditions

  Yes

  No

  N/A

• Seat belt being used

  Yes

  No

  N/A

• Swing radius barricaded

  Yes

  No

  N/A

• Operator following manufacturer's recommendations

  Yes

  No

  N/A

• Safe operations observed

  Yes

  No

  N/A

Rigging procedures

• Tag lines being used on all lift and hoisting maneuvers

  Yes

  No

  N/A

• Rigging equipment properly being stored when not in use

  Yes

  No

  N/A

• Personnel kept clear of swing radius/lifting zone/landing zone

  Yes

  No

  N/A

• Barricades being used to designate lifting area

  Yes

  No

  N/A

• Signalman/Flagger performing proper and safe operations

  Yes

  No

  N/A

Excavation

• Excavation properly protected

  Yes

  No

  N/A

• Excavation more than 5ft, protection system being used

  Yes

  No

  N/A

• Shoring, sloping, benching or trench box being used as protective system

  Yes

  No

  N/A

• Spoil bank kept at least 2ft from excavation

  Yes

  No

  N/A

• Ladder available

  Yes

  No

  N/A

• Competent person performing excavation requirements to protect employees

  Yes

  No

  N/A

Scaffold

• Competent person on site when erecting/dissembling scaffold

  Yes

  No

  N/A

• Mudsills places properly

  Yes

  No

  N/A

• Scaffold Inspection tag available

  Yes

  No

  N/A

• Base plates secured

  Yes

  No

  N/A

• Proper access and egress

  Yes

  No

  N/A

• Ladder secured and 3 feet above

  Yes

  No

  N/A

• Fully planked

  Yes

  No

  N/A

• Guardrails in place

  Yes

  No

  N/A

• Fixed to structure properly

  Yes

  No

  N/A

• Personal Fall arrest system used

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Kettle Safety

• Fire extinguishers by kettle

  Yes

  No

  N/A

• Kettle properly set up (levels & stable)

  Yes

  No

  N/A

• Located 25 ft from combustibles

  Yes

  No

  N/A

• Kettle operator with proper PPE

  Yes

  No

  N/A

• Fire watch on site

  Yes

  No

  N/A

• Tank at least 20 ft from building

  Yes

  No

  N/A

• Fire extinguishers at tanker on roof

  Yes

  No

  N/A

• Faceshield for tanker operator at roof

  Yes

  No

  N/A

• Protection for hot asphalt falling from roof

  Yes

  No

  N/A

• Gas cylinders upright and secured

  Yes

  No

  N/A

Torch operations

• Employees trained in torch operations

  Yes

  No

  N/A

• Heat detector in place

  Yes

  No

  N/A

• Fire extinguishers in place

  Yes

  No

  N/A

• Fire watch on site

  Yes

  No

  N/A

• Gas cylinders upright and secured

  Yes

  No

  N/A

Additional observations

• Other observations

  Yes

  No

  N/A

• Other observations

  Yes

  No

  N/A

• Other observations

  Yes

  No

  N/A

Pictures attached

• Attached media

  Media

• Author

  Sign