Title Page

  • Supervisor/Crew:

  • Conducted on

  • Prepared by

  • Location

1.0 Work at height

  • Guardrails/rigid barricades in place and adequate

  • Hole covers in place and adequate

  • Scaffolding- tagged, signed off, contact name and number

  • 100% tie off being followed

2.0 Scaffolds/ ladders/ gang planks

  • Scaffolding- tagged, signed off, contact name and number

  • Ladders- good condition, secured, correct angle, extended past landing

  • Gang planks- secured at one end, correct angle, proper handrails

3.0 Motorized heavy equipment

  • Pedestrian and vehicle traffic seperated

  • Flaggers in place

  • High-visibility clothing used

  • No approach of equipment until acknowledgement by operator

  • Swing radius barricades as appropriate

4.0 Material handling

  • Worker's clear of line of fire when loads moved

  • Loads are stable prior to unstrapping

  • Loads are secured before transit

  • Materials are stored properly, as required

5.0 Confined space entry

  • Permit requirements followed and signed permit available

  • Forced ventilation in place

  • Atmospheric testing done

  • Attendants in place

6.0 Cranes and rigging

  • Crane and suspended load area is clear of unauthorized personnel

  • Swing radius barricaded

  • Tag lines in use

  • Daily rigging inspection documented in team book

7.0 Trenching and excavations

  • Competent person available and daily inspection in team book

  • Benched, sloped, shared properly when deeper than 5 feet

  • Spill dirt, equipment and material storage at least 2 feet from edge

  • No water accumulation in excavations

  • Access and egress provided every 25 feet

8.0 Electrical work

  • Working on live equipment to be avoided unless not possible

  • Proper PPE in place such as flame resistant clothing and voltage rated gloves as needed for live work

  • Work area properly barricaded

  • Live work permits in place

  • All equipment, tools and materials kept minimum 20 feet from overhead lines (up to 350 kV)

9.0 Hazardous energy control/ line breaking

  • Identify and isolate potential energy sources and stored energy such as electrical, hydraulic, pressure and chemical

  • Lockout, tag, verify zero energy prior to working on systems, or equipment

Signatures

  • Auditor

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