Information

  • Supervisor

  • Foreman

  • Date

  • Job No.

  • Location
  • Prepared by

Daily Safety & Pre-Task Planning

Daily Safety & Pre-Task Planning

  • Are Daily Safety & Pre-Task Planning forms being completed?

  • Is the work being done matching the form?

  • Why is not being completed?

  • Daily huddle completed?

  • Employee feedback on daily huddle

Emergency

Emergency Plan

  • Do employees know of the emergency plan?

  • 911 Confirmation

  • Clinic/Hospital Location

New Employees

  • Jobsite Orientation

  • Integration

  • New Employee concerns

New Employee

New Employee

  • Have you completed job site orientation?

  • Are you being welcomed in/how are you fitting in?

  • Do you have any concerns?

New Employee

  • Have you completed job site orientation?

  • Are you being welcomed in/how are you fitting in?

  • Do you have any concerns?

New Employee

  • Have you completed job site orientation?

  • Are you being welcomed in/how are you fitting in?

  • Do you have any concerns?

TPR

TPR (Open Ended Questions)

  • Any issues or concerns

Machinery

  • Lubricated?

  • Clean?

  • Seat belt?

  • Safety equipment?

  • Any issues with One Call or Operator Care?

  • Explain

Locates

Overhead

  • Power Lines

  • How far away (in ft.)?

  • Phone Lines?

Underground

  • Power Lines

  • How far away (in ft.)?

  • Phone Lines?

  • Fiber-optics?

  • Gas lines?

  • Water Lines?

  • Sewer Lines?

Traffic Control

  • Designated employee parking?

  • Picture

  • Suggestions for parking spots

  • Picture

  • Designated equipment parking?

  • Picture

  • Suggestions for parking spots

  • Picture

  • Pedestrian Traffic Areas designated and guarded?

  • Picture

  • Haul Routes and/or Traffic Pattern in place?

  • Work zone signing/traffic control manual in place?

Trench Safety

  • Type of Soil Present

Which types? (check all that apply)

  • A

  • B

  • C

  • Is the trench safe?

  • Picture

  • Ladders within 25ft of employees?

  • Are employees aware of the rescue plan?

Confined Space

  • Permit entry?

  • Permit present?

  • 4 gas detector present?

  • Calibrated correctly (bump test)?

Rescue

  • Rescue plan in place?

  • Rescue equipment near entry/exit?

Entry/Exit

  • Location clearly marked?

  • Spotter present?

Chains and Slings

  • What is the condition of the chains/slings?

  • Photos

  • Have the chains/slings been inspected and certified within the last year?

  • Date of last inspection

  • Are employees operating within the danger zone/swing zone of equipment?

Fire Safety

  • Are extinguishers clearly marked?

  • Are the extinguishers free from materials in front and around of them?

  • Have the extinguishers been inspected recently?

  • Last inspection

  • Do employees know how to use extinguishers? (P.A.S.S. method)

  • Are gas cylinders stored properly?

PPE

Are employees wearing....?

  • Safety Vests?

  • Are the vests in good condition (clean, reflective material visible, etc.)?

  • Safety glasses?

  • If grinding/cutting, are face shields also being worn?

  • Hearing protection (if required)?

  • Hard hats?

  • Are hard hats free from nicks, gouges, and is suspension inside hard hat adjusted properly?

  • Sun protection? (sunscreen, UV protective clothing)?

  • Seat belts on equipment being worn?

  • Fall protection (if required)?

Chain Saw Safety (if applicable)

  • Chaps being worn and fitted properly?

  • Hard hat?

  • Face shield and safety glasses being worn?

  • Hearing protection?

  • Gloves being worn?

Cell Phone usage

  • Do employees have cell phones on their person?

  • Are cell phones being used during work hours?

Erosion Control

  • Erosion control measures in place?

  • Following SWPPP?

Previous Job Site Inspection

  • Date of Last Job Site Inspection

  • Name of Supervisor

Finalization

  • Executive Safety Committee Member

  • Select date

  • Add signature

  • Supervisor

  • Select date

  • Received copy?

  • Add 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.