Vacuum Contractor - Contractors

• Document No.

• General Inspection

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Job Briefing

• Is there a current Job Briefng

  Yes

  No

  N/A

• Has all the hazards been identify

  Yes

  No

  N/A

• Has all signed the Job Briefing

  Yes

  No

  N/A

HOUSEKEEPING

• Working areas clean

  Yes

  No

  N/A

• Well maintained lay down yards<br>

  Yes

  No

  N/A

• Passageways & Walkways unobstructed

  Yes

  No

  N/A

• Adequate functional lighting

  Yes

  No

  N/A

• Oil and grease removed from floors

  Yes

  No

  N/A

• Outside walkways clear of obstructions

  Yes

  No

  N/A

• Stairs and handrails in place as necessary

  Yes

  No

  N/A

• Condition of breakroom

  Yes

  No

  N/A

• All exits clearly marked and identified

  Yes

  No

  N/A

• Exit lighting properly working

  Yes

  No

  N/A

FIRE PREVENTION

• Fire extinguishers identified and inspected monthly

  Yes

  No

  N/A

• Phone numbers of fire department posted

  Yes

  No

  N/A

• Electrical receptacles covered and operable

  Yes

  No

  N/A

• Access to all Fire Extinguishers is clear/unobstructed

  Yes

  No

  N/A

HAND TOOLS

• Neat Storage?

  Yes

  No

  N/A

• Damaged tools repaired or replaced?

  Yes

  No

  N/A

POWER TOOLS

• Tools and cords in good condition?

  Yes

  No

  N/A

• All mechanical safeguards in use?

  Yes

  No

  N/A

• Tools neatly stored when not in use?

  Yes

  No

  N/A

• Right tool being used for the job at hand?

  Yes

  No

  N/A

• GFCIs (Ground Fault Circuit Interrupter) available for electrical tool use?

  Yes

  No

  N/A

• Is all tools with current quarterly inspection?

  Safe

  At Risk

  N/A

LADDERS

• Ladders inspected and in good condition?

  Yes

  No

  N/A

• Properly secured to prevent slipping, sliding, or falling?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Eye protection

  Yes

  No

  N/A

• Face shields

  Yes

  No

  N/A

• Proper hand protection

  Yes

  No

  N/A

• Respirators and masks

  Yes

  No

  N/A

• Head protection

  Yes

  No

  N/A

• Traffic vest and/or high visibility garment

  Yes

  No

  N/A

• Steel toe shoes

  Yes

  No

  N/A

• Personal fall arrest systems

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

Aerial Lifts

• Daily checklist preformed

  Yes

  No

  N/A

• Is fall protection being used

  Yes

  No

  N/A

• Standing on the floor of lift

  Yes

  No

  N/A

FORKLIFT

• Forklift meets code?

  Safe

  At Risk

  N/A

• Inspection sheet documented on days used?

  Yes

  No

  N/A

FLAMMABLE GASES & LIQUIDS

• All flammable containers are clearly identified?

  Yes

  No

  N/A

• Proper storage practices observed?

  Safe

  At Risk

  N/A

• Flammable cabinets in use?

  Yes

  No

  N/A

• Gas cylinders secured upright?

  Yes

  No

  N/A

• Flammable storage building

  Yes

  No

  N/A

• LP Tanks

  Yes

  No

  N/A

• LP transfer stations grounding/bonding

  Yes

  No

  N/A

Confined Space

• Is the location identified on the Confined Space Form

  Yes

  No

  N/A

• Is the form filled out correctly

  Yes

  No

  N/A

• Is the Attendant present

  Yes

  No

  N/A

• Is the Air Monitor running

  Yes

  No

  N/A

• Is the reading being recorded

  Yes

  No

  N/A

• Is the sign in and out list correct

  Yes

  No

  N/A

Trenching

• Are Ladders in for trench excavation four feet or greater

  Yes

  No

  N/A

• Is the spoil pile at least two feet back from the edge

  Yes

  No

  N/A

• Is air monitoring being done

  Yes

  No

  N/A

• If excavations is greater then 5 feet then is shoring being used

  Yes

  No

  N/A

WELDING & CUTTING

• Screens & Shields present

  Yes

  No

  N/A

• PPE (goggles, gloves, & clothing)

  Yes

  No

  N/A

• Equipment in proper operating condition?

  Yes

  No

  N/A

• Electrical equipment grounded?

  Yes

  No

  N/A

• Power cables protected and in good repair?

  Yes

  No

  N/A

• Fire Extinguishers of proper type nearby?

  Yes

  No

  N/A

• Area clear of fire hazards

  Safe

  At Risk

  N/A

• Flammable material protected?

  Safe

  At Risk

  N/A

• Gas cylinders chained upright?

  Yes

  No

  N/A

• Fuel or oxyacetylene protected and in good condition?<br><br>(Reminder: Oxygen/Acetylene tanks must be stored minimum 12 feet apart when not in use OR have fire proof barrier between the tanks)

  Yes

  No

  N/A

• Are all cylinder caps in place for tanks in storage?

  Yes

  No

  N/A

• Are regulators removed for tanks not in use?

  Yes

  No

  N/A

Safety Concerns

• All work being done safely

  Yes

  No

  N/A

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  Date

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• Is there a safety concern?

  Safe

  At Risk

  N/A

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• All work being done safely

  Safe

  At Risk

  N/A

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• All work being done safely

  Safe

  At Risk

  N/A

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• All work being done safely

  Safe

  At Risk

  N/A

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• All work being done safely

  Yes

  No

  N/A

• All work being done safely

  Yes

  No

  N/A

• All work being done safely

  Yes

  No

  N/A

• Select date

  Date

• Add signature

  Sign