Information
-
Project:
-
Date & Time
-
Inspection Focus:
-
Prepared by:
-
Housekeeping issues
-
Fire extinguisher
-
First aid kits & eye wash accessible and inspected
-
Signs for "overhead wires"
-
Traffic controls in place - by a certified worker
-
Pedestrian access
-
Excavation / Trench Safety
-
JHA addressed hazards of the operation
-
JHA signed off by all crew members
-
PDHA (pre-dig hazard analysis) completed
-
Daily equipment inspection(s) completed
-
Workers have been orientated (hard hat stickers)
-
Proper PPE worn or used for specific task ie/ fall arrest, hearing protection, proper gloves etc.
-
Access: walkways, ladders, ramps
-
Power tools: good working order
-
Hazardous materials: properly labeled and stowed
-
Spill kits are fully stocked and readily available
-
Lifting and hoisting: on the spot lift plan, daily visuals, rigging inspected, tag line used
-
Trespassing on private property: controls in place
Issue description
-
Item #1
-
Location
-
Description of issue
-
Corrective action
-
Person or crew responsible
-
Due date
-
Item #2
-
Location
-
Description of issue
-
Corrective action
-
Person or crew responsible
-
Due date
-
Item #3
-
Location
-
Description of issue
-
Corrective action
-
Person or crew responsible
-
Due date
-
Item #4
-
Location
-
Description of issue
-
Corrective action
-
Person or crew responsible
-
Due date
-
Additional photo #1
-
Additional photo #2
-
Additional photo #3
-
Additional photo #4
Comments & Sign-off
-
Comments:
-
Signature
