VMS #1-DAILY SAFETY INSPECTION FORM REV 1

• Template title

  Daily Safety Inspection

• Inspector

• Date & Time

  Date

• THIS REPORT MUST BE COMPLETED DAILY

• ALL VMS EMPLOYEES PRESENT MUST SIGN

• AT LEAST ONE REP FROM EACH SUBCONTRACTOR MUST SIGN

• INCLUDE PHOTOS AS APPROPRIATE FOR INDIVIDUAL ITEMS

• ENSURE THAT YOU INCLUDE SOME GENERAL PHOTOS OF THE JOBSITE

VMS DAILY PROJECT INSPECTION

• PROJECT NAME

• CONDUCTED ON

  Date

• PREPARED BY

• TASK TO BE PERFORMED TODAY

• LOCATION
  Address

• Personnel and Subcontractors

PERSONAL PROTECTIVE EQUIPMENT

• SAFETY VEST NEEDED?

  Yes

  No

  N/A

• HARD HAT NEEDED?

  Yes

  No

  N/A

• Why?

• SAFETY GLASSES NEEDED?

  Yes

  No

  N/A

• HEARING PROTECTION NEEDED?

  Yes

  No

  N/A

• PERSONAL FALL PROTECTION NEEDED?

  Yes

  No

  N/A

• DUST MASK NEEDED ?

  Yes

  No

  N/A

• ARE ALL PPE ITMES READILY AVAILABLE AND ONSITE IF NEEDED?

  Yes

  No

  N/A

HOUSEKEEPING

• SITE CLEAN WITH NO DEBRIS?

  Yes

  No

  N/A

• MATERIALS ARE STORED CORRECTLY?

  Yes

  No

  N/A

• ARE FALL ZONES, WORK ZONES, AND OTHER HAZARDS DELINEATED?

  Yes

  No

  N/A

• AREAS ARE CLEAN WITH NO TRIP HAZARDS?

  Yes

  No

  N/A

TOOLS AND EQUIPMENT

• ELECTRICAL CORDS ARE INSPECTED TODAY?

  Yes

  No

  N/A

• LADDERS ARE INSPECTED TODAY?

  Yes

  No

  N/A

• ALL GUARDS ARE INSTALLED AND WORKING PROPERLY?

  Yes

  No

  N/A

• ALL EQUIPMENT DAMAGED IS TAGGED AND OUT OF SERVICE? (click on follow up if equipment need immediate attention)

  Yes

  No

  N/A

• IS THE OPERATOR OF THE EQUIPMENT TRAINED?

  Yes

  No

  N/A

HAZARDOUS COMUNICATION

• SDS SHEET ON SITE FOR THE CHEMICALS/MATERIALS IN CONTACT?

  Yes

  No

  N/A

• ALL CHEMICALS STORED PROPERLY AND LABELED?

  Yes

  No

  N/A

EMERGENCY EQUIPMENT

• FIRE EXTINGUISHER ONSITE AND LESS THAN 50FT FROM WORK AREA?

  Yes

  No

  N/A

• FIRST AID KIT AND EVERYONE KNOWS THE LOCATION?

  Yes

  No

  N/A

• TELEPHONE OR RADIO ON SITE?

  Yes

  No

  N/A

EXCAVATION AND TRENCHING

• IS EXCAVATION OCCURING TODAY? HAS SUBCONTRACTOR DISCUSSED AND/OR PERFORMED THE FOLLOWING?

  Yes

  No

  N/A

• DIG SAFE NUMBER/ SITE IS MARKED?

  Yes

  No

  N/A

• POWER LINES LOCATION ARE IDENTIFY AND LESS THAN 10FT FROM REACH?

  Yes

  No

  N/A

• VISUAL SOIL TEST HAS BEEN PERFORMED?

  Yes

  No

  N/A

• SOIL CLASIFICATION

  A SOIL 1V TO 3/4H

  B SOIL 1V TO 1H

  C SOIL 1V TO 1 1/2H

  TRENCH BOX

• DEPTH OF THE EXCAVATION?

• LADDERS ARE AVAILABLE AND AT NOT MORE THAN 25 FT?

  Yes

  No

  N/A

• PURPOSE OF THE EXCAVATION?

  DRAINAGE

  WATER

  SEWER

  GAS

  BUILDING/TANKS

• SLOPE RATIO/TRENCH BOX?

  Yes

  No

  N/A

• IS THERE ANY WATER IN THE TRENCH AND PUMP AND GENERATOR ARE AVAILABLE ON SITE?

  Yes

  No

  N/A

• ARE ALL EMPLOYEES TRAINED ON THE HAZARDS AND PLAN TO PERFORMED THE EXCAVATION?

  Yes

  No

  N/A

• DISCUSS WITH OPERATOR THAT EXCAVATED MATERIAL TO BE LOCATED @ FT MIN FROM THE EDGE OF THE EXCAVATION?

  Yes

  No

  N/A

• HAS PEDESTRIAN AND VEHICULAR HAZARDS BEEN ADDRESSED?

  Yes

  No

  N/A

CONFINED SPACE

• ARE YOU OR A SUBCONTRACTOR WORKING ON A CONFINED SPACE TODAY?

  Yes

  No

  N/A

• GAS MONITOR, TRIPOD, HARNESS, WINCH HAS BEEN INSPECTED?

  Yes

  No

  N/A

• DID THE CONFINED SPACE PERMIT WAS FILLED?

  Yes

  No

  N/A

• HAS THE PRE-ENTRY TEST HAS BEEN PERFORMED?

  Yes

  No

  N/A

• ALL TEAM TRAINED IN THE SPECIFIC CONFINED SPACE TO ENTER?

  Yes

  No

  N/A

• IS THERE ARE PROCEDURE TO MONITOR AIR WHILE PERFORMING THE WORK?

  Yes

  No

  N/A

MATERIAL HANDLING

• CAN YOU LIFT THE LOAD BY HAND?

  Yes

  No

  N/A

• ANY AREAS OF THE BODY THAT CAN BE AFFECTED BY PICKING THE LOAD?

  Select HAND BACK KNEES FEET

  • HAND
  • BACK
  • KNEES
  • FEET

• HOW HEAVY IS THE LOAD?

• ARE THE LIFTING DEVICES, STRAPS,CHAINS TAGGED AND CERTIFIED FOR THE LOAD?

  Yes

  No

  N/A

• ARE THE LIFTING DEVICES INSPECTED TODAY?

  Yes

  No

  N/A

FALL PROTECTION

• IS ANY ONE WORKING TODAY HIGHER THAN 4 FT?

  Yes

  No

  N/A

• DO YOU NEED HAND RAILS AND TOES BOARDS?

  Yes

  No

  N/A

• ARE LADDERS TIED TO A FIXED LOCATION AND INSPECTED?

  Yes

  No

  N/A

• ARE YOU USING LIFT LIFE LINES?

  Yes

  No

  N/A

• HAVE HARNESSAND EQUIPMENT BEEN INSPECTED

  Yes

  No

  N/A

TRAFFIC CONTROL

• ARE YOU OR A SUB USING A TRAFFIC CONTROL PLAN TODAY?

  Yes

  No

  N/A

• IS THERE A SPECIFIC TRAFFIC CONTROL FOR THE PROJECT?

  Yes

  No

  N/A

• HAVE EMPLOYEES BEEN TRAINED IN THE TRAFFIC CONTROL?

  Yes

  No

  N/A

• HOW IS IN CHARGE OF THE TRAFFIC CONTROL PACKAGE SET UP AND TRAFFIC CONTROL DAILY PLAN?

  Yes

  No

  N/A

• ARE ALL FLAGGERS CERTIFIED?

  Yes

  No

  N/A

• DO YOU HAVE ALL SIGNS, PADDLES, CONES, BARRELS TO PERFORM A CORRECT TCP?

  Yes

  No

  N/A

SAFETY MEETING (EVERY MONDAY) (ALL PERSONS ONSITE MUST ATTEND)

• DID YOU HAVE A SAFETY MEETING TODAY

  Yes

  No

  N/A

• WHAT WAS THE TOPIC?

• PLEASE WRITE IF THERE WHERE ANY COMMENTS OR IDEAS

• DO YOU NEED ADDITIONAL INFORMATION ABOUT A SPECIFIC TOPIC FOR YOUR JOB?

  Yes

  No

  N/A

• ANY PICTURES GOOD SAFETY PRACTICES ON YOUR JOB?

  Media

COMMENTS

• WHERE THERE ANY ACCIDENTS YESTERDAY?

  Yes

  No

  N/A

• Briefly describe the incident/issue

• Has an accident report been completed

  Yes

  No

  N/A

• EVERYONE WENT HOME WITHOUT INJURIES YESTERDAY?

  Yes

  No

  N/A

• ARE THERE ANY SAFETY ISSUES ON SITE?

  Yes

  No

  N/A

• DO YOU NEED THE SAFETY DIRECTOR?

  Yes

  No

  N/A

• DO YOU HAVE ANY ADDITIONAL COMMENTS?

PHOTOS (Take a couple photos of the jobsite)

• Using Safety Equipment

  Media

• Work Area

  Media

• Potential Hazard

  Media

SIGNATURES (ALL VMS EMPLOYEES AND AT LEAST ONE REP FROM EACH SUBCONTRACTOR)

• SIGNATURES

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• SIGNATURES

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