Title Page

  • Project Name

  • Conducted on

  • Prepared by

  • Location

Safety Administration

  • Occupational Safety and Health Act (OSHA) poster is conspicuously located in the job trailer.

  • E-Verify poster is conspicuously located in the job trailer.

  • Fair Labor Standards Act (FLSA) minimum wage poster is conspicuously located in the job trailer.

  • OSHA 300 Log is posted (February 1st - April 30th only).

Emergency Action Plan

  • First aid kit is easily accessible.

  • First aid supplies are inspected at least weekly and replenished as needed.

  • Eye wash station is provided and accessible.

  • Evacuation route/type is outlined.

  • Nearest hospital and urgent care address and route is posted.

  • Exit signs are posted and readily visible where the exit is not immediately visible.

General Job Site Safety

  • Work areas are properly illuminated.

  • Workers are wearing the appropriate high visibility garments.

  • Workers are wearing the appropriate safety-toe footwear (ANSI Z41.1).

  • Workers are wearing the appropriate head protection (ANSI Z89.1).

  • Workers are wearing the appropriate hearing protection as needed.

  • Workers are wearing the appropriate face protection.

  • Workers are wearing the appropriate hand protection.

  • Workers are wearing the appropriate eye protection (ANSI Z87.1).

Housekeeping

  • Scrap lumber and all other debris is kept clear from work areas, passageways, and stairs.

  • All scrap lumber, waste material, and rubbish is removed from the immediate work area as the work progresses.

  • Temporary toilets and hand washing stations are regularly cleaned and stocked with supplies (toilet paper, hand soap, etc.).

  • Materials are not dropped more than 20 feet to a lower level outside of a building without a trash chute.

  • Trash chutes are closed in on all sides.

Fire Prevention

  • Fire extinguishers (minimum 2A rating) are provided every 100 feet (maximum).

  • At least one fire extinguisher (minimum 2A rating) is located adjacent to each stairway.

  • Fire extinguishers (minimum 10B rating) are provided within 50 feet of 5 gallons of flammable or combustible liquids (or more).

  • Portable fire extinguishers are inspected periodically (at least once a month) and maintained.

  • "No Smoke or Open Flame" signs are conspicuously posted where fire hazards may exist.

  • Only approved safety cans are used for flammable liquids.

Rigging

  • Only qualified riggers are allowed for hoisting activities.

  • Rigging equipment is inspected prior to use on each shift and as necessary during its use.

  • Slings, all fastenings, and attachments are inspected for damage or defects by a competent person.

  • Damaged or defective slings are removed from service.

Hand and Power Tools

  • All hand and power tools (and similar equipment) are maintained in a safe condition.

  • Power operated tools designed to accommodate guards are equipped with guards when in use.

  • Belts, gears, shafts, pulleys, sprockets, spindles, drums, fly wheels, chains, and other reciprocating, rotating, or moving parts of equipment are guarded to protect employees against contact or other hazards.

  • Guards on circular power tools automatically and instantly return to the covering position.

Welding and Cutting

  • A suitable cylinder truck, chain, or other steadying device is used to keep cylinders from being knocked over while in use.

  • Compressed gas cylinders are secured in an upright position at all times except, if necessary, for short periods of time while cylinders are being hoisted or carried.

  • Cylinders are kept far enough away from welding or cutting operations to avoid sparks, hot slag, or flames. If keeping distance is impractical, fire-resistant shields are in use.

  • Cables in need of repair are not in use.

Electrical

  • Ground fault circuit interrupters or an assured equipment grounding conductor program are utilized.

  • All lamps for general illumination are protected from accidental contact or breakage.

  • Temporary lights are not suspended by their electric cord and lights unless designed for this means of suspension.

  • Warning signs are posted and maintained where workers, tools, or equipment may make physical contact with energized electric power circuits.

  • Worn or frayed electric cords or cables are not used.

  • Extension cords are not fastened with staples, hung from nails, or suspended by wire.

Scaffold

  • Scaffold is fully planked between uprights and the guardrails (maximum 1” between wide spacing between the platform and the uprights).

  • The front edge of all platforms are not more than 14” from the face of the work (unless guardrail systems/PFAS are in place).

  • The maximum distance from the face of the work for plastering and lathing operations is 18”.

  • For scaffolds 3’ wide or less, guys, ties, and braces are installed according to manufacturer’s recommendations or at the closest horizontal member to the 4:1 height and be repeated vertically at locations of horizontal members every 20’ or less (26’ or less for scaffolds greater than 3’ wide).

  • Guys, ties, and braces are installed at horizontal intervals no more than 30’ (measured from one end towards the other).

  • Supported scaffolds bear on base plates and mud sills or other adequate firm foundation.

  • Debris is not allowed to accumulate on platforms.

  • Makeshift devices, such as boxes, barrels, or buckets, are not used on top of scaffold platforms to increase the working level height of employees.

  • Guardrail systems are installed before the scaffold is released for use by employees other than erection/dismantling crews.

  • Overhead protection of employees from falling objects on scaffold is provided via toe boards, screens, debris nets, catch platforms, or canopy structures.

  • Only authorized persons operate aerial lifts.

  • Employees always stand firmly on the floor of the basket on aerial lifts.

Fall Protection

  • The top edge height of top rails are 42” plus or minus 3” above the walking/working level.

  • Mid rails are installed between the top edge of the guardrail system and the walking/working system when there is no wall or parapet wall at least 21” high.

  • When guardrail systems are used around holes which are used as points of access (such as ladderways), they are provided with a gate, or be offset so that a person cannot walk directly into the hole.

  • Anchors are rigged so that employees can neither free fall more than 6’, nor contact any lower level.

  • Personal fall arrest systems are inspected prior to each use for wear, damage and other deterioration, and defective components are removed from service.

  • All other covers are capable of withstanding at least twice the weight of employees, equipment, and materials that may be imposed on the cover.

  • All covers are secured to prevent accidental displacement.

  • All covers are marked with the word “HOLE” or “COVER” to provide warning of the hazard (this excludes cast iron manhole covers or steel grates on streets or roadways).

Hoists and Elevators

  • All entrances of the hoist ways are protected by substantial gates or bars (which are painted diagonal contrasting colors), guarding the full width of the landing entrance.

  • An emergency stop switch is provided in the car, marked “Stop”.

  • All hoists are inspected and tested at not more than 3-month intervals.

  • Hoists are inspected and maintained on a weekly basis.

  • Whenever hoisting equipment is exposed to winds exceeding 35 miles per hour, it is inspected and put in operable condition prior to reuse.

Motor Vehicles and Mechanized Equipment

  • Equipment has an audible reverse signal alarm above the surrounding noise level.

  • If motor vehicle equipment view is obstructed from the rear the vehicle is backed up only when a spotter signals that it is safe to do so.

  • Equipment operators utilize seat belts as required.

  • All equipment is equipped with a horn in operating condition.

Excavations

  • Contractors conducting excavation operations have an active AZ 811 ticket.

  • Existing underground utility lines have been determined by safe and acceptable means (potholing, hand digging, etc.).

  • For excavations 4’ or deeper, a stairway, ladder, ramp, or other safe means of egress is provided at a minimum of every 25’.

  • Employees are required to stand away from equipment loading or unloading material (no employee under overhead loads).

  • Excavation spoils, other materials, or equipment are kept at least 2’ away from the edge of excavations.

  • The excavation competent person inspects excavations prior to the start of work and as needed throughout the shift.

  • Employees in excavations deeper than 4' are protected from cave-ins by appropriate sloping/benching, shoring, or shielding.

Concrete and Masonry

  • All impalement hazards (such as reinforcing steel) are guarded.

  • Employees are not permitted to work under concrete buckets while buckets are being elevated or lowered.

  • Employees operating concrete pumps or similar are wearing head and face protective equipment.

  • Proper face, hearing, and head protection are worn by employees when masonry saws are used.

  • The limited access zone is equal to the height of the wall to be constructed plus 4’ and runs the entire length of the wall.

  • Only employees actively engaged in constructing the wall can enter the limited access zone.

  • The limited access zone remains in place until the wall is adequately supported to prevent overturn and to prevent collapse (for walls less than 8’ tall).

  • All masonry walls over 8’ in height are adequately braced to prevent overturning and to prevent collapse unless the wall is adequately supported.

Steel Erection

  • Approvals to begin steel erection have been verified (75% minimum compressive design strength/sufficient strength of concrete to support the loads imposed during steel erection).

  • There are access roads into and through the site for safe delivery and movement of equipment and the material related to steel erection.

  • A site-specific erection plan is developed by a qualified person and available at the work site.

  • Covers for roof and floor openings are capable of supporting twice the intended load.

  • All covers are secured when installed to prevent accidental displacement.

  • All covers are painted with high-visibility paint or marked with the work “HOLE” or “COVER”.

  • Work below steel erection is prohibited unless overhead protection for the employees below is provided.

Stairways and Ladders

  • A stairway, ladder, ramp, runway, sloped embankment, or personnel hoist is provided where there is a break in elevation of 19”.

  • Portable ladders used to access an upper landing extend at least 3’ above the upper landing.

  • Ladders are used only on stable and level surfaces unless secured to prevent accidental displacement.

  • The top or top step of a step ladder is not used as a step.

  • Portable ladders with structural defects are immediately tagged out and withdrawn from service.

  • Employees do not carry any object or load that could cause the employee to lose balance and fall.

Confined Spaces

  • Permitted confined spaces have proper signage posted including, “DANGER-PERMIT REQUIRED CONFINED SPACE, DO NOT ENTER”.

  • Effective measures are taken to prevent unauthorized employees from entering permitted confined spaces.

  • A written permit space program is implemented and available for inspection.

  • Forced air ventilation is directed to ventilate the immediate areas where employees will be present and must continue until all employees have left the space.

  • The atmosphere within the permitted space is continuously monitored unless the entry employer can demonstrate periodic monitoring is sufficient.

  • Rescue and emergency services procedures are developed and implemented.

Cranes and Derricks

  • A proper lift plan is developed by a qualified person.

  • Ground conditions (slope, compaction, and firmness) are adequate.

  • Rigging work is done only by a qualified rigger.

  • A visual inspection for apparent equipment deficiencies has been conducted by a competent person prior to each shift the equipment is used.

  • The operator does not engage in any practice or activity that diverts their attention while actually engaged in operating the equipment.

  • Barricades or caution lines, and notices, are erected to prevent all employees from entering the fall zone. No employees are permitted in the fall zone.

  • A signal person is provided when the point of operation is not in full view of the operator, when the equipment is traveling and the view is obstructed, or when there are site specific safety concerns.

  • Control lines, warning lines, railings, or similar barricades to mark the boundaries of swing radius hazard areas are erected/maintained.

  • Swing radius hazards are clearly marked “Danger—Swing/Crush Zone” and there are high visibility markings on the equipment that identify the hazard areas.

  • Only employees needed to receive a load are permitted to be within the fall zone when a load is being landed.

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.