Information
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Document No.
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Job Name / Number
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Conducted on
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Prepared by
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Location
Programs / Information
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Safety Policy & Standard Operating Procedure Manual Onsite & Current
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All Required Postings Posted (All- In - One, Forklift, Permits, Current Cal OSHA 300 Log, Wage Orders, Etc..)
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First Aid/CPR Cards
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Chemical Containers Properly Stored and Labeled
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Hazardous Chemical / Prop 65 Chemical Inventory Current & Available
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All Safety Data Sheets (SDS) Available
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Weekly Toolbox Safety Trainings Held
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Topic Covered:
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Daily Foreman Safety Huddles Held & Reviewed
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Yellow Hard Hat Mentoring Program in Effect
Personal Protective Equipment
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Hard Hats
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Eye Protection
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Hearing Protection
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Appropriate Hand Protection
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Respirators Or Dust Masks
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High Visibility Garment (ANSI Class II Or III)
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Foot Protection - Toe Guards
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Other:
Fall Protection
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All Personnel Protected From Fall Height Greater Than 6' (PFP, Restraint, Guard-railing, Covers, Etc..)
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Other:
Housekeeping
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No excessive Debris On Site
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Lay-down Areas Organized, Piling & Stacking Secured
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Adequate Supply Of Trash Receptacles
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Nails Bent or Removed
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All Rebar and Similar Protrusions Capped or Troughed
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Other:
Fire Protection
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Extinguishers Certified Within Last 12 Months
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Extinguishers Inspected Monthly And Tags Signed
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Employees Trained On Proper Use - Annually
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Other:
Ladders (Zero Tolerance Item)
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Ladders Inspected And In Good Condition
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Employees Trained On Safe Ladder Use
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Ladders In Use Are Properly Secured
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Extension Ladders Extend 36" Above Landing
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Ladder Weight Rating 300 Lb. - 1A or Greater
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Ladders Not In Use Are Properly Stored
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Other:
Electrical
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Grounded / GFCI Protected
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Cords, Plugs and Receptacles In Good Condition And Protected
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Quarterly Color Code In Use
Hand Tools
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Whip Checks In Use On Pressurized Lines
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Proper Tool In Use For Task, Proper PPE In Use
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Defective Tools Tagged / Removed From Site
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Safety Guards And Devices Installed (Zero Tolerance Item)
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Other:
Equipment
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Operator Trained, Authorized And Or Certified (Certification Proof Readily Available)
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Pre-Inspection Check List Completed
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Maintenance Inspection Current (Annual & 90 Day)
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Required Manuals, Load Charts, With Equipment
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Seatbelt In Use
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Backup Alarm Functioning
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Operating At Safe Speeds
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Wheels Chocked On Mobile Equipment
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Other:
Confined Space (Zero Tolerance Item)
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Employees Trained (Supervisor, Attendant, Entrant)
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Permit For Entry Completed & Posted
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Continuous Air Monitoring Provided
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Adequate Ventilation Provided (Blower/Fan)
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Retrieval System In Place
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Other:
First Aid
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Trained Personnel Available
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Kits/Supplies Available and Fully Stocked
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Designated Medical Provider Identified
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Other:
Power Lines
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Designated Spotter Used
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Adequate Distance Maintained from Power Lines Min. 10' up to 50KV
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Other:
Trenching And Excavation (Zero Tolerance Item)
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Competent Person Designated And Identified
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Annual Permit Posted And Local Cal OSHA Office Notified (Over 5' In Depth)
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Documented Daily Trench/Excavation Inspection Performed
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Proper Protective System In Place (Over 5' In Depth)
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Safe Access / Egress Provided (Ladders With In 25' Or Ramp <30 Deg.)
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Approved Potholing and Verification of Utilities Used
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Other:
Site/Public Protection
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Traffic Control In Place
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Fences In Use And In Good Condition
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All Vehicles Parked in Cone Zone
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Hazard Warning Signs In Use
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Barricades In Use
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Other:
Heat Illness Prevention (Zero Tolerance Item)
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Employees / Supervision Trained
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New Employees Not Acclimated To Heat Under Additional Supervision
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Cool Clean Drinking Water Supplied
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Disposable Cups Provided w/ Trash Receptacle Nearby
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Shade & Comfortable Seating Provided For Preventative Recovery Breaks
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High Heat Provisions In Place (95 Deg. & Above)
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Other:
Subcontractor Compliance
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Compliance With Site Specific and Cal OSHA Safety Requirements
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Confined Space
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Scaffolding
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Trenching and Excavation
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Weekly Toolbox Safety Training Performed
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All PPE Requirements Being Met
Corrective Actions Taken / Inspection Summary
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All "Corrective Action" items are to be corrected at the jobsite within 24 hours. If corrective action is not possible, the item shall be brought to the immediate attention of the Safety Director.
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Project Supervision
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Safety Specialist
