Weekly Field Inspection

• Plant

• Prepared by

• Conducted on

  Date

• Site address

• Location - GPS
  Address

• Crew Members

Employee

• Employee

• Type of worked being done

  Select Rotary Construction Billposting Other

  • Rotary
  • Construction
  • Billposting
  • Other

• Explain

Answer the following questions

• Are crew members wearing hard hats

  Yes

  No

  N/A

• Are crew members using ear, eye, and hand protection

  Yes

  No

  N/A

• Are crew members utilizing other safety equipment that may be necessary

  Yes

  No

  N/A

• Was a walk around inspection of both the structure, (or work site) and the area immediately surrounding it done to identify any potential hazards prior to performing any work or ascending the structure

  Yes

  No

  N/A

• Is the electrical equipment servicing the structure turned off and properly locked/tagged out

  Yes

  No

  N/A

• Is the electrical equipment in good condition and free of hazards

  Yes

  No

  N/A

• Is all equipment being used in appropriate condition for safe usage

  Yes

  No

  N/A

• Are portable ladders properly tired off at the top

  Yes

  No

  N/A

• Are feet on portable ladders on stable footing

  Yes

  No

  N/A

• Are portable ladders placed at the proper angle

  Yes

  No

  N/A

• Are portable ladders extended 3 feet above surface being climbed onto

  Yes

  No

  N/A

• Is there a ladder safety cable on fixed ladders longer than 20'

  Yes

  No

  N/A

• Are crew members wearing safety harnesses and the appropriate safety devices

  Yes

  No

  N/A

• Are crew members' hands free of tools and/or materials while climbing all ladders on the structure

  Yes

  No

  N/A

• Are all safety cables present and properly installed on the structure

  Yes

  No

  N/A

• Are crew members hooking into a safety cable or anchoring point prior to transferring from the ladder to the catwalk

  Yes

  No

  N/A

• Are crew members properly hooked to a safety cable or anchoring point 100% of the time while on the structure

  Yes

  No

  N/A

• Is all work being done at least 10 feet from power lines

  Yes

  No

  N/A

• Are crew members working efficiently, without sacrificing safety

  Yes

  No

  N/A

• Are there any safety procedures or hazards in addition to the above not being followed by crew members

  Yes

  No

• Is the base of any and all ladders in use free of debris or material

  Yes

  No

  N/A

• If there are any violations committed by any member of the crew during this inspection explained Below in detail. Be sure to include the violation committed, the name of the crew member that committed the violation, and the corrective actions taken. If there are no violations committed, but there are comments, suggestions, or concerns to note, explain in detail below

• Photos of worker(s) and Work Site

  Media

• This field inspection was completed by

  Sign