Information

  • Conducted on

  • Job Name / Job Number

  • Superintendent

"ALL IN"

  • Is this Project Team "ALL IN"? Score must be consistent with an "A" grade (No significant safety culture issues). If No, provide action plan to Office Leader & Safety.

GENERAL SAFETY

  • Safety Planning (pre-con meetings, safety plan, JSA, morning huddles, pre-task plans)

  • Postings (State, Federal, Emergency #'s, Incident Reporting & Crisis Management)

  • Material Safety Data Sheets (3E MSDS on Demand Posting & Subcontractor MSDS's)

  • First Aid Kit / Eyewash Replenished

  • Sanitation (1 toilet per 20 workers)

  • Housekeeping (trash & debris removed, proper material storage)

  • Date Corrected:

  • Motorized Equipment (qualified operator identified, backup alarms, seat belts, equipment condition acceptable)

  • Date Corrected:

Personal Protective Equipment

  • Proper Attire (shirts 4" sleeves, pants, boots, hard hat)

  • Date Corrected:

  • Eyes (glasses, goggles, face shield)

  • Date Corrected:

  • Other (hearing, gloves, respirators, chemical protection, metatarsal guards)

  • Date Corrected:

Fall Protection System

  • Guardrails (200#, 42" +/- 3", toeboards, wire rope flagged every 6')

  • Date Corrected:

  • Holes (guarded, covered, secured, labeled)

  • Date Corrected:

  • Protection @ 6' (anchor point, harness, lanyard, retractable, rope grab, positioner)

  • Date Corrected:

  • Other (falling object protection, safety nets, warning lines minimum of 15' from edge)

  • Date Corrected:

Fire Protection/Prevention

  • Fire Extinguishers (accessible, identified, charged, w/in 100' of travel, @ stairways)

  • Date Corrected:

  • Fuel Storage (location, container, extinguisher, traffic protection)

  • Date Corrected:

  • Hot Work (fire watch, fire blankets, permit, extinguisher present, debris clear)

  • Date Corrected:

Cranes

  • Daily Lift Plan (Qualified Operator, Signal Person, Rigger, Daily, Periodic and Annual Inspections)

  • Date Corrected:

  • Set-Up (barricaded, level, powerlines 20' minimum clearance)

  • Date Corrected:

  • Outriggers (extended, pads adequate & level per Daily Lift Plan)

  • Date Corrected:

  • Operation (load path, taglines, signal person)

  • Date Corrected:

  • Capacity (charts available, critical lift plan, object weights identified)

  • Date Corrected:

  • Sling Condition (wire rope, synthetic, hardware)

  • Date Corrected:

Access Equipment

  • Extension Ladders (4V:1H, secured at top and base, 3' above landing, 3 points of contact)

  • Date Corrected:

  • Step Ladders (stable, proper use, inspected, non-conductive)

  • Date Corrected:

  • Stairs (metal pan treads filled, uniform w/in 1/4", rails @ 36", unobstucted, illuminated)

  • Date Corrected:

  • Aerial & Scissor Lifts (proper use, fall protection, condition, rails, operator training)

  • Date Corrected:

Electricity

  • Panels (covers in place, circuits identified, weatherproof, secured, breakers/holes filled)

  • Date Corrected:

  • GFCI (@ breakers, outlets, pigtails, electrician weekly testing log)

  • Date Corrected:

  • Electrical Cords (ground, strain relieve, condition, protected from traffic, proper use)

  • Date Corrected:

  • Romex (protected to 8', proper splices taped, fastened every 10' with non-conductive fastener, protected from physical damage)

  • Lighting (adequate- 5 ft candles, protected, secured, sockets filled, separate circuit)

  • Date Corrected:

Excavation

  • Daily Dig Permit (Competent Person Inspection, utilities located, cracks, spalling, water accumulation, changed conditions)

  • Date Corrected:

  • Access/Egress @ 4' (ladder, ramp, stairs within 25' of travel)

  • Date Corrected:

  • Protection @ 5' (slope, bench, shield, shore)

  • Date Corrected:

  • Other (spoils 2' back, vibration, hazardous atmosphere potential)

  • Date Corrected:

Scaffolding

  • Base (sills/plates/jacks/casters, secured, level, locked)

  • Date Corrected:

  • Braces (installed, secured, condition)

  • Date Corrected:

  • Frames (compatible, pinned, condition)

  • Date Corrected:

  • Platform (fully planked, overhang 6"-12" or cleated, plank condition)

  • Date Corrected:

  • Access (integral frame - 16 3/4" rung spacing, ladder w/ gate, stairtower)

  • Date Corrected:

  • Other (secured @ 4V:1H, level, tagged, competent person inspected, tarp/debris net engineer approval)

  • Date Corrected:

Miscellaneous (Items not captured in categories listed above)

  • Date Corrected:

Positive Observations

Inspector Signature

  • Add signature

Project Superintendent Signature

  • Add signature

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.