Information
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Conducted on
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Job Name / Job Number
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Superintendent
GENERAL SAFETY
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Safety Planning (pre-con meetings, safety plan, JSA, morning huddles, pre-task plans)
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Postings (State, Federal, Emergency #'s, Incident Reporting & Crisis Management)
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Material Safety Data Sheets (3E MSDS on Demand Posting & Subcontractor MSDS's)
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First Aid Kit / Eyewash Replenished
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Sanitation (1 toilet per 20 workers)
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First Aid/CPR Trained employee(s) on site
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Clear Access/Egress at Entrances
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Roadway around Project Clear
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Housekeeping (trash & debris removed, proper material storage)
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Date Corrected:
Confined Space
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Is permit required and completed
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Air monitoring completed and documented
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Rescue plan in place
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Training documentation
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Other/Miscellaneous
Personal Protective Equipment
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Proper Attire (shirts 4" sleeves, pants, boots, hard hat)
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Date Corrected:
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Eyes (glasses, goggles, face shield)
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Date Corrected:
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Other (hearing, gloves, respirators, chemical protection, metatarsal guards)
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Date Corrected:
Fall Protection System
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Guardrails (200#, 42" +/- 3", toeboards, wire rope flagged every 6')
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Date Corrected:
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Holes (guarded, covered, secured, labeled)
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Date Corrected:
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Protection @ 6' (anchor point, harness, lanyard, retractable, rope grab, positioner)
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Date Corrected:
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Rebar Protection
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Other (falling object protection, safety nets, warning lines minimum of 15' from edge)
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Date Corrected:
Fire Protection/Prevention
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Fire Extinguishers (accessible, identified, charged, w/in 100' of travel, @ stairways)
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Date Corrected:
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Fuel Storage (location, container, extinguisher, traffic protection)
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Date Corrected:
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Hot Work (fire watch, fire blankets, permit, extinguisher present, debris clear)
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Date Corrected:
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Other/Miscellaneous
Cranes
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Daily Lift Plan (Qualified Operator, Signal Person, Rigger, Daily, Periodic and Annual Inspections)
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Date Corrected:
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Set-Up (barricaded, level, powerlines 20' minimum clearance)
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Date Corrected:
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Outriggers (extended, pads adequate & level per Daily Lift Plan)
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Date Corrected:
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Operation (load path, taglines, signal person)
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Date Corrected:
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Capacity (charts available, critical lift plan, object weights identified)
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Date Corrected:
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Sling Condition (wire rope, synthetic, hardware)
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Date Corrected:
Access Equipment
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Job built ladders constructed properly
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Proper access for an elevation break of more than 19"
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Extension Ladders (4V:1H, secured at top and base, 3' above landing, 3 points of contact)
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Date Corrected:
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Step Ladders (stable, proper use, inspected, non-conductive)
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Date Corrected:
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Stairs (metal pan treads filled, uniform w/in 1/4", rails @ 36", unobstucted, illuminated)
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Date Corrected:
Scissor/Aerial boom Lift
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Aerial & Scissor Lifts (proper use, fall protection, condition, rails, operator training)
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Date Corrected:
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Chain or gate secured
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Surface free of holes / drop-offs
Electricity
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Panels (covers in place, circuits identified, weatherproof, secured, breakers/holes filled)
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Date Corrected:
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GFCI (@ breakers, outlets, pigtails, electrician weekly testing log)
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Date Corrected:
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Electrical Cords (ground, strain relieve, condition, protected from traffic, proper use)
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Date Corrected:
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Romex (protected to 8', proper splices taped, fastened every 10' with non-conductive fastener, protected from physical damage)
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Lighting (adequate- 5 ft candles, protected, secured, sockets filled, separate circuit)
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Date Corrected:
Excavation
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Daily Dig Permit (Competent Person Inspection, utilities located, cracks, spalling, water accumulation, changed conditions)
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Date Corrected:
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Access/Egress @ 4' (ladder, ramp, stairs within 25' of travel)
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Date Corrected:
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Protection @ 5' (slope, bench, shield, shore)
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Date Corrected:
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Other (spoils 2' back, vibration, hazardous atmosphere potential)
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Date Corrected:
Hand/Power Tools
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Guards in place
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Cord in good condition
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Proper tool for the job
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Tool in good condition
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Other/Miscellaneous
Scaffolding
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Base (sills/plates/jacks/casters, secured, level, locked)
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Date Corrected:
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Braces (installed, secured, condition)
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Date Corrected:
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Frames (compatible, pinned, condition)
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Date Corrected:
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Platform (fully planked, overhang 6"-12" or cleated, plank condition)
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Date Corrected:
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Access (integral frame - 16 3/4" rung spacing, ladder w/ gate, stairtower)
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Date Corrected:
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Other (secured @ 4V:1H, level, tagged, competent person inspected, tarp/debris net engineer approval)
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Date Corrected:
Hazard Communication
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SDS Trained
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Proper labeling on containers
Site / Public Protection
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Barricades installed properly
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Overhead /Falling object protection
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Other / Miscellaneous
Other
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Concrete (pump 20' from power lines, impalement protection - flat rebar caps)
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Date Corrected:
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Motorized Equipment (qualified operator identified, backup alarms, seat belts, glass free from obstructions, equipment condition acceptable)
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Date Corrected:
General Observations (items not referenced in inspection form and / or add positive comments)
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Date Corrected:
"ALL IN"
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Is this Project Team "ALL IN"?
Inspector Signature
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Project Superintendent Signature
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