Western National Site Safety Inspection Report

• Customer name

• Job Site Name

• Job Site Location
  Address

• Conducted on

  Date

• Prepared by

• Crew Foreman

Safety Training

• Have employees been trained on the proper use, inspection, and maintenance of tools and equipment

  Yes

  No

• Has a job briefing been completed before the start of the job

  Yes

  No

• Is the job briefing formal

  Yes

  No

Electrical Hazards

• Do electrical hazards exist on this job site

  Yes

  No

• If yes fill out the rest of the questions in the Electrical Hazards section

• Have employees been trained to recognize and qualified to work within proximity to electrical hazards

  Yes

  No

• Are the employees aware what the voltage of the lines are

  Yes

  No

• Are the employees at the proper distance

  Yes

  No

• If the distance is not correct did the employer implement a hazard abatement plan

  Yes

  No

• Are employees using non-conductive equipment and tools when working around energized electrical conductors<br>

  Yes

  No

• If employees are closer than 10 feet to an energized line, is there a second qualified line clearing worker within visual or voice communication

  Yes

  No

• Are tie-ins for climbers above the work area and located so if the worker were to slip it would swing them away from the energized line<br>

  Yes

  No

Traffic Control

• Is the job site exposed to traffic

  Yes

  No

• If Yes, answer the following questions in the Traffic Control section

• Have employees been trained in working next to traffic and setting up signs & barricades

  Yes

  No

• Are employees exposed to traffic wearing high visibility apparel

  Yes

  No

Emergency Proceedures

• Is there a first aid kit on the job site

  Yes

  No

• Have employees been trained in identifying poisonous plants & animals

  Yes

  No

• Have employees been trained in emergency response and rescue procedures

  Yes

  No

• Have employees been trained in general first aid and CPR

  Yes

  No

Personal Protective Equipment Compliance

• Hard Hat

• Face Protection

• Hearing Protection

• Eye Protection

• Cut resistant leg protection for chainsaw operators on the ground

Chain Saws

• Do climbers have their chain saws secure when working aloft

  Yes

  No

• Are employees operating the chain saws with two hands

  Yes

  No

• Are climbers that are using chain saws using a second means of being secure to the tree

  Yes

  No

• If the chain saw is being carried more than two feet is the chain brake engaged or saw shut off

  Yes

  No

General

• Is equipment being run at least 10 feet from refueling areas

  Yes

  No

• Are flammable liquids stored and dispensed from approved containers<br>

  Yes

  No

• Is smoking prohibited when handling or working around flammable liquids<br>

  Yes

  No

• Are fire extinguishers seen on the job

  Yes

  No

• Ladders in good condition

  Yes

  No

• Are the tree climbers secure at all times while working in the tree, including climbing up

  Yes

  No

• If work is above 12 feet is there a second worker trained in emergency procedures within visual or voice communication

  Yes

  No

• Is the tie-in position above the climber in the tree

  Yes

  No

• Has a safe drop zone and communications been established between employees before cutting begins

  Yes

  No

• Are large limbs that cannot be controlled by the climber lowered down with rigging line

  Yes

  No

• If workers are installing a cabling system are they positioned to the side of it

  Yes

  No

  N/A

• Is brush being chipped, shredded, or dumped and not burned

  Yes

  No

Brush Chippers

• Have employees been trained on how to operate wood chippers

  Yes

  No

• Do chippers without mechanical in feed systems have anti-kickback device

  Yes

  No

  N/A

• Are the chippers with mechanical feeds equipt with quick stop and reversing device

  Yes

  No

  N/A

• Is the proper PPE being used loading the chipper

  Yes

  No

• Are employees loading the chipper in a safe manner

  Yes

  No

Stump Grinders

• Are employees properly trained on how to use wood chippers

  Yes

  No

• Are there enclosures or guards on the grinder

  Yes

  No

Pesticide Applications

• If pesticides are being applied fill out the rest of the questions in this section

• Are pesticide applicators liscensed

  Yes

  No

• Have employees been trained in OSHA's HAZCOM Standard

  Yes

  No

• Is there a clean water source at the work site for emergency decontamination<br>

  Yes

  No

• Is proper PPE being used based on the chemicals SDS sheets

  Yes

  No

Vehicles and Aerial Devices

• Vehicle #

• Are outriggers or stabilizers out and on pads

  Yes

  No

  N/A

• If there are no outriggers, are the wheels chocked<br>

  Yes

  No

  N/A

• If there are no outriggers, are the wheels chocked

  Yes

  No

  N/A

• Dielectric Date

  Date

• Signs

  Yes

  No

• Cones

  Yes

  No

  N/A

• Are employees wearing the correct fall protection in the bucket<br>

  Yes

  No

  N/A

• Fire Extinguisher

  Yes

  No

• Pre/Post Trip Inspections

  Yes

  No

  N/A

• Vehicle #

• Are outriggers or stabilizers out and on pads<br><br>

  Yes

  No

• If there are no outriggers, are the wheels chocked

  Yes

  No

  N/A

• Are employees wearing the correct fall protection in the bucket

  Yes

  No

  N/A

• Dielectric Date

  Date

• Signs

  Yes

  No

  N/A

• Cones

  Yes

  No

• Fire Extinguisher

  Yes

  No

• Pre/Post Trip Inspections

  Yes

  No

• Vehicle #

• Are outriggers or stabilizers out and on pads

  Yes

  No

  N/A

• If there are no outriggers, are the wheels chocked

  Yes

  No

  N/A

• Dielectric Date

  Date

• Signs

  Yes

  No

  N/A

• Are employees wearing the correct fall protection in the bucket<br>

  Yes

  No

  N/A

• Cones

  Yes

  No

  N/A

• Fire Extinguisher

  Yes

  No

• Pre/Post Trip Inspections

  Yes

  No