Information
-
Project:
-
Day of Week:
-
Monday
-
Tuesday
-
Wednesday
-
Thursday
-
Friday
-
Saturday
-
Sunday
-
Conducted on
-
Conducted by
-
1. Safety Plans:
-
IIPP
-
What needs attention?
-
MSDS
-
What sheets are missing?
-
SSSP
-
What needs attention?
-
HIPP
-
What needs attention?
-
JHA's / AHA's
-
What needs attention?
-
2. Emergency Action / First Aid
-
What items are missing?
-
3. Water / Sanitary Facilities:
-
What needs addressing?
-
4. Personal Protective Equipment:
-
Additional PPE needed?:
-
5. Fire Extinguisher / Fire Prevention:
-
What needs addressing?:
-
6. Access / Walkways / Ladders / Manlift:
-
What needs addressing?:
-
7. Guardrail / Railing / Safety Cable
-
What needs addressing?:
-
8. Fall Arrest Equipment:
-
What needs addressing?:
-
9. Fall Rescue Plan (Location Specific):
-
What needs addressing?:
-
10. Impalement Protection:
-
What needs addressing?:
-
11. Floor Openings / Hole Coverings:
-
What needs addressing?:
-
12. Plumb Cables / Guying:
-
What needs addressing?:
-
13. Forklift Inspection /Aerial Lift Inspection:
-
SUBMIT INSPECTION REPORT
-
Provide explanation for incomplete Inspection Report:
-
14. Crane / Rigging / Hoisting:
-
What needs addressing?:
-
15. Overhead Obstructions / Power Lines:
-
What needs addressing?:
-
16. Barricades / Signage / Secured Area:
-
What needs addressing?:
-
17. Oxygen / Acetylene / Propane:
-
What needs addressing?:
-
18. Welding Machines / Generators
-
What needs addressing?:
-
19. Material Storage / Laydown Area:
-
What needs addressing?:
-
20. Traffic Control / Flagging / Vests:
-
Compliant? Or Non-compliant?
-
What needs addressing?:
-
21. Access Roads / Equipment:
-
What needs addressing?:
-
22. Open Trenches / Excavations:
-
What needs addressing?:
-
23. Scaffolds / Angel Wings / Chairs:
-
What needs addressing?:
EQUIPMENT
-
24. Is a forklift being used on the job?
-
Fill out Forklift Inspection.
-
25. Is an Aerial lift being used on the job?
-
Fill out Aerial Lift Inspection.
IF ANY ITEM NEEDS CORRECTION, PLEASE ADDRESS ISSUE IMMEDIATELY.
-
Additional Comments:
Signed:
-
Add signature