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:

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