Work Site Safety Inspection Form

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

GC AND SUPERINTENDENT NAME

SPECIFIC AREA(S) INSPECTED

PERSONAL PROTECTIVE EQUIPMENT

• Hard hats (with bills forward)

  Yes

  No

  N/A

• Safety glasses with side shields

  Yes

  No

  N/A

• Leather work boots

  Yes

  No

  N/A

• Reflective vests

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

• Face shields

  Yes

  No

  N/A

• Burning goggles

  Yes

  No

  N/A

• Welding hood and gloves

  Yes

  No

  N/A

HOUSEKEEPING

• Material stacked orderly

  Yes

  No

  N/A

• Trash cans in work area

  Yes

  No

  N/A

• Debris properly removed

  Yes

  No

  N/A

• Cords and hoses off the floor

  Yes

  No

  N/A

• Access maintained

  Yes

  No

  N/A

TEMPORARY BARRICADES

• Proper tape used (red for danger, yellow for caution)

  Yes

  No

  N/A

• All sides of work area barricaded

  Yes

  No

  N/A

• Barricade removed or properly disposed of

  Yes

  No

  N/A

ELECTRICAL

• Cords checked for damage

  Yes

  No

  N/A

• Third prong on cords

  Yes

  No

  N/A

• GFCI working

  Yes

  No

  N/A

LADDERS AND SCAFFOLDING

• Ladders tied off

  Yes

  No

  N/A

• Ladder extended 3'

  Yes

  No

  N/A

• Stepladders in open position

  Yes

  No

  N/A

• Inspected and tagged

  Yes

  No

  N/A

• Components undamaged

  Yes

  No

  N/A

• Handrail in place

  Yes

  No

  N/A

• Ladder access

  Yes

  No

  N/A

• Sections properly pinned

  Yes

  No

  N/A

• Planking secured

  Yes

  No

  N/A

FALL PROTECTION

• Guardrail system checked

  Yes

  No

  N/A

• Harness and lanyards checked

  Yes

  No

  N/A

• Horizontal lifeline checked

  Yes

  No

  N/A

• Floor openings covered

  Yes

  No

  N/A

• Roof opening guarded

  Yes

  No

  N/A

• Wall openings guarded

  Yes

  No

  N/A

• Blue fencing up

  Yes

  No

  N/A

• Netting checked

  Yes

  No

  N/A

MOBILE EQUIPMENT

• Seatbelts used

  Yes

  No

  N/A

• Workers trained

  Yes

  No

  N/A

• Equipment inspected

  Yes

  No

  N/A

• Backup alarms working

  Yes

  No

  N/A

• Spotters used when needed

  Yes

  No

  N/A

HOISTING AND RIGGING EQUIPMENT

• Daily crane inspection performed

  Yes

  No

  N/A

• 1 eye per hook

  Yes

  No

  N/A

• Sling/chokers stored

  Yes

  No

  N/A

• Qualified rigger named

  Yes

  No

  N/A

• Safety latch on hook checked

  Yes

  No

  N/A

• Cranes flagged off

  Yes

  No

  N/A

• Slings/chokers insoected

  Yes

  No

  N/A

• Lift zone designated

  Yes

  No

  N/A

• Knowledge of crane signals

  Yes

  No

  N/A

EXCAVATION

• Competent person named

  Yes

  No

  N/A

• Shore/slope/bench

  Yes

  No

  N/A

• Excavation checked daily

  Yes

  No

  N/A

• Proper access/egress

  Yes

  No

  N/A

• Spoil pile at least 2' from edge

  Yes

  No

  N/A

• Workers trained

  Yes

  No

  N/A

PREWORK

• Daily Project EHS Inspections are being conducted and inspection sheets are available for review

  Yes

  No

  N/A

• IFE postings and other EHS Postings are in place for the workers on the Project

  Yes

  No

  N/A

• Safe Work Plan was communicated to all workers on the project as a Toolbox Talk (Sign-in sheets are on site and available for review)

  Yes

  No

  N/A

• Weekly EHS Toolbox Talks are relevant to the Project, and sign-in sheets are onsite available for review

  Yes

  No

  N/A

• Daily Pre-Task Safety Plans for each sub-contractor have been reviewed and signed by sub-contractor employees and the GC Superintendent

  Yes

  No

  N/A

• Daily Pre-Task Safety Plans for the GC and all sub-contractors are are onsite available for review

  Yes

  No

  N/A

• MSDS for all chemicals on the project are onsite available for review

  Yes

  No

  N/A

• Preconstruction Safety Meeting was conducted for the Project

  Yes

  No

  N/A

• Safe Work Plan is available for review and completed with all required MOP's, Permits and risk assessments.

  Yes

  No

  N/A

• All required permits obtained, posted and dated properly.

  Yes

  No

  N/A

• UGL LOTO or UOME first lock/tag on and last lock/tag off

  Yes

  No

  N/A

• First Aid Kit is on site, in a sanitary condition and available for all workers on the Project

  Yes

  No

  N/A

• Employee training records are available for work being performed

  Yes

  No

  N/A

• 36" minimum emergency egress requirement and uninstructed access to emergency equipment (fire extinguishers, pull stations, eyewash stations) is maintained

  Yes

  No

  N/A

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INSPECTION PERFORMED BY:

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