JOB SITE SAFETY INSPECTION REPORT JOB NAME: DATE: SUPERVISOR JOB NO: INSPECTOR: SIGNATURE: Yes No N/A

TIME:

Overall Environment Are all work areas clean and orderly? Are work surfaces kept dry ? Are aisles, walkways, doorways, and exit routes clear Are the toilets and washing facilities provided, clean and safe? Are all work areas adequately lighted? Are material safety data sheets on-site ? Is the public protected from exposure to work activities? Are required postings readily available to all employees? Are monthly and weekly safety meetings held ? Is material piled, stacked or racked ? COMMENTS:

Safety Equipment Where personnel may be exposed to vehicle traffic; are high-visibility traffic vests and traffic cones provided and used properly? Are safety glasses worn at all times in areas where there is any danger of flying particles or corrosive materials? Is appropriate foot protection worn? Is waterproof clothing available to employees required to work in adverse weather conditions? Are flaggers wearing appropriate orange hard hats and class II vests? Is hearing protection provided in areas that expose employees to loud noises? Are dust masks available to employees who may need them? COMMENTS:

Yes

No

N/A

First Aid and Emergency Equipment Are emergency telephone numbers posted on the job site? Is there at least one person on-site trained in first aid and CPR? Are first aid kits easily accessible, inspected and stocked at least monthly? Is the red trauma bag inspected and stocked at least monthly?

Yes

No

N/A

Are there at least 2 exits provided to evacuate in case of an emergency? Are there any exit doors that open into streets or other high traffic areas? Are adequate warnings provided to alert employees of the hazard? COMMENTS

FIRE PROTECTION AND PREVENTION Is there at least one ABC fire extinguisher for every 3000 sq ft of work area? Are fire extinguishers clearly visible and unobstructed at all times? Are fire extinguishers inspected monthly for proper tags, pins, hoses not cracked or plugged, fully charged and tags up to date? Are fuel gas cylinders and oxygen cylinders secured, separated by 20 feet or have fire resistant barriers while in storage? COMMENTS

Yes

No

N/A

FALL PROTECTION Are holes and other floor openings guarded by a grate, cover, guardrail, or equivalent on all sides (except at entrance to stairways or ladders)? Are there stair rails or handrails on all stairways having four or more steps? Are railings provided on ramps? Do all elevated surfaces have guardrails at least 42 inches high? Are all elevated surfaces equipped with a safe means of access? Are fall protection harnesses and lanyards used by every employee working 6 feet or higher above the ground or on steeply pitched roofs 6/12 or greater? Are fall protection harnesses and lanyards a minimum of 1/2-inch nylon or equivalent, and short enough to prevent employees from falling more than 6? Are lifelines (lanyards) secured above the point of operation to an anchor point that will withstand 5,000 pounds of force for each attached worker? Are harnesses, lanyards, other fall protection equipment inspected prior to use? Where a job site has protruding steel rebar below the work level, are the steel rebar protected by covers to prevent impaled injuries? COMMENTS

Yes

No N/A

PORTABLE LADDERS Are all ladders maintained in good condition and inspected before each use, broken/defective ladders taken out of service immediately? Are ladders being used for their designed purpose only? (Step Ladders/Extension) Are ladders being used beyond their maximum intended load? Are ladder rungs/steps slip-resistant and free of dirt, grease, oil, ice, snow, etc. Are employees facing the ladder when climbing up and down? Are employees standing below the top 2 steps when using stepladders? When ladders are used to gain access to elevated platforms, does the ladder always extend at least 3 feet above the elevated surface, and properly secured?

Yes

No N/A

Are ladders placed on dry, stable footing and properly secured? COMMENTS

MATERIALS - HANDLING, STORAGE, USE AND DISPOSAL Are compressed gas cylinders (propane etc.) secured and stored properly, and blocked from potential traffic or vehicle hazards? ( Utilize Jersey barriers) Are concrete batch/plants/mixing facilities properly inspected for electrical and other potential hazards or damage? COMMENTS:

Yes

No N/A

SCAFFOLDING Are scaffolds set up on level, stable ground with dry footings? Has the scaffold been assembled and inspected by a competent person? Was the scaffold inspected prior to use and scaffold tag properly filled out? Do all scaffolds higher than 4 feet have 42-inch-high guardrails and midrails halfway between the top and platform? Are scaffolds in good working condition with no damage, or missing parts? Do all planks on scaffolds fit tightly with no open spaces between boards? Where planks are overlapped are they lapped over the supports? Do all scaffold planks extend 6-18 beyond the ends of the scaffold frame? Are all ladders or stairs used to access scaffolds either tied or welded to the scaffolds for safe access? Are ladders positioned to provide direct access? Are materials being stockpiled on scaffolds? Are all materials removed from scaffold at the end of the day? Are open sides of scaffold less than 14 inches from the face of the work? Are platforms of 10 or less extending over their end supports no more than 12 Are guardrails in place at the open ends of the scaffold? Has the movement of occupied scaffold been prohibited (unless designed by a registered professional engineer)? Have toeboards been installed to prevent falling objects? Is X bracing installed on the ends of the scaffold and every third set of posts horizontally and every fourth runner vertical? Are all pins installed where required and locked? Are castors locked during use? Are castors pinned into the frames or adjustment screws? Are adjustment screws extended no greater than 18? COMMENTS

Yes

No

N/A

ELECTRICAL

Yes No

N/A

Are all cord-connected, electrically-operated tools and equipment double insulated or effectively grounded? Are ground-fault circuit interrupters provided on all temporary electrical circuits used and tested regularly during periods of construction? Are all electrical rooms/panels secured and have proper signage? Do all extension cords have 3-prong plugs and all 3-prongs intact? 1926-404(f)(6) Are all electrical cords inspected and in good working condition (i.e. no splices, frays or the ground prong is removed)? Are extension cords a No. 12 or larger and properly marked? 1926-405(g)(2) Where electrical cords must cross roads, driveways or walkways, are they protected by solid, weather-resistant bridges to prevent damage to the cords? Are multiple plug adapters (octopus plugs) prohibited? Are electrical circuits and equipment shut off, de-energized and locked out before equipment installation, repairs, maintenance, or servicing? Are unused switches, receptacles and junction boxes covered with tight-fitting covers or plates? COMMENTS

TRENCHING AND SHORING Are spoils, materials and equipment set back a minimum of 2 from edge of excavation? Are barriers in place around excavation areas? Is a means of egress available in all trenches that are 4 feet deep or more? Are means of egress within 25 lateral feet of workers? Is high visible PPE worn by all employees working in and around trenches? Are employees protected from loose rock or soil? If needed are trench boxes/shoring used? COMMENTS

Yes No N/A

POWER-ACTUATED TOOLS / HAND AND POWER TOOLS Are employees who operated power actuated tools properly trained and carry a valid operators card? Are power-actuated tools inspected for obstructions or defects before use? Are all tools maintained in safe condition? Are damaged and defective tools removed from service and repaired or replaced as soon as the damage or defect is found? Are grinders, saws, and other tools with moving parts, equipped with appropriate safety guards to prevent physical contact with moving parts? COMMENTS:

Yes No N/A

TRAFFIC CONTROL Yes No N/A Are proper signs placed on road to alert drivers on construction danger ahead? Are cones used in the street at least 28 high?
Do flagger stations provide 2 safe means of egress in the event of an emergency? Have flaggers been properly trained and are carrying their flagger certification card?

COMMENTS:

ADDITIONAL COMMENTS

Any Additional PPE or Safety Supplies Needed?

Any items to note for follow up at tool box talk?