Location
________________________________________________
Date _________________________
Contractor
____________________________________________________
Contract Title ________________________________
Contract % Complete _____________________
Contract Superintendent
______________________________________
PREPARATORY PHASE (Planning)
(Yes) (No) (N/A) 1)
Activity Hazard Analysis performed and used on the site for each definable
feature of work?
(Yes) (No) (N/A) 2) Are weekly
safety meetings and indoctrination held on site and documented for all workers?
(Yes) (No) (N/A) 3) Is the
submitted safety plan on site and in use?
(Yes) (No) (N/A) 4) Is the
Activity Hazard Analysis reviewed during the preparatory inspection?
(Yes) (No) (N/A) 5) Hazardous
materials program in place with MSDS sheets on site and maintained?
OFFICE TRAILER GENERAL
(Yes) (No) (N/A) 8)
Are office and storage trailers anchored?
(Yes) (No) (N/A) 9) Are
emergency phone numbers posted?
(Yes) (No) (N/A) 10) Is a phone
available?
(Yes) (No) (N/A) 11) First aid
log maintained (contractors must use OSHA Form 300)?
(Yes) (No) (N/A) 12) Toilet
facilities available?
(Yes) (No) (N/A) 13) Site
posted "HARD HAT AREA,"
"NOISE HAZARD," "CONSTRUCTION AREA," etc.
(Yes) (No) (N/A) 14) Garbage
cans and dumpsters available?
(Yes) (No) (N/A) 15) Jobsite
cleaned daily?
(Yes) (No) (N/A) 16) Is traffic
control around site adequate?
FIRE PREVENTION
(Yes) (No) (N/A) 18) Are fire extinguishers available, fully charged, and easily
visible within 75 feet for low hazard areas?
(Yes) (No) (N/A) 19) Is fuel
stored in proper containers?
(Yes) (No) (N/A) 20) Are hot
work permits being obtained?
(Yes) (No) (N/A) 21) Are fire
watches provided?
(Yes) (No) (N/A) 22) Are gas
cylinders stored upright and secured with chain or rope?
(Yes) (No) (N/A) 23) Is
Housekeeping acceptable?
SCAFFOLD SAFETY
(Yes) (No) (N/A) 25)
Are daily scaffold inspections performed by designated competent person?
(Yes) (No) (N/A) 26) Planks
overlapped not less than 6" or more than 12" over end supports with toe boards
in place?
(Yes) (No) (N/A) 27) Tubing
pinned properly and all cross bracing in place?
(Yes) (No) (N/A) 28) If
scaffold height is 4X smallest base dimension, is system secured to structure?
(Yes) (No) (N/A) 29) All
guardrails are in place?
(Yes) (No) (N/A) 30) Full work
platform at each working level with no cracks/splits?
(Yes) (No) (N/A) 31) Safe
access provided to each working level?
(Yes) (No) (N/A) 32) Scaffold
and components not overloaded?
(Yes) (No) (N/A) 33) Is
scaffold system plumb and level?
(Yes) (No) (N/A) 34) Suspended
scaffold systems using independent personal fall arrest system?
FALL PROTECTION
(Yes) (No) (N/A) 36)
Is a full body harness used where required?
(Yes) (No) (N/A) 37) Tied off
at all times to structural element capable of supporting 5,000 lbs/person?
(Yes) (No) (N/A) 38) Is
protection provided for all personnel working in areas where they could fall 6'
or more?
(Yes) (No) (N/A) 39) Are
employees trained for fall protection systems in use?
(Yes) (No) (N/A) 40) Does the
contractor have a certified competent person?
(Yes) (No) (N/A) 41) Have
standard guardrails been provided where required?
(Yes) (No) (N/A) 42) Have
horizontal life lines been designed and installed under supervision of a
qualified person?
LADDER SAFETY
(Yes) (No) (N/A) 44)
Do ladders extend 3' above landing platform and tied to structure?
(Yes) (No) (N/A) 45) Are
ladders used with hand tools only?
(Yes) (No) (N/A) 46) Are ladder
base distances from structure 1/4 height?
(Yes) (No) (N/A) 47) Are floor
openings either covered or surrounded by a guardrail?
(Yes) (No) (N/A) 48)
Electricians not using portable "conductive" ladders?
(Yes) (No) (N/A) 49) Stairways
provided on all structures over 20' during construction and supplied with
guardrail?
(Yes) (No) (N/A) 50) Portable
step ladders over 20' not used on the site?
(Yes) (No) (N/A) 51) Are
ladders properly used?
EXCAVATIONS
(Yes) (No) (N/A) 53) Does excavation over 4' deep have a ladder within 25' and
two means of egress?
(Yes) (No) (N/A) 54) Has proper
slope or trench box/shoring been provided?
(Yes) (No) (N/A) 55) Is water
controlled/removed?
(Yes) (No) (N/A) 56) Is
excavated material at least 2' back from trench edge?
(Yes) (No) (N/A) 57) Is
excavation barricaded, etc., to prevent workers and public from falling into
trench/hole?
(Yes) (No) (N/A) 58) In
locations of known or suspected contamination, is excavation atmosphere
monitored?
(Yes) (No) (N/A) 59) Does
contractor have certified competent person on site?
ELECTRICAL
(Yes) (No) (N/A) 61)
Are temporary power panels and receptacles protected from weather?
(Yes) (No) (N/A) 62) Are GFCI's
in use for site tools ?
(Yes) (No) (N/A) 63) Are
temporary lights rigged and secured to supports properly, and with covers?
(Yes) (No) (N/A) 64) If
overhead power lines are in area, are operations maintaining required distance
or isolation?
(Yes) (No) (N/A) 65) Is
lockout/tagout program in effect?
(Yes) (No) (N/A) 66) Has a
sketch of proposed temporary power distribution been submitted/accepted before
installing?
CRANES
(Yes) (No) (N/A) 69) Has periodic inspection been performed prior to use on site
(Yes) (No) (N/A) 70) Are daily
start up inspections performed by operator and submitted?
(Yes) (No) (N/A) 71) Is crane
operator qualified and is crane certification posted in cab?
(Yes) (No) (N/A) 72) Are
workers protected from the crane swing radius and prevented from passing under
the load?
(Yes) (No) (N/A) 73) Are
rigging cables and slings in good repair free of kinks and cracks?
(Yes) (No) (N/A) 74) Is the
crane level and on firm ground and outriggers in use with appropriate cribbing?
(Yes) (No) (N/A) 75) Is crane
side loading prohibited?
(Yes) (No) (N/A) 76) Near
electric power sources, are rules followed for clearance/isolation in operating
zone?
(Yes) (No) (N/A) 77) Is crane
equipped with anti two-block device if required?
CONFINED SPACES
(Yes) (No) (N/A) 79) Has entry plan been submitted and accepted?
(Yes) (No) (N/A) 80) Is
atmosphere being monitored?
(Yes) (No) (N/A) 81) Is space
being ventilated?
(Yes) (No) (N/A) 82) Are
entrants, attendants and entry supervisor properly trained?
(Yes) (No) (N/A) 83) Is
rescue/retrieval system in place?
(Yes) (No) (N/A) 84) Are daily
entry permits posted at point of entry and signed by entry supervisor?
(Yes) (No) (N/A) 85) Is point
of entry posted "DANGER CONFINED SPACE"?
(Yes) (No) (N/A) 86) Has
blanking or locking out of systems taken place?
ROOFING
(Yes) (No) (N/A) 88) Are hot-kettles at least 25 feet away from buildings?
(Yes) (No) (N/A) 89) Has an
employee fall protection system been implemented and in proper use?
(Yes) (No) (N/A) 90) Are
skylights and roof penetrations covered or barricaded appropriately?
(Yes) (No) (N/A) 91) Has the
roof been evaluated for its ability to support the intended construction loads?
(Yes) (No) (N/A) 92) Has the
roof been surveyed for deterioration?
(Yes) (No) (N/A) 93) Are two
fire extinguishers at the kettle?
(Yes) (No) (N/A) 94) Fuel
cylinder a minimum of 10' from open flame?
EQUIPMENT
(Yes) (No) (N/A) 97) Are forklift operators qualified through training at the
site (certificate included in Safety Plan)?
(Yes) (No) (N/A) 98) Does
mobile equipment have rollover cages and backup alarms, with moving parts
adequately guarded?
(Yes) (No) (N/A) 99) Are
equipment operations maintaining safe clearance from electrical power lines?
(Yes) (No) (N/A) 100) Do
modifications meet safety rating per manufacturer (i.e., lifting personnel with
forklift)?
(Yes) (No) (N/A) 101) Are
safety lashings provided for high pressure hose connections, i.e., air
compressors?
(Yes) (No) (N/A) 102) Are
workers clear of blind spots associated with mobile construction equipment?
(Yes) (No) (N/A) 103) Do aerial
lifts have basket/platform with guardrail?
(Yes) (No) (N/A) 104) Are
workers not extending over guardrail of aerial lifts?
(Yes) (No) (N/A) 105) Are
articulating boom platforms (JLG type) used with Full Body Harness attached to
boom or basket?
DEMOLITION
(Yes) (No) (N/A) 108) Has demolition plan been submitted and accepted?
(Yes) (No) (N/A) 109) If waste
is being dropped > 6' is it in an enclosed chute and is area secured from
traffic?
(Yes) (No) (N/A) 113) For
building demolition, has notification been made to State having jurisdiction?
(Yes) (No) (N/A) 114) Are nails
removed from scrap lumber/materials?
PERSONAL PROTECTIVE EQUIPMENT
(Yes) (No) (N/A)
117) Workers wearing leather shoes (not tennis), long pants, sleeved shirts, and
steel toes where required?
(Yes) (No) (N/A) 118) Are hare
hats being worn?
(Yes) (No) (N/A) 119) Are
safety glasses where appropriate?
(Yes) (No) (N/A) 120) Hearing
protection where appropriate? (if you need to yell to converse)
(Yes) (No) (N/A) 121)
Respirators where appropriate?
(Yes) (No) (N/A) 122)
Impalement protection provided where personnel could work above vertical
impalement?
(Yes) (No) (N/A) 123) Is
lighting adequate?
ABATEMENT
(Yes) (No) (N/A) 125) Has abatement plan been submitted and accepted?
(Yes) (No) (N/A) 126) Is
independent air monitoring being performed as required inside and outside
barriers?
(Yes) (No) (N/A) 127) Is
containment in place without integrity compromise?
(Yes) (No) (N/A) 128) Are
employees utilizing appropriate PPE?
(Yes) (No) (N/A) 129) If
negative air is used, are fans used continuously and monitored for pressure
differential?
(Yes) (No) (N/A) 130) Has
baseline been performed and necessary final clearance readings taken?
(Yes) (No) (N/A) 131) Are
inspections by independent PQP performed prior to barrier removal?
(Yes) (No) (N/A) 132) Is waste
material properly containerized and stored?
(Yes) (No) (N/A) 133) Are air
monitoring results provided to Safety Office?
(Yes) (No) (N/A) 134) Are waste
shipment records provided to Safety Office?
WATERFRONT AREAS
(Yes) (No) (N/A)
136) Are employees wearing appropriate flotation devices (PFDs)?
(Yes) (No) (N/A) 137) Is a
rescue skiff available?
(Yes) (No) (N/A) 138) Are
emergency life rings available?
(Yes) (No) (N/A) 139) If diving
operations are taking place, has a dive plan been submitted and accepted?
(Yes) (No) (N/A) 140) Does dive
team consist of proper number and qualifications for employees?