Company Name:

Supervisor:

Inspected by:

Project / Location:

No. of Employees:

Date:

Sr.No

Description

Yes / No

Remark / Comments

1

 SITE ACCESS

1.1

Clean, level ground

1.2

Adequate ramps

1.3

Adequate stairs

1.4

Adequate ladders

2

PROTECTIVE EQUIPMENT

2.1

Hard hats worn

2.2

Foot protection

2.3

Eye & face protection: Worn

2.4

 Available

2.5

Hearing protection:      Worn

2.6

Available

2.7

Respiratory protection: Worn

2.8

Available

3

GUARDRAILS, BARRICADES

3.1

Located where required

3.2

Properly constructed

3.3

Adequately secured

4

LADDERS

4.1

Secured

4.2

Proper angle (extension)

4.3

Proper size and type

4.4

Safe, usable condition

4.5

Properly used

4.6

Proper handrails and landings

4.7

Non-slip bases

5

FIRE PREVENTION

5.1

Extinguishers where required

5.2

Fully charged

5.3

Adequately identified

5.4

Master emergency plan

6

PUBLIC WAY PROTECTION

6.1

Properly located

6.2

Covered where required

6.3

Min. height, width requirement

6.4

Proper rail on street side

6.5

Proper lighting, where required

7

HOUSEKEEPING

7.1

Clear walkways

7.2

Clear work areas

7.3

Clear access and landing

8

FALL PROTECTION

8.1

NIOSH approved

8.2

Properly worn

8.3

Safe, usable condition

8.4

 Working from: Ladder

8.5

Scaffolds                     

8.6

Swing stages

8.7

Unprotected openings and edges

9

STAIRWELLS & RAMPS

9.1

Proper filler blocks in metal stairs

9.2

Proper cleats on ramps

9.3

Adequate lighting in stairwells

9.4

Proper handrails or guardrails

10

SCAFFOLDS

10.1

Properly erected (all parts used)

10.2

Properly secured

10.3

Properly planked

10.4

Proper guardrails, toe boards

10.5

Proper access to platform

10.6

Acceptable loading

10.7

Inspection Tag

11

POWER TOOLS, EQUIPMENT

11.1

General condition

11.2

Proper guards, cords, PPE

11.3

Use of defective tags

12

 EXTENSION CORDS

12.1

Heavy Duty-type 12 Gauge

12.2

General condition of casing,

12.3

ends, and connections

13

COMPRESSED GAS CYLINDERS

13.1

Properly located

13.2

Properly secured

13.3

Properly moved or lifted

14

WORKER EDUCATION

14.1

HAZCOM training

14.2

Company safety policy & program

14.3

Injury reporting

14.4

Hazard reporting

14.5

Personal H & S responsibilities

15

FIRST AID REQUIREMENTS

15.1

Adequate number of qualified first

15.2

aiders on jobsite

15.3

First aid boxes: Adequate number

16

 CRANES, HOISTS, etc.

16.1

Safe setup of equipment

16.2

Maintenance log available

16.3

Competent operator(s)

16.4

Condition of slings, hardware

16.5

Safety clips on all hooks

16.6

Proper use of tag lines

16.7

Proper lifting containers

16.8

Competent signaler

17

WELDING

17.1

Rods & cylinders properly labeled

17.2

MSDSs readily available

17.3

Properly secured ground cables

17.4

Proper eye protection worn

17.5

Proper screens and exhaust

17.6

Cylinders upright and secured

17.7

Fire extinguisher readily available

18

ELEVATING WORK PLATFORM

18.1

Worker training

18.2

Properly used

18.3

Safe, useable condition

18.4

Acceptable loading

18.5

Manufacturer’s operating manual

19

TRAFFIC CONTROL

19.1

Trained traffic controllers

19.2

Properly located

19.3

Clean, regulation sign

19.4

Properly dressed (including vest)

20

TEMPORARY POWER SUPPLY

20.1

Properly identified

20.2

Overhead lines flagged & secured

20.3

Surface cables buried or protected

21

SIGNS & PRINT MATERIAL

21.1

Required Posters

21.2

MSDS copies

21.3

Warning signs

21.4

Emergency phone list

21.5

Report forms

22

MATERIALS STORAGE

22.1

Properly located

22.2

Safely piled, stacked, bundled

22.3

Properly moved or lifted

22.4

Properly labeled

23

TRENCHES & EXCAVATIONS

23.1

Properly angled, where required

23.2

Excavated materials properly placed

23.3

Appropriate shoring used

23.4

Proper access to trench

23.5

Proper storage of materials             

24

CONFINED SPACES

24.1

Proper access

24.2

Air testing before entry

24.3

Rescue equipment readily available

24.4

Safety harness, lifeline properly

24.5

anchored and used

24.6

Second person for rescue

24.7

Outgoing air monitored

24.8

Entry permit system

25

SUSPENDED SCAFFOLDS

25.1

Properly attached and capable of

25.2

   at least 4 times maximum load

25.3

Outrigger beam tied to fixed support

25.4

   with adequate counterweight

25.5

All mechanical/electrical devices

25.6

   in good working condition

25.7

Independent lifelines for each

25.8

   worker (extend to ground)

25.9

Engineers drawing on site if required.

26

FORMWORK

26.1

Guardrails and fall-arrest system

26.2

Design drawings kept on project

26.3

Inspection statement by engineer or

26.4

   competent worker

27

HYGIENE

27.1

Cleanliness of facilities