Project / Location



Project Safety Rep

Safety Permits & Documentation

Safe Work Permit issued for job scope +-na

JSA complete & understood by crew +-na

Contractors properly signed in/out +-na

Required legal & safety posters/signs +-na

Pre Job Safety Meeting Signed +-na

SAPs signed & understood by crew +-na

STAC complete, hazards understood +-na

General Site Conditions

Fire Extinguishers present & insepcted +-na

Materials properly stored on cribbing trip hazards avoided cords managed +-na

Emergency equip./exits/walkways clear +-na

Good Housekeeping, debris cleaned up trash cans emptied tools put away +-na

No sharp edges or fasteners exposed +-na

Flammables & chemical agents stored in approved labeled containers +-na

Barricades & tags in place as required +-na

Floor & wall openings properly guarded or covered & marked +-na

Precautions to avoid dropped objects +-na

Slip hazards ice & snow removed +-na

Material Handling / Ergonomics

Material handling devices inspected
and properly used +-na

Proper manual lifting techniques used +-na

Contractors using hand on stair rails +-na

Contractors keeping clear of Line of Fire +-na


All cords & tools protected by GFCI +-na

All cords & plug ends in good condition +-na

Adequate lighting, guards on lights +-na

Cords protected form cuts & water +-na

10-Feet min. clearance from power lines +-na

Powered Ind. Trucks/Heavy Equipment

Operator permit/traingin up to date +-na

Equipment inspection/maint. Complete +-na

Seatbealts in use +-na

Proper rigging/load secured & balanced +-na

Vehicle/crane spotter used as required +-na

Equipment operated in safe manner +-na

Aerial Lifts

Operator permit/training up to date +-na

Equip. Inspection/maint. Complete +-na

Gate/Chain latched when in use +-na

Vehicle spotter used as required +-na

Equipment operated in safe manner +-na

Hot Work

Air Monitoring conducted where required +-na

Fire Watch assigned/on duty as requried +-na

Flammables moved 50-ft/combustables moved
35-ft or covered with fire blanket +-na

Welding machine properly grounded +-na

Cylinders restrained, fuel & oxygen seperated
by 20-ft or fire wall+-na

Unused cylinders capped +-na

Leads, hoses, regulators in good condition +-na


Inspection completed & tag updated +-na

Erected properly on level firm surface +-na

Scafold plumb & properly braced +-na

Walking/Working surfaces fully planked +-na

Ladder & components in safe condition+-na

Top rail, midrail & toe baords in use +-na

Wheels locked & in good condition +-na


Adequate restroom facilities available +-na

Fresh drinking water available +-na

Personal Protective Equipment

Safety glasses with shields/sheilds worn +-na

Monogoggles properly worn &/or on person +-na

Faceshield for grinding chipping LEO +-na

Hardhat worn as required +-na

Proper gloves worn for task +-na

Long sleeves worn where required +-na

Steel toe boots worn +-na

Hearing protection worn as required +-na

Welding jacket worn for hot work +-na

Proper welding helmet/sheild worn +-na

Harness & lanyard properly worn +-na

Suitable anchor point used +-na

Proper outer protective clothing and boots worn where required +-na

High visibility vest for spotter & as required +-na

Respiratory protection worn as required +-na

PPE inspected & in safe condition +-na


Guards in place & in good condition +-na

T-Handle used on grinder & hammer drill +-na

Tool used in safe manner +-na


Ladder inspected & properly sloped +-na

Proper ladder selected for task +-na

Ladder used safely 3 points of contact +-na

Excavations/concrete work

Excavation is inspected & properly sloped +-na

Soil piles kept minimum 2-ft from edge +-na

Access ladder within 25-ft of workers +-na

Rod caps on all upright resteel +-na

Other Safety

Driving +-na


Crew Size


Safety Positives

Corrected Items