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