This checklist must be filled out by a supervisor at the beginning of each day, and prior to the beginning of a new job/task. Job Description: Location: YES NO NA YES NO NA SCAFFOLDS (>6’) PPE Competent person Face Shield Gloves Inspected daily Hearing Protection Solid footing, bases, mud sills Respirators Fully planked Proper / Appropriate Top rails / mid rails / toe boards Training Secured / tied off Fit test FALL PROTECTION SYSTEMS Medical Trained & competent person Safety toe Shoes PFAS Worn properly Safety Glasses Proper anchor points Hard Hat (bill forward) Harness & Lanyard inspected daily Reflective Clothing All openings guarded Proper clothing: long pants, 4” Roof and floor penetrations guarded & sleeve on shirt labeled HOUSEKEEPING 100 % tie off as required Aisles, stairwells, doors, electric panels clear MECHANIZED EQUIPMENT Cords off floor Inspected daily Materials stored and stacked neatly Trained and competent operators Floors swept daily Audible backup alarms Flammables stored separately Seat belt worn Proper lighting Chain secured/latch closed Egress marked MATERIAL HANDLING Trash cans provided Load secured FIRE PROTECTION Daily crane inspection No smoking in wood buildings Fire extinguishers charged/in place Proper Lifting techniques Fire watch as required Proper Equipment Weight Limits – Hot work permit as required Slings, chokers, chain inspected POWER TOOLS Tag lines needed Inspected Daily Spotter as required Cords in good condition Qualified rigger Plug UL approved for tool Knowledge of signals Guards in place Stretch before lifting HAND TOOLS TRENCHING/EXCAVATION Inspected daily (see attached form) In good condition Competent person: Tools tethered @ elevated work Utilities verified and marked, 811 Called – STRAIGHT LADDERS Soil type Rock A B C – Inspected daily (see attached form) Barricades Tied off 4 feet deep = ladder every 25 feet Extend 3’ above landing 5 feet deep = shoring, sloping, etc. Set up 4:1 20:5 4 feet deep air testing if hazard exists – Work between rails/no leaning ELECTRICAL STEP LADDERS (>250#) GFCI protection Inspected daily Fully opened and locked Energized panels covered and locked Work between rails/no leaning PPE FR clothing, v rated tools etc. – No straddling / sitting on Extension cords inspected (14AWG >) Only 1 person on a ladder Ground pins intact
This checklist must be filled out by a supervisor at the beginning of each day, and prior to the beginning of a new job/task. Job Description: Location: YES NO NA PPE Face Shield Gloves Hearing Protection Respirators Proper / Appropriate Training Fit test Medical Safety toe Shoes Safety Glasses Hard Hat (bill forward) Reflective Clothing Proper clothing: long pants, 4” sleeve on shirt HOUSEKEEPING Aisles, stairwells, doors, electric panels clear Cords off floor Materials stored and stacked neatly Floors swept daily Flammables stored separately Proper lighting Egress marked Trash cans provided FIRE PROTECTION No smoking in wood buildings Fire extinguishers charged/in place Fire watch as required Hot work permit as required POWER TOOLS Inspected Daily Cords in good condition Plug UL approved for tool Guards in place HAND TOOLS Inspected daily (see attached form) In good condition Tools tethered @ elevated work STRAIGHT LADDERS Inspected daily (see attached form) Tied off Extend 3’ above landing Set up 4:1 20:5 Work between rails/no leaning STEP LADDERS (>250#) Inspected daily Fully opened and locked Work between rails/no leaning No straddling / sitting on Only 1 person on a ladder YES NO NA SCAFFOLDS (>6’) Competent person Inspected daily Solid footing, bases, mud sills Fully planked Top rails / mid rails / toe boards Secured / tied off FALL PROTECTION SYSTEMS Trained & competent person PFAS Worn properly Proper anchor points Harness & Lanyard inspected daily All openings guarded Roof and floor penetrations guarded & labeled 100 % tie off as required MECHANIZED EQUIPMENT Inspected daily Trained and competent operators Audible backup alarms Seat belt worn Chain secured/latch closed MATERIAL HANDLING Load secured Daily crane inspection Proper Lifting techniques Proper Equipment – Weight Limits Slings, chokers, chain inspected Tag lines needed Spotter as required Qualified rigger Knowledge of signals Stretch before lifting TRENCHING/EXCAVATION Competent person: Utilities – verified and marked, 811 Called Soil type – Rock A B C Barricades 4 feet deep = ladder every 25 feet 5 feet deep = shoring, sloping, etc. 4 feet deep – air testing if hazard exists ELECTRICAL GFCI protection Energized panels covered and locked PPE – FR clothing, v rated tools etc. Extension cords inspected (14AWG >) Ground pins intact