Mark every line Yes, No, or N/A. Each No becomes a finding and is
counted at the bottom of the form.
Safety glasses and/or goggles available and being used?
Face shield available for bulk liquid tasks? Grinding?
Hand protection used / worn as required?
Foot protection worn as required?
Hearing protection worn where required?
Hard hats worn on construction site?
Respirators if required? Type?
Fall protection, full body harness and lanyard used above 4 ft?
GFCIs used for all portable electrical hand tools?
Electrical cords and panels free of damage?
Light bulbs for illumination protected from breakage?
Lockout/tagout is being used for appropriate tasks?
Strain relief integrity for cords and plugs intact?
Extension cords 3-wire marked S, ST, SO, STO, SJ, SJO, SJT, SJTO?
Electrical cords inspected and have all prongs intact?
Portable generators grounded per NEC requirements?
Electrical power tools double insulated or grounded?
Grinders (portable and stationary) have guards in place?
Impact style air tools have safety clips / retainers installed?
Pneumatic power tools have hoses secured?
Portable circular saws equipped with protective guards?
Unsafe hand tools are prohibited?
Impact tools and hammers kept free of splinters and mushrooming?
Tools inspected quarterly by a qualified person?
SDS openly available to all employees?
Flammable liquids are in approved safety cans?
Flammable liquids storage containers labeled properly?
All hazardous containers labeled appropriately?
Supplies on hand for hazardous material spills?
Ladders are safe and inspected as appropriate?
Stair rails for 30″ change in elevation or 4 risers?
Stairs or ladder provided for access points over 19″ high?
Extension and straight ladders extend 3 ft beyond landing?
Stepladders are only used in open position?
Rigging equipment tagged and inspected within last 12 months?
Using safe lifting techniques and aids?
Hooks used for hoisting have safety latch in place?
Wire rope slings free of kinks and broken wires?
Synthetic slings free of damage to webbing or stitching?
Emergency phone numbers posted?
Emergency eyewash and/or shower units accessible?
First aid kit available at work site?
Fire extinguishers readily available and not blocked?
Fire extinguishers inspected?
CPR and first aid trained person on site?
First aid log on site and documented?
General housekeeping is neat and orderly?
Wall openings and floor holes are covered or guarded?
Hot work permit issued and followed?
Scaffolding guardrails and access ladders or stairs used?
Competent person for scaffolding and fall protection on site?
Scaffold design by qualified person?
Illumination adequate in all work areas?
Are supervisors actively monitoring work areas?
Is there a clear chain of command for safety concerns?
Are safety audits done weekly and documented?
Toolbox talks conducted and documented?
Signs, signals, and barricades in place?
Health and Safety Plan available and reviewed with workers?
Training conducted and documented?