Construction Safety Assessment
Status
Open
Closed
Type of Assessment
Self-Assessment
Corporate Assessment
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
State
Project Name
*
Project Number
Name of Inspector
*
Email
*
example@example.com
Management
Superintendent Email
example@example.com
Project Manager Email
example@example.com
RVP Email
example@example.com
1. Site Regulatory Postings
a. State labor posters
b. Federal labor posters
c. OSHA 300 Logs posted (Feb 1-April 30)
d. Other
N/A
1. Findings
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2. Access Point and General Site Conditions
a. Location entry access road
b. Entry signage and worksite expectations
c. Parking
d. Work trailers
e. Tech and internet access
f. Combustibles
g. Concrete activities
h. Crushed between
i. Dust prevention
j. Fall prevention
k. Fire prevention/extinguishers
l. First Aid
m. Housekeeping
n. Hydration
o. Lay down areas and storage yards
p. Lighting
q. Overhead utilities
r. Restrooms
s. Signage and Labeling
t. Site security
u. Storage
v. Struck by
w. Traffic
x. Underground utilities
y. Walking and working ground surfaces
z. Waste and garbage
aa. Wildlife
bb. Impalement hazards present on location
cc. Combustible Dust
dd. Other
N/A
2. Findings
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3. Buildings
a. Access and escape routes
b. Chemical and flammable/combustible liquid storage
c. Housekeeping and organization
d. Lighting
e. Signage
f. Ventilation
g. Walking surface
h. Other
N/A
3. Findings
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4. Chemicals
a. Chemical inventory
b. Chemical storage
c. Compressed gas
d. Eye wash supplies
e. Flammable/combustible liquids
f. Gas Cylinders
g. Hazard Communication
h. Hazardous waste
i. Spills
j. Other
N/A
4. Findings
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5. Confined Space Entry
a. Atmosphere
b. Attendant
c. Body Harnesses
d. Egress and access
e. Lifelines
f. Lighting
g. Permit system in use
h. Rescue
i. Respiratory protection
j. Safety Support Ticket
k. Training
l. Ventilation
m. Other
N/A
5. Findings
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6. Electrical
a. Assured equipment grounding
b. Circuits labeled
c. Electrical dangers posted
d. Fusing
e. Ground fault circuit interrupters used and tested
f. Grounding
g. Inspection and coding
h. Terminal box covers
i. Panel access
j. Extension cords
k. Other
N/A
6. Findings
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7. Emergency Preparedness
a) Alarms
b) Directions
c) Emergency Action Plan
d) Emergency numbers
e) Emergency response
N/A
7. Findings
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8. Environmental Conditions
a. Air
b. Humans and dwellings
c. Noise
d. Spills
e. Terrain
f. Waterways and drainage
g. Other
N/A
8. Findings
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9. Excavation and shoring
a. Adjacent structures
b. Barricading
c. Competent person
d. Dailey inspections
e. Dewatering
f. Egress
g. Engineering design and approval
h. Fluid accumulation
i. Lighting
j. Safety Support Ticket
k. Shoring, benching, and sloping
l. Spoil banks (24" inches)
m. Trench boxes
n. Other
N/A
9. Findings
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10. Fall Protection
a. Barricades
b. Guardrails
c. Ladders
d. Open edges
e. Open holes
f. PPE and fall prevention equipment
g. Stairs
h. Toe-boards
i. Grating walk surfaces secured
j. Other
N/A
10. Findings
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11. Hoists, Cranes, and Derricks
a. Alarms
b. Annual inspection
c. Collisions
d. Daily inspections
e. Operator behaviors
f. Operator certification
g. Outriggers
h. Overhead utilities
i. Rigging
j. Signaling and spotting
k. User Manual
l. Other
N/A
11. Findings
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12. Permit Required Activities
a. 811 Locates
b. Confined Space Entry
c. Excavations and Trenching
d. Hotwork
e. Other
N/A
12. Findings
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13. Personal Protective Equipment
a. Atmospheric monitoring
b. Body protection
c. Chemical protection
d. Eye protection
e. Face protection
f. Fall protection
g. Fit testing & medical evaluation
h. Foot protection
i. Hand protection
j. Head protection
k. Hearing protection
l. PPE availability
m. Respiratory protection
n. Seatbelts
o. Other
N/A
13. Findings
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14. Powered Equipment and Vehicles
a. Backup alarms
b. Booms
c. Brakes
d. Cab clutter
e. Daily inspections
f. Fire extinguishers
g. Forklifts
h. Fueling equipment
i. Glass
j. Heavy equipment
k. Hydraulics
l. Lights and warning signals
m. Manlifts
n. Mirrors
o. Passengers
p. Reflectors
q. Seat belts
r. Security
s. Tires/Tracks
t. Trailers
u. Trucks & Cars
v. Maintenance
w. Other
N/A
14. Findings
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15. Systemic Conditions
a. Competent persons
b. Energy isolation
c. Impromptu Training- Toolbox Talks
d. Incident reporting
e. Job Planning- Job Hazard Analysis
f. Machine guarding
g. Maintenance
h. Safety meetings
i. Safety Training & Orientation
j. Self safety assessments
k. Stop Work- Good Catches
l. Subcontractor Safety Management
m. Other
N/A
15. Findings
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16. Tools
a. Electrical tools
b. Hand tools
c. Ladders
d. Lifting and hoisting equipment
e. Power tools
f. Proper tools
g. Saws
h. Scaffolding
i. Tool storage
j. Other
N/A
16. Findings
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17. Welding, Cutting, and Hot Work
a. Electrical
b. Eye and skin protections
c. Fire extinguishers
d. Flashback arresters
e. Gas bottles and protective caps
f. Gas hoses
g. Operator qualification
h. Oxygen and acetylene storage
i. Permit program in use
j. Screens and shields
k. Other
N/A
17. Findings
17. Images
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18. Follow-up Notes:
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