Jobsite Safety Inspection

Jobsite Safety Inspection

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Jobsite Safety Inspection
  • 1

    You Represent the Company!

    Use this form to help with daily job site inspections. The form will help provide a guide on what to look for and provide a way to take notes on observations.

    Remember

    Safety is a mindset and to help promote good safety practices on our sites we need to encourage safe behavior. When you see someone doing a safe act, compliment them and thank them.

    TIPS: Find coaching opportunities and take pictures. TAKE PICTURES HORIZONTALLY.

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  • 2
    • 555 Fulton Street
    • 801 Brannan Street
    • Francis of Assisi Renovation
    • Pinole Valley HS
    • Oceanside Pump Station
    • 2698 California
    • Mission Dolores
    • 3850 18th Street
    • 1750 McAllister
    • Alemany-Plumbing
    • Alemany-HVAC
    • Tierra Linda MS
    • SF Central Shops
    • Origin Building B
    • 1500 Mission Goodwill Office Bldg
    • SFO GTU Phase 2
    • Fire Station 5
    • Hayward Fire Station 1-5 (HVAC only)
    • Henry M Gunn HS
    • Village ES-Phase 1
    • Montclaire ES
    • Junipero Serra ES Modernization
    • Tierra Linda Campus, Increment 3
    • Palo Alto HS Bldg 500 Library
    • Tide Academy(Menlo Park Small HS)
    • Kent MS Modernization & New Music Classroom
    • Mountain View Community Center
    • 1601 Mariposa
    • Pier 31 Utility & Restroom Project
    • SFO Bice Offce Relocation
    • Glenview Elementary School
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  • 3
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  • 4
    • Khoi Nguyen
    • Joe Wilkins
    • Kim Chung
    • Minh Luong
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  • 5
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  • 6
    Yes
    No
    NA
    Are Toolbox Training conducted Weekly?
    Passage Ways and Walkways Clear?
    Adequate Lighting?
    Waste Containers Provided and Used?
    Portable Toilets Available?
    Drinking Water Available?
    Material Staging and Housekeeping
    Are Toolbox Training conducted Weekly?
    Passage Ways and Walkways Clear?
    Adequate Lighting?
    Waste Containers Provided and Used?
    Portable Toilets Available?
    Drinking Water Available?
    Material Staging and Housekeeping
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 7
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    Select files to upload
    Upload a Photo
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  • 8
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  • 9
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  • 10
    Yes
    No
    NA
    Annual Crane Inspections Recorded?
    Crane Operator Certified and Current?
    Outriggers on Crane Used?
    Power Line Clearance Identified?
    Riggers Qualified?
    Signal Person Qualified?
    Hoisting Equipment Tagged and Inspected?
    Annual Crane Inspections Recorded?
    Crane Operator Certified and Current?
    Outriggers on Crane Used?
    Power Line Clearance Identified?
    Riggers Qualified?
    Signal Person Qualified?
    Hoisting Equipment Tagged and Inspected?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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    Yes
    No
    NA
    Correct Size for The Job?
    Correct Capacity Rating for The Job?
    Fully Opened and Spreader Bars Locked?
    Ladder Feet Firm and Secured?
    Extension Ladders Tied Off?
    Extension Ladders Extended 3' Above Landing?
    Correct Size for The Job?
    Correct Capacity Rating for The Job?
    Fully Opened and Spreader Bars Locked?
    Ladder Feet Firm and Secured?
    Extension Ladders Tied Off?
    Extension Ladders Extended 3' Above Landing?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 12
    Yes
    No
    NA
    Scaffolding Inspected by Competent Person?
    Scaffolding Properly Tagged?
    Scaffolding Inspection Recorded?
    Guardrails, Mid-rails, & Toe Boards in Place?
    Proper Fall Protection Utilized?
    Scaffolding Inspected by Competent Person?
    Scaffolding Properly Tagged?
    Scaffolding Inspection Recorded?
    Guardrails, Mid-rails, & Toe Boards in Place?
    Proper Fall Protection Utilized?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 13
    Yes
    No
    NA
    Are Welders Qualified?
    Proper Eye Protection and PPE Used?
    Screens and Shields in Place?
    Oxygen and Acetylene Stored Properly?
    Fire Extinguisher Nearby?
    "Hot Work" Permit Completed?
    Are Welders Qualified?
    Proper Eye Protection and PPE Used?
    Screens and Shields in Place?
    Oxygen and Acetylene Stored Properly?
    Fire Extinguisher Nearby?
    "Hot Work" Permit Completed?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 14
    Yes
    No
    NA
    Are Trenches Over 5' Properly Sloped, Shored or Trench Box?
    Operation Supervised by Competent Person?
    Spoils 2' From Trench Edge?
    Underground Utilities Identified?
    Regular Inspections Completed by Competent Person?
    Are Heavy Equipment Operated Away from Trenches?
    Are Trenches Over 5' Properly Sloped, Shored or Trench Box?
    Operation Supervised by Competent Person?
    Spoils 2' From Trench Edge?
    Underground Utilities Identified?
    Regular Inspections Completed by Competent Person?
    Are Heavy Equipment Operated Away from Trenches?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 15
    Yes
    No
    NA
    Backup Alarms are Audible?
    Seat Belts Provided and Used?
    Operators Properly Train or Certified?
    Equipment Stored Properly?
    Backup Alarms are Audible?
    Seat Belts Provided and Used?
    Operators Properly Train or Certified?
    Equipment Stored Properly?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 16
    Yes
    No
    NA
    Are employees working with good posture?
    Pipe Sweating Ventilation Adequate?
    Are Sinks and Countertops Secured?
    Are Exposures to Hand Laceration Minimized?
    Are employees working with good posture?
    Pipe Sweating Ventilation Adequate?
    Are Sinks and Countertops Secured?
    Are Exposures to Hand Laceration Minimized?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 17
    Yes
    No
    NA
    Fall Protection Provided for Heights Above 6'?
    Harnesses Properly Worn and Attached?
    Anchorage Points Rated 5,000lbs Per Attachment?
    Guardrails Installed Properly?
    Guardrails can Withstand 200lbs of Pressure?
    Deflection is Less than 3"?
    Are Leading Edges Properly Zoned Off?
    Fall Protection Provided for Heights Above 6'?
    Harnesses Properly Worn and Attached?
    Anchorage Points Rated 5,000lbs Per Attachment?
    Guardrails Installed Properly?
    Guardrails can Withstand 200lbs of Pressure?
    Deflection is Less than 3"?
    Are Leading Edges Properly Zoned Off?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 18
    Yes
    No
    NA
    Forms Properly Installed and Braced?
    Caps Installed on Rebar?
    Adequate PPE Utilized?
    Silica Dust Controlled?
    Forms Properly Installed and Braced?
    Caps Installed on Rebar?
    Adequate PPE Utilized?
    Silica Dust Controlled?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 19
    Yes
    No
    NA
    Is the Operator properly trained?
    Is the Operator Tied-off per Equipment Manufacturer?
    Is the Scissorlift used in a safe manner?
    Is the operator contained in the basket while working?
    Is the Operator properly trained?
    Is the Operator Tied-off per Equipment Manufacturer?
    Is the Scissorlift used in a safe manner?
    Is the operator contained in the basket while working?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 20
    Yes
    No
    NA
    Are the proper tools used to control Silica Dust?
    Is proper PPE used?
    Are guards in place as recommended by the Manufacturer?
    Is the right tool used for the task?
    Are the proper tools used to control Silica Dust?
    Is proper PPE used?
    Are guards in place as recommended by the Manufacturer?
    Is the right tool used for the task?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 21
    Yes
    No
    NA
    Is Cave-in hazard properly controlled?
    Is CO properly ventilated from nearby heavy equipment?
    Adequate trench egress?
    Slips & Trips minimized?
    Heat Illness Prevention in place?
    Is Cave-in hazard properly controlled?
    Is CO properly ventilated from nearby heavy equipment?
    Adequate trench egress?
    Slips & Trips minimized?
    Heat Illness Prevention in place?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 22
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  • 23
    Yes
    No
    NA
    Hardhats Being Worn?
    Safety Glasses Being Worn?
    Proper Clothing Being Worn?
    Proper Footwear Being Worn?
    Hearing Protection Utilized Where Applicable?
    Respiratory Protection Utilized Where Applicable?
    Additional Task Specific PPE Worn?
    Hardhats Being Worn?
    Safety Glasses Being Worn?
    Proper Clothing Being Worn?
    Proper Footwear Being Worn?
    Hearing Protection Utilized Where Applicable?
    Respiratory Protection Utilized Where Applicable?
    Additional Task Specific PPE Worn?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 24
    Yes
    No
    NA
    Adequate Type of Fire Extinguishers Available?
    Are Fire Extinguishers Certified Annually?
    Are Fire Extinguishers Inspected Monthly?
    Flammable Liquids Stored Properly?
    Compressed Cylinders Stored Properly?
    No Smoking in Work Area Policy Followed?
    Adequate Type of Fire Extinguishers Available?
    Are Fire Extinguishers Certified Annually?
    Are Fire Extinguishers Inspected Monthly?
    Flammable Liquids Stored Properly?
    Compressed Cylinders Stored Properly?
    No Smoking in Work Area Policy Followed?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 25
    Yes
    No
    NA
    Proper Tools Used for Task?
    Tool Guards and Handles Properly Attached?
    Tools Inspected Before Use?
    Tools Neatly Stored?
    Electrical Cords Inspected?
    Proper Tools Used for Task?
    Tool Guards and Handles Properly Attached?
    Tools Inspected Before Use?
    Tools Neatly Stored?
    Electrical Cords Inspected?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 26
    Yes
    No
    NA
    Electrical Devices Inspected?
    Electrical Devices Properly Grounded?
    GFCI Used and Inspected Where Applicable?
    Lock Out/Tag Out Procedures in Place?
    Electrical Panels Properly Covered?
    Proper Electrical Signage Posted?
    Electrical Devices Inspected?
    Electrical Devices Properly Grounded?
    GFCI Used and Inspected Where Applicable?
    Lock Out/Tag Out Procedures in Place?
    Electrical Panels Properly Covered?
    Proper Electrical Signage Posted?
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
    Yes
    No
    NA
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  • 27
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  • 28
    Select all of the Hazards noted during the visit.
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  • 29

    Fall Hazards

    Instructions: Select the number of Fall Hazards you have to include in the report. You will be able to upload pictures and describe it in the amount you selected. You can always go back to increase or decrease the number.

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  • 31
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    Max. file size: 9.8MB
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  • 32
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  • 33
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    Max. file size: 9.8MB
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  • 34
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  • 35
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    Max. file size: 9.8MB
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  • 36
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  • 37
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    Max. file size: 9.8MB
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  • 38
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  • 39
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    Max. file size: 9.8MB
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  • 40
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  • 42
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  • 43

    Electrocution Hazards

    Instructions: Select the number of Electrocution Hazards you have to include in the report. You will be able to upload pictures and describe it in the amount you selected. You can always go back to increase or decrease the number.

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  • 44
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    Max. file size: 9.8MB
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  • 46
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  • 47
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    Max. file size: 9.8MB
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  • 48
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  • 49
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    Max. file size: 9.8MB
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  • 50
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  • 51

    Struck By Hazards

    Instructions: Select the number of Struck By Hazards you have to include in the report. You will be able to upload pictures and describe it in the amount you selected. You can always go back to increase or decrease the number.

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    Max. file size: 9.8MB
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  • 54
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  • 55
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    Max. file size: 9.8MB
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  • 56
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  • 57
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    Max. file size: 9.8MB
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  • 58
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  • 59

    Crushed By Hazards

    Instructions: Select the number of Crush By Hazards you have to include in the report. You will be able to upload pictures and describe it in the amount you selected. You can always go back to increase or decrease the number.

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  • 61
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    Max. file size: 9.8MB
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  • 62
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  • 63
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    Max. file size: 9.8MB
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  • 64
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  • 65
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    Max. file size: 9.8MB
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  • 66
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  • 67

    Other Hazards

    Instructions: Select the number of Other Hazards you have to include in the report. You will be able to upload pictures and describe it in the amount you selected. You can always go back to increase or decrease the number.

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  • 68
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  • 69
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    Max. file size: 9.8MB
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  • 70
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  • 71
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    Max. file size: 9.8MB
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  • 72
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  • 73
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    Max. file size: 9.8MB
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  • 74
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  • 75

    Positive Observation(s)

    Instructions: Select the number of Positive Observations noted. The number selected will open up the number of picture and description boxes. You can always go back to increase or decrease the number.

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  • 76
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    Max. file size: 9.8MB
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  • 78
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  • 79
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    Max. file size: 9.8MB
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  • 80
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  • 81
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    Max. file size: 9.8MB
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  • 82
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  • 83
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    Max. file size: 9.8MB
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  • 84
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  • 85
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    Max. file size: 9.8MB
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  • 86
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  • 87
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  • 88
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  • 89

    By clicking submit, the entire Cal Pacific Systems Management Team will get a copy of this report. Please double check your work before submitting. If there are corrections to be made after submitting, contact Khoi for administrative support immediately.

    Thank you for your work!

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