Site Inspection Form
Name
First Name
Last Name
Site
*
Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
PPE - Personal protective equipment is worn to minimize exposure to hazards that cause serious workplace injuries and illnesses.
Rows
Yes
No
N/A
Eye protection provided and being utilized
1
2
3
Hearing protection provided
4
5
6
Hard hats are provided and being utilized
7
8
9
Work boots worn by employees (steel-toed where required)
10
11
12
Respirators/respiratory protection program in place. (fit test records available)
13
14
15
Welding/cutting helmets, eye protection, gloves, and bibs are available and worn when required
16
17
18
Welding/cutting helmets, eye protection, gloves, and bibs are available and worn when required
19
20
21
Ladders/Stairways - Working on and around stairways and ladders is hazardous. Stairways and ladders are major sources of injuries and fatalities among construction workers.
Rows
Yes
No
N/A
Ladders inspected for defects
22
23
24
Ladders extend 3' above landing and secured
25
26
27
Ladders pitched at 1' out from vertical for every 4' of height
28
29
30
Ladders secured in place.
31
32
33
Stairways free of debris, slip, trip and fall hazards
34
35
36
Stairways equipped with stair rails and handrails
37
38
39
General Fall Protection - Fall protection is the use of controls designed to protect personnel from falling or in the event they do fall, to stop them without causing severe injury. Typically, fall protection is implemented when working at heights over 6', but may be relevant when working near any edge, such as near a pit or hole, or performing work on a steep surface.
Rows
Yes
No
N/A
Floor openings covered or guarded (cover secured)
40
41
42
Workers exposed to falls 6’ or more are protected
43
44
45
Scaffolds - Each employee more than 10 feet above a lower level shall be protected from falls by guardrails or a fall arrest system.
Rows
Yes
No
N/A
Competent person assigned to supervising erection/disassembly
46
47
48
Competent person assigned to conduct regular or pre-use inspections
49
50
51
Working surfaces 10' or higher equipped with guardrails
52
53
54
Working surfaces clear of debris, slip, trip and fall hazards
55
56
57
Excavations and Trenches - Employers must ensure that a competent person inspects all excavations, adjacent areas, and protective systems daily for possible cave-ins, indications of failures in protective systems and equipment, hazardous atmospheres, and other hazardous conditions. Inspections must be done prior to the start of work and as needed throughout the shift.
Rows
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Competent person assigned to supervise operations at all times
58
59
60
61
All excavations and trenches 4' or deeper equipped with protective system
62
63
64
65
Ladders or other means of quick exit within 25' of each worker
66
67
68
69
Spoil pile at least 2' from edge of excavation or trench
70
71
72
73
Electrical - Electrical hazards can cause burns, shocks and electrocution (death). Assume that all overhead wires are energized at lethal voltages.
Rows
Yes
No
N/A
GFCI or Assured Equipment Grounding Conductor Program in place
74
75
76
All outlets checked for proper wiring and GFCI checked if applicable
77
78
79
All tools and equipment inspected for defects in cords and plugs
80
81
82
All tools and equipment were inspected for defects in cords and plugs
83
84
85
Extension cords are in good condition
86
87
88
Sources of electricity such as panel boxes, overhead lines, etc. marked
89
90
91
Cylinders - Mishandling compressed gas cylinders – which can have an internal pressure of up to 2,500 pounds per square inch – can be disastrous. Dropping, tipping over, or exposing a cylinder to heat can cause weaknesses or cracks in the cylinder’s shell, which can result in a shrapnel-laden explosion.
Rows
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Oxygen and fuel cylinders properly separated and secure
92
93
94
95
Compressed gas cylinders labeled
96
97
98
99
Cylinders turned off and valve caps in place when not in use
100
101
102
103
Hoses and torches free from defects
104
105
106
107
Fire Prevention - A fire extinguisher is one of your first lines of defense in a small fire. If working on a multi-level structure, make sure there is access to an extinguisher on each floor. Extinguishers should be clearly-visible and easily accessible. According to OSHA 1926.150(c)(1)(i), an extinguisher shall be provided for every 3,000 square feet of the protected building.
Rows
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Flammable/combustible liquids stored away from ignition sources
108
109
110
111
Portable containers of such liquids are approved and have self-closing lids
112
113
114
115
Adequate number of properly charged fire extinguishers available
116
117
118
119
Extinguishers properly located with current inspection tag
120
121
122
123
Flammable/combustible, debris/trash kept from welding and cutting operations
124
125
126
127
Oily rags disposed of in approved self-closing waste containers
128
129
130
131
Tools and Equipment - Employees should be trained in the proper use of all tools. Workers should be able to recognize the hazards associated with the different types of tools and the safety precautions necessary.
Rows
Not Satisfied
Somewhat Satisfied
Satisfied
Very Satisfied
Tools and equipment in good condition
132
133
134
135
Defective equipment tagged as such and removed from the work area
136
137
138
139
Tool and equipment guards in place and in good condition
140
141
142
143
Confined Space - Work areas that (1) are large enough for an employee to enter, (2) have limited means of entry or exit, and (3) are not designed for continuous occupancy are deemed confined spaces. These spaces can present physical and atmospheric hazards that can be prevented if addressed prior to entering the space to perform work.
Rows
Yes
No
N/A
Air sampling equipment calibrated
144
145
146
Air samples show acceptable oxygen concentration. (19.5% to 23.5%)
147
148
149
Air samples show space is free of toxic/flammable/ explosive gasses
150
151
152
Trained attendant assigned to keep constant contact with all workers inside space
153
154
155
Trained person assigned to recheck air quality frequently throughout the project
156
157
158
Hazard Communication - All employers with hazardous chemicals in their workplaces must have labels and safety data sheets for their exposed workers, and train them to handle the chemicals appropriately.
Rows
Yes
No
N/A
Written Hazard Communication Program in place
159
160
161
The written program includes a complete list of all chemicals
162
163
164
SDS is available for every chemical on the list
165
166
167
Chemical containers properly labeled
168
169
170
First Aid - First-aid kits should be provided at the work site or additional quantities of supplies should be included in the first-aid kits:1. Gauze pads (at least 4 x 4 inches).2. Two large gauze pads (at least 8 x 10 inches).3. Box adhesive bandages (band-aids).4. One package gauze roller bandage at least 2 inches wide.5. Two triangular bandages.6. Wound cleaning agent such as sealed moistened towelettes.7. Scissors.8. At least one blanket.9. Tweezers.10. Adhesive tape.11. Latex gloves.12. Resuscitation equipment such as resuscitation bag, airway, or pocket mask.13. Two elastic wraps.14. Splint.15. Directions for requesting emergency assistance.
Rows
Yes
No
N/A
First aid kits readily accessible to all workers
171
172
173
Contents of first aid kits approved by qualified health care provider
174
175
176
First aid kits include rubber gloves, eye protection, and CPR mask
177
178
179
Properly trained first aid provider on-site
180
181
182
Housekeeping - Construction sites can present many hazards to employees when they are performing construction-related activities. Keeping a construction site relatively clean of debris can further reduce hazards. The benefits of good housekeeping far exceed the small additional effort required to establish good housekeeping practices at a construction site.
Rows
Yes
No
N/A
Suitable containers available for disposal of trash and debris
183
184
185
Walkways, aisles, hallways, and passageways clear of trash, debris, and materials
186
187
188
Trash and debris containers are empty
189
190
191
Equipment is not use stored properly
192
193
194
Tools not in use stored in job boxes
195
196
197
Pipe, conduit, ductwork and other materials stored neatly
198
199
200
Other
Rows
Yes
No
N/A
Potable water readily accessible to all workers
201
202
203
Clean, private toilets accessible to all workers
204
205
206
OSHA Job Site Poster posted
207
208
209
Emergency telephone numbers posted or made available to all workers
210
211
212
Action items
Items that need corrective action
Items that need corrective action
Items that need corrective action
Items that need corrective action
Items that need corrective action
Items that need corrective action
Items that need corrective action
Items that need corrective action
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