Safety_Inspection_Checklist Safety Inspection Checklist Fill out form completely.Client NameJob NameJob#1. Inspection Date MM slash DD slash YYYY 2. Location3. Inspector's Name4. Eye protection worn when using Powder Actuated/Pneumatic guns? Yes No N/A 5. Foot protection worn? (Hard soled boots) Yes No N/A 6. Hearing protection worn where required? Yes No N/A 7. Hard hats worn? (If required) Yes No N/A 8. Respirators properly in use? (If required) Yes No N/A 9. GFCI's used for all portable electrical hand tools? Yes No N/A 10. Electrical cords inspected & have all prongs intact? Yes No N/A 11. Electrical power tools are double insulated or grounded? Yes No N/A 12. Ladders are safe and inspected as appropriate? Yes No N/A 13. Stair rails – for 30" change in elevation or 4 risers? Yes No N/A 14. Stairs or ladder provided for access points > 19" high? Yes No N/A 15. Extension & straight ladders extend 3' beyond landing? Yes No N/A 16. Stepladders are only used in open position? Yes No N/A 17. Emergency phone numbers posted and/or available to all workers? Yes No N/A 18. Workers wearing high-visibility garments? Yes No N/A 19. Tied off in lifts properly? (If required) Yes No N/A 20. Training conducted and documented? Yes No N/A 21. Pneumatic power tools have hoses secured? Yes No N/A 22. First aid kit available at work site? Yes No N/A 23. Fire extinguishers inspected? Yes No N/A 24. Fire extinguishers readily available (not blocked)? Yes No N/A 25. General housekeeping is neat and orderly? Yes No N/A 26. Wall openings & floor holes are covered or guarded? Yes No N/A 27. Rebar cabs used for protruding bars? Yes No N/A 28. Scaffolding is properly assembled and in good condition? Yes No N/A 29. Illumination adequate in all work areas? Yes No N/A 30. Misc. Topic Reviewed (i.e. SDS sheets, Emergency Response, Vehicular Accident, General Safety Topic)Corrective Action PlanFor all the items marked as “No”, list the item, person responsible and expected completion date.Action Items31. Action Item – 132. Person Responsible – 133. Due Date – 1 MM slash DD slash YYYY 34. Date Verified (as complete) – 1 MM slash DD slash YYYY 35. Verified By (Initials by individual verifying Observation/Corrective Action was verified as complete) – 136. Action Item – 237. Person Responsible – 238. Due Date – 2 MM slash DD slash YYYY 39. Date Verified (as complete) – 2 MM slash DD slash YYYY 40. Verified By (Initials by individual verifying Observation/Corrective Action was verified as complete) – 241. Action Item – 342. Person Responsible – 343. Due Date – 3 MM slash DD slash YYYY 44. Date Verified (as complete) – 3 MM slash DD slash YYYY 45. Verified By (Initials by individual verifying Observation/Corrective Action was verified as complete) – 346. Action Item – 447. Person Responsible – 448. Due Date – 4 MM slash DD slash YYYY 49. Date Verified (as complete) – 4 MM slash DD slash YYYY 50. Verified By (Initials by individual verifying Observation/Corrective Action was verified as complete) – 451. Action Item – 552. Person Responsible – 553. Due Date – 5 MM slash DD slash YYYY 54. Date Verified (as complete) – 5 MM slash DD slash YYYY 55. Verified By (Initials by individual verifying Observation/Corrective Action was verified as complete) – 556. Action Item – 657. Person Responsible – 658. Due Date – 6 MM slash DD slash YYYY 59. Date Verified (as complete) – 6 MM slash DD slash YYYY 60. Verified By (Initials by individual verifying Observation/Corrective Action was verified as complete) – 6
