DATE: __________________
COMPLETED BY: ____________________________
Safety Inspection Checklist – Part 1
Annex B to Project Site Guidelines & Procedures
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Safe Work Practices
Proper manual lifting
Smoking only in safe, designated area
No horseplay
Other: ___________________________
Use of Personal Protective Equipment
Eye/face protection
Footwear
Gloves
Protective clothing
Head protection
Aprons
Respirators
Other: ___________________________
Housekeeping
Equipment and supplies in storage area
Storage of chemicals
MSDS binder present and up-to-date
Proper disposal of waster
Floors clean, dry, uncluttered
Maintenance of yard, driveway
Other: ___________________________
Electrical safety
Equipment grounded / GFCI
Electrical cords satisfactory
Electrical outlets satisfactory
Other: ___________________________
Other checklist items to be added to checklist:
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Fire Protection
Fire extinguisher(s) present and charged
Proper extinguisher type and location
Storage of flammable materials
Other: ___________________________
Tools & Equipment
Lockouts present and used
Personnel trained and experienced
Supervision of new users
Guards in place
Proper PPE worn
Maintained, clean, adjusted, oiled
Blades sharp
Ladders used safely
Proper use of air hoses
Other: ___________________________
First Aid
First Aid kit present and stocked
Trained first aid providers present
Emergency numbers posted
Injuries reported
Use of first aid kit reported
Other: ___________________________
DATE: __________________
COMPLETED BY: ____________________________
Safety Inspection Checklist – Part 2
Annex B to Project Site Guidelines & Procedures
During the inspection, both work conditions and procedures should be observed. If a hazard poses an immediate risk, preventative action must be taken right
away, not after the inspection.
For all hazards identified above or any other hazard whether corrected immediately or not, record the following details:
Hazard
Location
Recurring
Hazard?
Priority
Code*
Yes / No
A B C
Yes / No
A B C
Yes / No
A B C
Yes / No
A B C
Yes / No
A B C
Yes / No
A B C
Yes / No
A B C
Recommended Action
Responsible
Person
Action Taken
Date
Priority of action is determined by severity of consequence and likelihood of risk. For SEVERE and LIKELY risks, choose Priority A. For SEVERE but UNLIKELY or
MINOR but LIKELY, choose Priority B. For MINOR and UNLIKELY risks, choose Priority C. Take action in priority sequence.