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J O B S I T E S A F E T Y S U R V E Y

JOB NUMBER: DATE: FORMAN:

This form is to be completed at each Safety Tailgate Meeting. Turn this form in to the office without delay.

Please answer each Inspection Query by indicating the date in the appropriate column, and fill-in the appropriate response
in the section marked "COMMENTS." For example, please mark "OK" if there is no correction necessary, "N/A" if the
item is not applicable to your work environment, or "C" to indicate that correction is needed.
If there is indication of "C" on "COMMENTS", correction note "WHO & WHEN CORRECTED" should be followed.
WHO & WHEN
INSPECTION QUERY DATE COMMENTS
CORRECTED

1. Are Safety Meetings being held weekly ( as scheduled)?
2. Are ladders properly constructed, in good condition and secure?
3. Is the job truck in acceptable condition?
4. Is housekeeping good-all unnecessary debris cleaned-up?
5. Are guardrails erected around floor-openings and other critical areas?
6. Is temporary electrical wiring properly grounded?
7. Are all extension cords in good condition?
8. Is Power-Tool Safety being observed?
9. Are the cords on the power tools in good condition?
10. Are all electrical tools guarded and grounded?(Electrical cords in good shape?)
11. Are first-aid supplies adequate?
12. Are workers protected from protruding nails?
13. Are workers protected from falling objects?
14. Are Job Safety Rules being carried-out?
15. Do all employees lift equipment properly?
16. Are safety-glasses worn according to company policy?
17. Is proper clothing and boots worn?
18. Are Hard Hats being worn as required?
19. Are employees who work above 6' tied-off by a Life-Line Harness?
20. Are fire hazards controlled?
21. Are all flammable materials stored properly?
22. Is the fire extinguisher available in each vehicle?
23. Are fire extinguishers onsite?
24. Are fire extinguishers fully charged?
25. Have employees who operate forklifts received the proper traning?
26. Are all safety signs clearly posted?
27. Is drinking water available?
28. Are protable toilets available?
29. Is proper drainage provided?