Job Site Information
(Ex: VA Bldg 9, Asheville, NC)
MM slash DD slash YYYY
If not this must be corrected immediately, contact Safety Director ASAP 828-767-2183.
All welding sites MUST have a fire extinguisher.
Please inspect each cord for nicks and firm ground pin. If the cord is damaged discontinue from use immediately. Teach coworkers to do this when they lay-out and put-up the cord each time.
Make sure all power sources are either a GFCI outlet or pigtail. Please remind employees to test the GFCI EVERY SINGLE TIME they plug-in.
Make sure all extension cords are safely out of the way and never in a stairwell or walkway.
Always make sure grounded tools have a firm ground pin in place. Never use a tool with a loose or missing ground pin.
Never try to repair or alter a power tool or machine.
Please remind coworkers about this rule, ladders become very unstable if you are on the top two rungs.
Any hole or penetration in the floor greater than 2" must be covered with a board and secured with 2x4 in the hole. The board must be marked "HOLE" in orange spray paint. This includes circular and square penetrations.
Ensure there is a 20 minutes barrier between fuel and oxygen tanks.
Ensure dust masks for available for any employee who wants one.
Ensure all employees know how to access the digital SDS on job site tablet or online.
Check all that apply
Conclusion & Signature
Please be accurate and use the additional space for any notes, special considerations, and suggestions to improve the safety program.
Based on your observations today, how would you rate the overall safety of the entire job site including other contractors?
Based on your observations today, how would you rate the safety of HVAC, Inc.'s work and safety awareness?
Use this space to provide any suggestions that could improve the HVAC, Inc. safety program.
Sign your initials here with your finger to acknowledge that you have completed this form to the best of your ability and that the job site is either totally safe, proper corrective actions have been taken, or the safety director has been contacted.