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Site / Area Inspection Form
Observer Name
*
Date of Inspection
*
Date Format: MM slash DD slash YYYY
Site
*
Field (Wells)
Sealants
Area / Job
*
House Keeping
*
1
2
3
4
5
NA
(trip hazards, spills, garbage)
Comments (House Keeping)
*
Rigging
*
1
2
3
4
5
NA
(Mousetraps, frays, kinks, hooks)
Comments (Rigging)
*
Machines and tools
*
1
2
3
4
5
NA
(guards, properly used)
Comments (Machines and tools)
*
Falls Hazards
*
1
2
3
4
5
NA
(fall plan signed, proper tie off points, ladders in good condition and tied off)
Comments (Fall Hazards)
*
PPE & Signage
*
1
2
3
4
5
NA
(Hard hats, steel toe, glasses, gloves, exit signs, controlled access signs)
Comments (PPE & Signage)
*
Electrical
*
1
2
3
4
5
NA
(Grounds, sheathing, overloads)
Comments (Electrical)
*
Hot Work
*
1
2
3
4
5
NA
(Area clear of flammables, extinguisher near)
Comments (Hot Work)
*
Heavy Equipment Operation
*
1
2
3
4
5
NA
(Certified operator, Spotters, Equipment inspections, Speed limits)
Comments (Heavy Equipment Operation)
*
Ergonomics/ Lifting/ Carrying/ Repetitive
*
1
2
3
4
5
NA
(Lifting technique, Worker rotation, Lifting partners, Heavy/unstable loads, uneven/unstable ground)
Comments (Ergonomics/Lifting/Carrying/Repetitive)
*
Inspection Total
Photos of Issue
Drop files here or
Accepted file types: jpg, gif, png, jpeg.
You may upload 4 images at a time. Each image must be 10MB or less in size.
Comments