Golder Acoustics, Inc.

Inspection performed by

Jobsite Name

Location

Date of Inspection

Ladders & Stairways

Ladders inspected for defects

NA
Yes
No

Ladders extend 3’ above landing

NA
Yes
No

Ladders pitched 1’ from vertical for every 4’ of height from foot of ladder to top support

NA
Yes
No

Ladders secured in place

NA
Yes
No

Stairways equipped with stair rails & handrails

NA
Yes
No

Stairways free of debris & other slip, trip & fall hazards

NA
Yes
No

General Fall Protection

Floor openings covered or guarded

NA
Yes
No

Workers exposed to potential falls of 6’ or more protected

NA
Yes
No

Scaffolds

Competent person assigned to supervising erection

NA
Yes
No

Competent person assigned to supervising disassembly

NA
Yes
No

Working surfaces 10’ or higher equipped with guardrails

NA
Yes
No

Working surfaces clear of debris & other slip, trip & fall hazards

NA
Yes
No

Electrical

All tools & equipment inspected for defects in cords & plugs

NA
Yes
No

Extension cords are in good condition

NA
Yes
No

Personal Protective Equipment

Eye protection

NA
Yes
No

Hearing protection

NA
Yes
No

Hardhat protection

NA
Yes
No

Protected toe boots or shoes worn

NA
Yes
No

Manual Handling of Materials

Materials delivered as close to work area as possible

NA
Yes
No

Materials staged on tables, pallets or racks off the ground close to waist height

NA
Yes
No

Material moving equipment such as carts, mobile pipe racks & wheelbarrows available

NA
Yes
No

Waste containers/bins are on wheels & readily available

NA
Yes
No

Tools & Equipment

Tools & equipment in good condition

NA
Yes
No

Defective equipment tagged & removed from work area

NA
Yes
No

Tool & equipment guards in place & in good condition

NA
Yes
No

First Aid & Hazard Communication

First aid kits readily accessible to workers

NA
Yes
No

SDS available for each chemical on site

NA
Yes
No

Chemical containers properly labelled when on site

NA
Yes
No

Housekeeping

Suitable containers/bins available for disposal of trash & debris

NA
Yes
No

Walkways, aisles, hallways & passageways clear of trash, debris & materials

NA
Yes
No

Tools not in use stored in job boxes

NA
Yes
No

Equipment not in use properly stored

NA
Yes
No

Materials stored neatly

NA
Yes
No

Clean, private toilets accessible to workers

NA
Yes
No

Comments

Verbal Warnings Given (Name and Reason)