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Project HSE Inspection Form <br /> Safe At N/A I/H Safe At N/A I/H <br /> Risk Risk <br /> 10.24 Suspended scaffolds,suspended work 15.5 Adequate&safe working conditions? <br /> platforms&aerial lifts approved? Used correctly? 15.6 Derrick or crane in safe working condition? <br /> 10.25 Insulation link provided when welding Operator certified? <br /> from suspended platform or suspended scaffold? 15.7 Cap22L charts at operators station? <br /> 10.26 Are independent lifelines with correct 15.8 Written crane, <br /> cable grab device used on suspended work derrick/wire rope inspection within last 30 days on <br /> platforms&scaffolds(except when suspended from site? Annual inspection for hoist&crane available? <br /> crane or derrick)? 15.9 Tail-swing of crane barricaded when within 7' <br /> 10.27 Correct cable grab used on cable (2.1 m)of rade? <br /> ladders? 15.10 Signal person <br /> 10.28 Boatswain chair onjob? Approved e? designated? <br /> 10.29 Powered single or double point 15.11 No part of crane or load closer than 15'(4.6m) <br /> suspended scaffold have"U.L."approved label& to energized electrical lines? <br /> capacity chart? 16.0 EXCAVATIONS,TRENCHING& <br /> 11.0 ROLLING SCAFFOLDS(Manually SHORING <br /> propelled) 16.1 Excavated material effectively stored& <br /> 11.1 Wheel brakes set while in use? retained at least 2'(.6m)or more from edge of <br /> 11.2 No riders on work platform while moving? excavations&trenches? <br /> 11.3 Work level 6'(2m)or more above ground floor 16.2 Utility company contacted&advised of <br /> level have guard rails and toe boards? proposed excavation work to determine underground <br /> 11.4 All cross&diagonal bracing in place&properly utility exposure or when overhead power lines are <br /> connected? involved? <br /> 11.5 Height does not exceed 4 times least base 16.3 Substantial stop logs or barricades installed <br /> dimension unless outriggers are used? when mobile equipment working adjacent to <br /> 11.6 Ladder access to work latform? excavation? <br /> 11.7 Are rolling scaffolds properly assembled, 16.4 Trenches more than 5'(1.5m)in depth shored <br /> inspected&tagged? to standard,laid back to stable slopes or provided <br /> 12.0 SWINGING SCAFFOLDS-2 points with other equivalent protection where hazard of <br /> Suspension moving round exists? <br /> 12.1 Roof hooks or irons secure) installed& 16.5 Trenches less than 5'(1.5m)protected where <br /> y hazardous ground movement exists? <br /> anchored? 16.6 Trenches in hard or compact soil shored to <br /> 12.2 Sheaves fit size of rope used? standard when depth is more than 5'(1.5m)&8' <br /> 12.3 Equipped with standard guardrails&toe 2.4 or more in length? <br /> boards? 16.7 In lieu of shoring in hard or compact soil,trench <br /> 12.4 Load limit marked on each scaffold? above the 5'(1.5m)level sloped(slope not steeper <br /> 12.5 Suspension lines inspected before first use& than a 1' .3m rise to each 1.5'(.45m)horizontal)? <br /> frequently during use? Record of inspection kept)? 16.8 Trenches 4'(1.2m)deep or more provided with <br /> 12.6 Each employee equipped with safety harness& ladder located no more than 25'(7.6m)of lateral <br /> shock absorbing lanyard&attached to life line? travel? <br /> 12.7 Lifeline attached at top to independent support 17.0 WELDING,CUTTING,BURNING <br /> &extending to ground level? 17.1 Proper PPE provided,in good condition& <br /> 12.8 Suspension lines capable of supporting six being used? <br /> times rated load? 17.2 All oxygen&fuel gas gauges in working <br /> 12.9 Power cables for electric hoist machines condition? <br /> secured to platform to prevent snagging between 17.3 All oxygen&fuel gas hoses in good condition& <br /> ower supply joint&platform? free of grease&oil? <br /> 13.0 FLOOR&WALL OPENINGS 17.4 Burning torch equipped with back flow <br /> 13.1 Wall openings 30"(762mm)H,18"(467mm)W prevention devices for both oxygen&fuel gas at the <br /> or greater from which there is a drop of 4'(1.2m)or torch? <br /> more&bottom of opening less than 3'(1 m)above 17.5 Back flash arrestors on regulators used for <br /> workina surface Providedwithguardrails? flamecuttin ? <br /> 13.2 Bottom of wall openings less than 4"(102mm) 17.6 Mechanical lighters used for lighting torches? <br /> above work surface provided with standard toe board 17.7 Oxygen&fuel gas cylinders stored in upright <br /> 4" 102mm high position in designated areas with caps in place? <br /> 13.3 Open sided floors 6'(2m)or more above floor Cylinders tied off? Oxygen stored 20'(6.1 m)from <br /> or ground level provided with standard railing&toe fuel gas cylinders? <br /> board or other equivalent perimeterprotection? 17.8 Electric arc welding cables in good condition& <br /> 13.4 Stairways when used during construction have properly attached by lugs to weld machine? <br /> handrails on all open sides,guardrails at landings& 17.9 Welder's shields&helper's goggles in good <br /> filler blocks in all recessed treads? condition&equipped with proper lenses? <br /> 14.0 MATERIAL HANDLING EQUIPMENT 17.10 Fire extinguishers provided within 25'(7.6m) <br /> 14.1 Approved canopy guards on fork lift trucks& of welding,cutting or burning operations? <br /> roll-over protection on all earth movin2 equipment? 17.11 All welding cable positioned to eliminate <br /> 14.2 Rated capacity posted on all lifting,hoisting tripping hazards? <br /> equipment clear) visible to the operator? 18.0 ROOFING <br /> 14.3 Wire rope inspection within last 30 days? 18.1 Safe harness and life lines or catchplatform? <br /> 14.4 Where mobile cranes are regularly used,daily 18.2 Roofing bracket scaffolds secured? <br /> inspections made of critical items&records kept? 18.3 Crawl or chicken ladders secured&evenly <br /> 14.5 Written tractor,crane,derrick,inspection within spaced cleats? <br /> last 30 days? <br /> Flat&Low Pitch Roofs Less than 4!1 Pitch? <br /> 14.6 Hand signal chartposted? 18.4 Warning line 6'(2m)from roof edge in work <br /> 14.7 Qualified personnel operating equipment? area? <br /> 15.0 CRANES-GENERAL 18.5 Safety harness&lines in use at perimeter or <br /> 15.1 Annual inspection made of crane hoisting standard handrails orequivalent? <br /> machinery&record kept of dates&results? 18.6 Protective equipment used when handling hot <br /> 15.2 On tower cranes,daily inspection made of itch? <br /> rigging? 18.7 Ladder access same as for pitch roofs? <br /> 15.3 On tower cranes,weekly inspections made of 18.8 Materials stored 6' 2m from edge? <br /> supporting parts,safety appliances&record kept of 18.9 All openings covered or protected by <br /> repairs required? guardrails? <br /> 15.4 Where a crane is used-lift log being 19.0 CONCRETE FORMING&POURING <br /> maintained? <br />