Language
English (US)
Spanish (Latin America)
Safety Inspection Report
Date of Inspection
*
/
Month
/
Day
Year
Date
GMF Job Name:
*
2nd DCOA
Acadia Behavioral Health Hospital
Acadia Behavioral Health Apopka
AH Minneola
AHU Nursing Sim
Airside D - TPA
Asheville Airport
East Tampa Rec
Encompass Daytona
Encompass Lake Worth
Encompass Villages
FSU Doak Campbell Stadium Renovation
FSU Ops
Gateway Phase 2
Lake Ariana Park
NCH Vascular
OH Lakeland Highlands
Project Daisy
RSW - Concourse
RSW - Terminal
Southeast Toyota Jaxport Facility
TECO ESC
TECO Ops. Center
TGH Lifepoint Behavioral Health
TIA Redside VCB
Tyndall Airforce Base
Tyndall CCF
Tyndall FS
Tyndall H1
Tyndall H2
Tyndall H3
Tyndall WLT
USCH - Ft Lauderdale
USF Stadium
Walmart Renovation
Yakult USA
*Other Job*
Please Fill in Job Name
If Other was selected, please type in job location
Site Safety Competent Person(s)
*
Safety Observations
Administrative Safety Requirements
*
Rows
Acceptable
Unacceptable
N/A
DHA
Hot Work Permit(s)
SDS Accessibility
GC Required form(s)
Administrative Safety Requirements Comments/ Corrective Actions Taken (if any)
Environmental Hazards
*
Rows
Acceptable
Unacceptable
N/A
Weather Conditions
Housekeeping
Spill Kits
Chemical Storage
Environmental Hazards Comments/ Corrective Actions Taken (if any)
Work at Heights Hazards
*
Rows
Acceptable
Unacceptable
N/A
Barricades, flagging, and signs in place
Protect from falling items (tool tethers)
Others working overhead/below
Fall Protection Systems (temp cable)
Properly tied off in Mobile Elevated Work Platforms
Proper Use and Set up of Ladders
Open Hole(s)/Leading Edge(s)
Work at Heights Comments/ Corrective Actions Taken (if any)
Equipment Hazards
*
Rows
Acceptable
Unacceptable
N/A
Equipment Inspections Completed
Proper Use of Heavy Equipment
Swing Radius Barricaded
Properly Tied Off
Weight Capacity of Equipment
Equipment Hazards Comments/ Corrective Actions Taken (if any)
Hot Work Activity Hazards
*
Rows
Acceptable
Unacceptable
N/A
Welding/Grinding
Burn/Heat Sources
Compressed Gases
Working on/near energized equipment
Electrical cords/tools
Tools inspected (guards)
Firewatch (for each area of hot work)
Flammable liquids (cabinet)
Fuel Storage Protection
Hot Work Activity Hazards Comments/ Corrective Actions Taken (if any)
Crane Activity Hazards
*
Rows
Acceptable
Unacceptable
N/A
Crane Plan Accessible
Crane Inspected
Crane Outrigger Pads
Near Energized Powerlines
Swing Radius Barricaded
Erection Area Barricaded
Multiple Crane Picks
Rigging
Crane Activity Hazards Comments/ Corrective Actions Taken (if any)
PPE Requirements
*
Rows
Acceptable
Unacceptable
N/A
Z87 Safety Glasses
Hard Hat
Task Oriented Gloves
Hearing Protection
Respirator/Masks
Harness
Reflective vest
Footwear (condition/application)
Self Retracting Lifelines
Face Shield / Welding Hood
PPE Requirements Comments/ Corrective Actions Taken (if any)
Illustration Of Deficiencies
Please attach before and after pictures of all safety deficiencies.
Deficiency 1
Browse Files
Cancel
of
Comments
Deficiency 2
Browse Files
Cancel
of
Comments
Deficiency 3
Browse Files
Cancel
of
Comments
Deficiency 4
Browse Files
Cancel
of
Comments
Deficiency 5
Browse Files
Cancel
of
Comments
Deficiency 6
Browse Files
Cancel
of
Comments
Deficiency 7
Browse Files
Cancel
of
Comments
Deficiency 8
Browse Files
Cancel
of
Comments
Safe Work Observations
Attach picture and description of areas or tasks where all safety requirements are followed.
Safe Observation(s)
Browse Files
Cancel
of
Comments
General Remarks
GMF Inspector's Name
*
First Name
Last Name
GMF Inspector's Signature
*
Submit
Should be Empty: