Ground Mount General Inspection
Site
Date/Time
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
24-Hour Time Minutes
Safety Inspector
First Name
Last Name
Foreman/Lead
First Name
Last Name
Machine #1 Operator
First Name
Last Name
Machine #1
Machine #2 Operator
First Name
Last Name
Machine #2
Machine #3 Operator
First Name
Last Name
Machine #3
Job Safety Briefing performed for the crew?
Acceptable
Marginal
Unacceptable
N/A
N/O
Job Hazard Analysis performed?
Acceptable
Marginal
Unacceptable
N/A
N/O
Does the JHA Process Form match the work?
Acceptable
Marginal
Unacceptable
N/A
N/O
Is the JHA Form complete and with hazards and mitigation?
Acceptable
Marginal
Unacceptable
N/A
N/O
Energized work being done?
Acceptable
Marginal
Unacceptable
N/A
N/O
Permits needed?
Acceptable
Marginal
Unacceptable
N/A
N/O
Was a Job Safety Briefing given to the inspector?
Acceptable
Marginal
Unacceptable
N/A
N/O
Was a signature asked for on the appropriate form after the briefing?
Acceptable
Marginal
Unacceptable
N/A
N/O
Ask someone what's the scope of work and hazards. Does it match the JHA?
Acceptable
Marginal
Unacceptable
N/A
N/O
Permits and posters displayed?
Acceptable
Marginal
Unacceptable
N/A
N/O
Fuel station free of spills?
Acceptable
Marginal
Unacceptable
N/A
N/O
Fuel station has pole mounted fire extinguisher between 10-25 feet from tank?
Acceptable
Marginal
Unacceptable
N/A
N/O
Walkways clear of obstructions for evacuation?
Acceptable
Marginal
Unacceptable
N/A
N/O
Laydown area neat and clean?
Acceptable
Marginal
Unacceptable
N/A
N/O
Cardboard protected from decay?
Acceptable
Marginal
Unacceptable
N/A
N/O
Rachet straps are tight?
Acceptable
Marginal
Unacceptable
N/A
N/O
Everyone wearing PPE? (Safety-rated glasses, high-vis, safety-rated boots, hard hat with chin strap, and hazard appropriate gloves)
Acceptable
Marginal
Unacceptable
N/A
N/O
Cool water on site for crew?
Acceptable
Marginal
Unacceptable
N/A
N/O
Crew dressed for weather conditions (Hot, cold, wet)?
Acceptable
Marginal
Unacceptable
N/A
N/O
Submit
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