Daily Safety Inspection Form
Assessment Date
*
-
Month
-
Day
Year
Date
Assessor Name
*
Main Hazards Identified
*
Working at Height
Excavation
Lifting Operations
Heavy Machinery in Use
Electrical Exposure
Manual Handling
Slips/Trips/Falls
Confined Spaces
Hot Works
Weather Exposure
Other
Site Conditions
Complete checklist and note observations about site condition in comments section.
Site Checklist
*
Rows
Yes
No
N/A
Site Housekeeping is Acceptable
Excavation Routes are Clear (foot path)
Emergency Access is Maintained (EMS vehicle path)
Traffic Control is in Place as Needed
Site Fencing is Secure
Materials are Stored Safely
Signage at Site Entrance is Adequate & Visible
Signage for Traffic Control is Adequate & Visible
Signage at Potential Hazards is Adequate & Visible
Comments:
Building Conditions
Complete all checklist and note observations in comments sections.
General Building Checklist:
*
Rows
Yes
No
N/A
Building Housekeeping is Acceptable
Excavation Routes are Clear (foot path)
Emergency Access is Maintained (EMS vehicle path)
Walkways are Free of Trip Hazards
Materials are Stored Safely
Lighting is Adequate
Signage at Potential Hazards is Adequate & Visible
Electrical Cords are NOT Damaged and Clear of Walkways
Impalement Hazards Covered (rebar caps)
Comments:
Fall Prevention Checklist:
*
Rows
Yes
No
N/A
Guardrails Installed
Leading Edge Protection Adequate
Floor Openings Protected
Ladders Inspected
Harnesses Inspected
Comments:
Fire Prevention Checklist:
*
Rows
Yes
No
N/A
Fire Extinguishers are Accessible
Fire Extinguishers are NOT Expired
Hot Work Permits are Displayed for Applicable Work
Flammables (ex. fuel can) are Stored Correctly
Comments:
Trailer Conditions:
Complete checklist and note observations about trailer condition in comments section.
Trailer Conditions:
*
Rows
Yes
No
N/A
Trailer Entrance/Exit is Free of Debris or Excessive Dirt
First Aid Kit is Complete and in Good Condition
Signage for First Aid Location is Adequate & Visible
Eye Wash Station is in Good Condition
Signage for Eye Wash Station is Adequate & Visible
Spill Kit is Complete and Accesible
Project Safety Binder is Complete and Accesible
Comments:
PPE Compliance
Complete checklist and note observations about PPE in comments section.
PPE Checklist:
*
Rows
No PPE Issues Observed
Subcontractor Non-Compliance Observed
Neeser Non-Compliance Observed
Hard Hats
High Visibility Worn
Safety Glasses
Boots
Gloves
Hearing Protection (where applicable)
Respiratory Protection (where applicable)
Fall Protection (where applicable)
Comments:
Mitigation Actions and Follow-up
Are any corrective actions required?
If non-compliance or unsafe conditions where observed was it Neeser or Subcontractor directed work.
Neeser
Subcontractor
If subcontractor was answered above, provide subcontractor Company Name here.
Priority level
Low
Medium
High
Additional notes
Submit Assessment
Should be Empty: