Daily Contractor Self Inspection

Have all contract employees on-site completed the Roeslein EHS Contractor and site-specific orientation?

• Pass
• Flag
• Fail

Have all contract employees signed the site sign-in log?

• Pass
• Flag
• Fail

Has the JHA/JSA been completed for work to be performed and reviewed with all involved employees?

• Pass
• Flag
• Fail

Are all required PPE - safety glasses, hearing protection, boots, gloves, etc., present, worn properly, and in safe, working condition, as required?

• Pass
• Flag
• Fail

Are Fire Retardant garments and 4-gas personal meters worn and used properly, as required?

• Yes
• No
• N / A

Are exit paths maintained, cords out of walking paths, debris clear, etc.?

• Pass
• Flag
• Fail

Are hot-work permits, fire watches, clear work zones, flammable containment, and other fire prevention practices acceptable?

• Pass
• Flag
• Fail

Are fire extinguishers present, charged, and inspected?

• Yes
• No
• N / A

Are fall protection, standard rails, warning barriers, and signage used properly?

• Yes
• No
• N / A

Are suspended loads properly secured, and areas beneath flagged to prevent pedestrian or vehicle traffic?

• Yes
• No
• N / A

Is a spotter in place when suspended loads are in motion?

• Yes
• No
• N / A

Are the conditions and presence of barricades, signage, etc., acceptable?

• Pass
• Flag
• Fail

Is the equipment being used properly?

• Pass
• Flag
• Fail

Are operators authorized to operate the equipment?

• Yes
• No
• N / A

Are tools in good condition and properly used?

• Pass
• Flag
• Fail

Are all guards in place and not bypassed?

• Pass
• Flag
• Fail

Are cylinders capped when not in use, secured, stored with proper orientation and signage?

• Yes
• No
• N / A

Are Cover Entry and Repair procedures and requirements being followed by the contractor?

• Yes
• No
• N / A

Is all required equipment used for cover repairs present and in safe, working order?

• Yes
• No
• N / A

Are permits properly completed, safe work practices followed, and monitoring done correctly for confined space entry?

• Yes
• No
• N / A

Required equipment is present, inspected, in safe working condition, and being used properly, if applicable?

• Yes
• No
• N / A

Are all panels closed when not being actively worked on?

• Yes
• No
• N / A

Are panels properly labeled when work is completed?

• Yes
• No
• N / A

Are appropriate clearances maintained and PPE utilized?

• Yes
• No
• N / A

Are excavations and trenches properly sloped, or is a trench box in place?

• Yes
• No
• N / A

Are all barriers or warnings in place?

• Yes
• No
• N / A

Are MSDS/SDS available for onsite chemicals, with proper chemical labeling?

• Yes
• No
• N / A

Are the chemicals used and stored properly, transported safely, in containment, and disposed of properly?

• Yes
• No
• N / A

Are both permanent and temporary electrical cords, including those used for welders and other high-load equipment, in safe, serviceable condition?

• Yes
• No
• N / A

Are the Roeslein Equipment-Specific LOTO Procedures available for all equipment that maintenance will be performed on?

• Yes
• No
• N / A

Are LOTO procedures being followed?

• Yes
• No
• N / A

Is the work area free from negative environmental impacts (trash, waste, energy waste, etc.)?

• Yes
• No
• N / A

Are training records available for work being performed?

• Pass
• Flag
• Fail

Are records of inspection available for powered industrial vehicles, cranes, PPE welders, and other related industrial equipment?

• Pass
• Flag
• Fail

Name of Person Completing the Inspection