Ref.

#: CMO-F-038
Rev. #: 0
Rev. Date: 01 October 2011

DAILY DETAILED SAFETY SUPERVISION CHECKLIST

Project Name : Date :
Group/ Location : No of Workers : ________
Foreman/ Supervisor :
NATURE OF WORK :
SCAFFOLDING STRUCTURAL ELECTRICAL MECHANICAL
OTHERS, SPECIFY :
I. PREPARATION STAGE
YES NO N/A REMARKS
1. ARE PERMITS COMPLETED AND CHECKED?
2. IS THE WORK/ ACTIVITY COORDINATED TO ALL PARTIES?
(Security, Admin, etc.)
3. IS THE WORK AREA PRE-INSPECTED, IDENTIFIED ALL THE HAZARDS
AND COMPREHENDED IN THE PTP (WITH MITIGATION MEASURES)?
4. IS THE WORK AREA BARRICADED AS PER REQUIREMENTS?
5. ARE TOOLS/ EQUIPMENT CHECKED AND COLOR CODED?
6. ARE WORKERS COMPLETE WITH THE APPROPRIATE PPE's?
7. ARE MATERIALS INSPECTED AND IN GOOD CONDITION?
8. ARE ALL INSTALLED MATERIALS PROPERLY SECURED?
9. ARE ALL NETTINGS PROPERLY INSTALLED AND IN COMPLIANCE

10. ARE EXISTING UTILITIES IDENTIFIED AND MARKED?

11. ARE SHUT OFF VALVE's IDENTIFIED AND TAGGED?
12. ARE LIFELINES CORRECTLY INSTALLED?
II. WORK STAGE
1. DO TOOLS, RADIO & EQUIPMENT HAVE TOUGH RETAINING STRINGS?
2. ARE MATERIALS PROPERLY TIED OFF DURING INSTALLATION?
3. DO WORKERS OBSERVED 100% TIE OFF?
4. IS THE WORK TO BE DONE NEAR/ BESIDE THE EXISTING UTILITIES?
5. ARE PRECAUTIONS PLANS TO AVOID EXISTING UTILITIES MADE?
6. ARE WORKERS AWARE OF THE EXISTING UTILITIES AND THE PLANS
PRECAUTIONS TO AVOID THEM?
7. DOES THE FOREMAN/ SUPERVISOR AND CERTIFIED WATCHMAN HAVE
RADIO'S AND ARE CONSTANTLY MONITORING THE WORK AREA?
8. IS THE BUDDY SYSTEM BEING OBSERVED?
III. KNOCK-OFF STAGE
1. IS THE WORKING AREA CLEAN OF DUST AND OTHER
CONSTRUCTION DEBRIS (Proper Housekeeping)?
2. ARE TOOLS/ EQUIPMENT/ UNINSTALLED MATERIALS REMOVED
AND TAKEN OUT OF WORKING AREA?
3. ARE ALL INSTALLED MATERIALS (ex. Nettings, etc.) SECURED?
4. ARE WORKERS OUT OF THE WORKING AREA PRIOR TO REMOVAL
OF BARRICADE BELOW?

PREPARED BY : ATTESTED BY:

Project Manager (Contractor) Contractor's Safety Officer

AUDITED BY : AUDITED BY : AUDITED BY :
TIME : TIME : TIME :
REMARKS : REMARKS : REMARKS :
NOTED BY :
_______________________
Construction Manager