| Project Address |
|
| General Contractor |
|
Block / Lot |
|
| DOB Job No. |
|
DOB Permit No. |
|
| SSM / SSC Name |
|
License No. |
|
| Date |
|
Shift |
AM
PM
Night
|
| Time In |
|
Time Out |
|
| Weather (AM / PM) |
|
No. of Workers on Site |
|
| Areas Inspected |
|
| Safety Orientation Held Today |
Yes
No
|
Building Reached 75 ft. |
|
| Deck Floor |
|
Walkable Floor |
|
| Stripping Floor |
|
Stairway Within 40 ft. of Deck |
|
Contractors & Workers On Site — BC §3301.9
| # |
Company / Subcontractor |
Workers |
Scope of Work & Floor / Location |
| 1 | | | |
| 2 | | | |
| 3 | | | |
| 4 | | | |
| 5 | | | |
| 6 | | | |
| 7 | | | |
| 8 | | | |
| 9 | | | |
| 10 | | | |
| 11 | | | |
| 12 | | | |
| 13 | | | |
| 14 | | | |
| 15 | | | |
| 16 | | | |
| 17 | | | |
| 18 | | | |
| 19 | | | |
| 20 | | | |
| 21 | | | |
| 22 | | | |
| 23 | | | |
| 24 | | | |
| 25 | | | |
SSM / SSC Daily Inspection Report (Page 2 of 2)
| General Safety — BC §3309 / §3310 / §3315 | YES | NO | N/A |
| Weekly contractor coordination meeting conducted and documented | | | |
| Construction standpipe system tested, pressurized, and log current — BC §3320 | | | |
| Perimeter construction fence inspected, continuous, and compliant — BC §3310.9 | | | |
| Vertical debris netting inspected, properly secured at all attachment points | | | |
| Horizontal netting installed (Date: ) | | | |
| Horizontal netting removed (Date: ) | | | |
| Horizontal netting daily inspection completed and deficiencies corrected | | | |
| Guardrail systems (42" top rail, 21" mid-rail) and toe boards properly installed — BC §3315.3 | | | |
| All floor openings and penetrations covered, secured, and marked — BC §3315.1 | | | |
| All stairways have compliant handrails and mid-rails; stairway lighting operational | | | |
| Required DOB, FDNY, OSHA, and site safety signage posted and legible | | | |
| Public Protection & Site Maint. — BC §3307 / §3309.4 | YES | NO | N/A |
| All public sidewalks and pedestrian routes free of tripping and slipping hazards | | | |
| Guards, shields, and barricades properly separate the public from all construction hazards | | | |
| Adjacent property protected as required — roof, window, and overhead protection in place | | | |
| Traffic control flaggers stationed as required by DOT permit conditions | | | |
| All means of egress and ingress clear and unobstructed; sidewalk shed free of debris | | | |
| Debris containers provided, covered, and secured; combustible debris removed daily | | | |
| Materials stored minimum 10 ft. from open floor edges (5 ft. where perimeter < 1,000 SF) | | | |
| Debris chutes installed and maintained per code; plans and permits on site | | | |
| Material Handling & Hoisting — BC §3318 / §3319 | YES | NO | N/A |
| DOB crane / derrick approval certificate on site; operator license current and available | | | |
| PE-stamped crane pick schedule on site and reviewed prior to lifting operations | | | |
| DOT highway / street closing permits available on site and properly posted | | | |
| Communication system confirmed among all parties during all hoisting operations | | | |
| Flaggers and exclusion zones in place during all lifting and material hoisting operations | | | |
| All hoisted loads inspected and properly rigged; rigging equipment in good condition | | | |
| Logbook, Training & Permits — BC §3321 / LL 196 | YES | NO | N/A |
| Sidewalk shed / supported scaffold daily log updated | | | |
| Suspended scaffold / rigger's daily log updated | | | |
| Active DOB, DOT, DEP, and FDNY permits posted on site | | | |
| Approved Site Safety Plan on site; daily spot check conducted | | | |
| Approved scaffold drawings and permits on site (supported and suspended) | | | |
| Noise / dust mitigation plans posted and conditions being met | | | |
| Fall protection equipment inspection log current; PFAS log updated | | | |
| Safety orientation log updated; new worker orientations completed today | | | |
| Contractor toolbox talk conducted and recorded this week | | | |
| SST Cards verified, scanned, and logged per Local Law 196 / 2017 — BC §3321.2 | | | |
| 4-hr supported scaffold training verified (all workers accessing supported scaffold) | | | |
| 16-hr suspended scaffold training verified (all workers on suspended scaffold) | | | |
| 32-hr scaffold erection / dismantling training verified (erectors) | | | |
| Licensed Rigger / Rigging Foreman certificate confirmed on site | | | |
Incidents — Report ALL injuries, near-misses, and property damage
| Injury / Accident to Worker or Public |
YesNo |
Near-Miss Reported |
YesNo |
Report Filed |
YesNo |
Photos Taken |
YesNo |
| Brief Description of Incident |
|
Agency Inspections
| Regulatory Inspection Today |
YesNo |
Agency |
|
Inspector Name / Badge No. |
|
| Violation / SWO Issued |
YesNo |
SWO Lifted (Date / By) |
|
Shift Safety Personnel
| Concrete Safety Manager (CSM) Name |
|
License # |
|
| Fire Safety Manager (CSFSM) Name |
|
COF No. |
|
| Licensed Rigger / Rigger Foreman |
|
License # |
|
Observations, Conditions & Corrective Actions
| SSM / SSC Name (print) |
|
License # |
|
Signature |
|
Date |
|
| Alternate SSM / SSC (print) |
|
License # |
|
Signature |
|
Date |
|