| Project Address |
|
GC |
|
DOB Job No. |
|
Date |
|
SSM |
|
SSM Lic. # |
|
KEY: P = Pass F = Fail N/A = Not Applicable. All Fail items must be corrected within 24 hours. Record corrective action in the notes column.
| Shanty No. |
1. Waste and debris cleared on a daily basis |
2. Walls and roof in sound condition — all openings, holes, and gaps closed and weather-tight |
3. Heating equipment is an approved type — open-flame heaters prohibited per OSHA 1926.154 |
4. Min. 10-ft. clearance from combustibles for heating devices |
5. Portable fire extinguisher present — charged & tagged |
6. Main electrical disconnect switch unobstructed and properly identified |
7. No unapproved extension cords or improvised temporary wiring in use |
8. Adequate lighting (min. 10 fc) inside |
9. Potable water & toilet facilities within 200 ft. — OSHA 1926.51 |
10. No combustible material storage inside shanty |
11. Site emergency contact information posted conspicuously inside shanty |
Corrective Action Required |
SSM Initials |
| Shanty 1 | | | | | | | | | | | | | |
| Shanty 2 | | | | | | | | | | | | | |
| Shanty 3 | | | | | | | | | | | | | |
| Shanty 4 | | | | | | | | | | | | | |
| Shanty 5 | | | | | | | | | | | | | |
| Shanty 6 | | | | | | | | | | | | | |
| Shanty 7 | | | | | | | | | | | | | |
| Shanty 8 | | | | | | | | | | | | | |
| Shanty 9 | | | | | | | | | | | | | |
| Shanty 10 | | | | | | | | | | | | | |
| Shanty 11 | | | | | | | | | | | | | |
| Shanty 12 | | | | | | | | | | | | | |
| Shanty 13 | | | | | | | | | | | | | |
| Shanty 14 | | | | | | | | | | | | | |
| Shanty 15 | | | | | | | | | | | | | |
| SSM Name (print) | | License No. | | Inspector Name | |
| SSM Signature | | Date | | Inspector Signature | |