Information
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Job number & Name
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Conducted on
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Prepared by
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Location Address
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Forman/Mechanic-in-Charge
Instructions
Employee PPE
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The intent of this survey is to create a safe work place for your employees. If a hazard is found, mark it as "At Risk" and note the remediation in the comments section. Also, document the violation by photograph and insert into this survey. Be sure to inform the contractor of any safety issues involving his work or the work of other trades.<br><br>Forward a copy of this survey to FQA (Ivan Andrews) and to your local Safety commmittee chairman. if you understand these instruction marke "yes" and begin the survey.
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Employees wearing hard hats.
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Employees wearing eye protection (including MIC).
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Employees wearing gloves (including MIC).
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Employees wearing fall protection when required.
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Face Shields are available for use in gang box.
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Employees wearing hearing protection when applicable.
Safety Instructions
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Medical emergency number and map to medical facility posted.
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Injury Illness Prevention Program (IIPP) and Employees' Safety Handbook are available for review.
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Employees aware of contractors emergency evacuation plan.
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Mechanic-in-Charge daily safety audit (20.5) is being done daily. Records are available for review at the site or turned into the office.
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Weekly "Tool Box" safety meeting are being conducted. Records are available for review at the site or turned in to the office.
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Safety Data Sheets (SDS) are available for review by employees.
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Are employee gang boxes, PPE (hard hats), uniforms (FOR THOSE UNIFORMS THAT WERE SEEN) free from graffiti stickers, writings, and images other than the Mitsubishi Electric logo, IUEC sticker and manufacturer logo for the item in question?
Equipment Condition
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Job site tool power is from a GFCI distribution box?
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Ladders are in good condition (no broken or dented rungs, etc.) and without modification.
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Electrical cords are not damaged (outer insulation not exposing inner conductors) and grounding lug is not broken.
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Employees have needed carts, dollies, hand trucks available to prevent back strains, etc.
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Extension Ladders are extending 3 feet above the landing, and secured at the top.
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Grinders and saws have guards installed per manufacturers requirements.
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Compressed gases are separated and safely stored.
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Flammable liquids are clearly marked and safely stored (gasoline, solvent, etc).
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Material handling equipment is in good condition (forklift, pallet jack, etc).
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Adequate number of material handling equipment is available.
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Fire extinguishers are sealed and charged.
Hoistway Safety
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Hoistway barricades and toe boards are installed and in good condition.
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Hoistway screening installed and covering full opening at all known entrances.
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All fall hazards above 4 feet have been eliminated.
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Job site material is not stored within 6 feet of the hoistway opening.
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Safety lines for fall protection are installed, or D-Rings slings are installed on moving platforms for fall protection.
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Work area lighting is adequate.
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Work area is clean and free from unnecessary tripping hazards.
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Hoisting rigging is safety installed. All hooks and clevises are moused.
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"Men Working Below" signs are posted at each opening.
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Scaffolding is tied off and braced to prevent tipping.
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Scaffold planks are in good condition and fully planked across (2 board minimum).
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No work conducted above our workers in pits or hoistways (i.e., stacked work).
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Scaffolding is tied off and braced to prevent tipping.
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Vertical safety lines in place for false car (skip) use.
Machine Room
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All holes in overhead are covered to prevent debris from falling down.
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Power disconnects are labeled for the controller they power.
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Jumper log is posted on each controller (Logs found in wiring book).
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All guards to machines in place or are installed on all moving equipment.
Contractor and other Trades
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The elevator staging/gang box area and break areas free of any offensive graffiti, stickers, writing, images, items, or other material.
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Has the contractor or other subcontractors created work place hazards. If so, document the hazard and inform the contractor of the hazard.
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Portable bathrooms free from any offensive graffiti, stickers, writing, images, items, or other materials.
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Respirable Crystalline Silica hazards are mitigated and/or eliminated.
Before continuing Work
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All hazards must be eliminated before allowing employees to resume work. If the hazard cannot be eliminated employees must be move away from the hazard before continuing work. Is this work place now safe for your employees?
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Reminded employees to take their meal breaks timely and to be sure to take their morning and afternoon rest breaks.
