Information

  • Company Name

  • Conducted on

  • Prepared by

  • Location
  • Company Contact

  • Company Contact Phone

  • Company Contact Email

  • Owner/ GC/ Sub-tier/ Other

Principal Commitment

  • 1.1 A written safety policy statement signed by a company principal<br> <br>

  • 1.2 Each company must comply with one (1) or more of the following:

  • 1.3 Employ a designated Safety Coordinator/ Manager/ Director:

  • 1.3.1 Safety responsibilities clearly defined in writing

  • 1.3.2 Safety Coordinator must report to executive management of the company

  • 1.3.3 Safety Coordinator attends all management/ project/ safety meetings

  • 1.4 Be active in an AGC Safety Committee

  • 1.5 Participation in the Safety Team audit by a Company Principal

  • 1.6 Principal has been a presenter at an industry safety function

A Written Accident Prevention Program (per WAC-296-155-110) That Addresses:

  • 2A. A Written New Hire Orientation that Contains the Following Items
    (each item must be itemized in a written format):

  • 2.1 How, where, and when to report injuries

  • 2.2 Location of first aid kits/facilities

  • 2.3 How to report unsafe conditions and practices

  • 2.4 Use and care of personal protective equipment

  • 2.5 Actions to take in the event of emergencies

  • 2.6 Identification of chemical hazards and proper use

  • 2.7 An outline of the company’s overall safety program

  • 2.8 A definition of your company’s safety roles and responsibilities

  • 2.9 Chemical Hazard Communication Training (WAC 296-800-170)

  • 2.10 Fire Prevention Training (WAC 296-155 Part D)

  • 2.11 Fall Protection Training (WAC 296-155 Part C-1)

  • 2.12 Site Specific Training (i.e. confined space)

  • 2.13 In-house or AGC safety classes/ training

  • 2B. A Written Policy on the Following Safety Items:

  • 2.14 Asbestos and Lead Policy

  • 2.15 Assured Grounding Program or Ground-Fault Circuit Interrupter (WAC 296-155-447)

  • 2.16 Bloodborne Pathogen Exposure Policy (WAC 296-823)

  • 2.17 Chemical Hazard Communication Policy (WAC 296-800-170)

  • 2.18 Confined Space Policy (WAC 296-809)

  • 2.19 Crane Usage Policy

  • 2.20 Disciplinary procedures & enforcement of health & safety rules for Subcontractors & Employees

  • 2.21 Emergency procedure plan

  • 2.22 Employee Safety Concerns Procedure

  • 2.23 Fall Protection Policy (WAC 296-155 Part C-1)

  • 2.24 Fire Prevention Policy (WAC 296-155 Part D)

  • 2.25 Hearing Loss Prevention Program (WAC 296-817)

  • 2.26 Heat Stress Program (WAC 296-62-095)

  • 2.27 Lock-out/Tag-out Policy (WAC 296-803)

  • 2.28 Motorized Vehicle/Fleet Safety Policy (WAC 296-155 Part M)

  • 2.29 Respiratory Protection Policy (WAC 296-842)

  • 2.30 Trenching & Shoring Policy (WAC 296-155 Part N)

  • 2.31Workplace Violence Policy

First Aid/CPR & Record Keeping

  • 3. All Supervisors’ First Aid/CPR cards checked at start of all new projects

  • 3.1 Certification information for employees are tracked and on file

  • 3.2 OSHA 300

Accident Investigations and Reports

  • 4. Reporting procedures are clarified at the time of hire (see Orientation Checklist)

  • 4.1 Investigation procedures for “near misses”

  • 4.2 Investigations are conducted in 24 hours

  • 4.3 Investigations are documented on a company report form

  • 4.4 Investigations of accidents & “near misses” are discussed during weekly safety meeting<br><br>

Substance Abuse

  • 5. A written Drug & Alcohol Policy, reflecting current company policies

  • 5.1 Drug Testing (optional) For example: Pre-employment, post-accident, for-cause, random, DOT

Participation

  • 6. Participation in at Least One Construction Safety Activity by One or More Employees: (For example: AGC Safety Symposiums, AGC Safety Committee meetings, ASSE meetings or seminars, Puget Sound Safety Summit meetings, Seattle Vicinity Construction Safety Council meetings, or Evergreen Safety Council)

Return-to-Work Program (Optional)

  • 7. AGC RETRO PARTICIPANT

  • 7.1 Written Return-to-Work Program

  • 7.2 Written Light Duty job descriptions

  • 7.3 Documentation of supervisory training in Return-to-Work criteria

  • 7.4 Top management commitment to a Return-to-Work program

Safety Management Items/ Jobsite

  • 8.0 Accident prevention program on site

  • 8.1 Job Hazard Analysis

  • 8.2 Confined Space Permit

  • 8.3 Fall Protection Work Plan

  • 8.4 Complete inspection forms: Assured Grounding/GFCI Program

  • 8.5 Weekly Jobsite Inspection Forms

  • 8.6 Weekly Toolbox Meeting Minutes

  • 8.7 Site Specific Safety Plan

  • 8.8 Cranes documentation:

  • 8.8.a Crane Operator Certification and hours

  • 8.8.b Crane Certification with proof of load testing

  • 8.8.c Certifier Certification

  • 8.8.d Rigger Qualification (by Type)

  • 8.8.e Signal Person Qualification

  • 8.9 WAC Standards for construction located on worksite

  • 8.10 Safety Bulletin Board with required posting

  • 8.11 Emergency phone numbers posted

  • 8.12 OSHA 300A (Posted February through April)

  • 8.13 First Aid/CPR training certification cards (Superintendents, Foremen)

Employee Facilities/ Jobsite

  • 9.0 Toilet

  • 9.1 Wash area with temperate water/ Sanitizer

  • 9.2 Dry shack - lunch room

  • 9.3 Above listed facilities clean and sanitary

Jobsite Protective Equipment/ Jobsite

  • 10.0 First aid kit suitable for crew size (office, dry shack, tool van)

  • 10.1 Fire protection (extinguisher date and type correct for situation)

Housekeeping/ Jobsite

  • 11.0 Work Areas clean and orderly

  • 11.1 Deck free of: protruding nails, holes, loose boards

  • 11.2 Aisles and walkways clear of obstructions

  • 11.3 Guardrails in place where required

  • 11.4 Trash chute for over 20’ heights

Required Personal Protectice Equipment/ Jobsite

  • 12.0 Head Protection - hard hats

  • 12.1 Hearing protection - ear plugs<br>Sound Level Meter: _____dB reading <br>

  • 12.2 Leg protection - chain saw chaps

  • 12.3 Foot protection - work boots

  • 12.4 Eye and face protection - safety glasses

  • 12.5 Respiratory protection - mask dependent on exposure

  • 12.6 Fall protection - safety harness, lanyards

  • 12.7 Reflective Clothing- vest, 360 degrees

General Jobsite Safety Items/ Jobsite

  • 13.0 Office trailer step railings

  • 13.1 Only approved ladders in use (and secured)

  • 13.2 Machine guards in place (saws, grinding wheels, etc.)

  • 13.3 All power equipment is properly grounded

  • 13.4 Extension cords and power equipment checked for shorts

  • 13.5 Compressed gas cylinders in secured storage area

  • 13.6 Fuel gas stored at a minimum of 20 feet from compressed gas cylinders

  • 13.7 Flash back protectors for oxygen-acetylene torches in place/use

  • 13.8 Proper access/egress for trenches more than 4 feet deep

  • 13.9 Gas and diesel fuel stored in approved and properly marked safety cans

  • 13.10 Proper barricades around pinch point exposure area (revolving cranes)

  • 13.11 Proper Scaffold erection and usage

  • 13.12 Back-up alarms on appropriate motorized equipment

  • 13.13 Provisions for public safety

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.