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 Forman).
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Employees wearing gloves (including Forman).
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Employees wearing fall protection when required.
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Face Shields are available for use in Gang box.
Safety Instructions
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Medical emergency number and map 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" saety meeting are being conductede. Records are available for review at the site or turned in to the office.
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Material Safety Data Sheets (MSDS) are available for review by employees.
Equipment Condition
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Job site tool power from GFCI spider box is being tested monthly and tagged with the test date (tag can be tape with a test date).
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Ladders are in good condition (no broken or dented rungs, etc.)
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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.
Hoistway Safety
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Hoistway barricades and toe boards are installed and in good condition.
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All fall hazards 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.
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No personnel are working more than 1 floor above employees in the hoistway or pit.
Machine Room
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All holes in the floor have been filled to prevent debris fall down the hoistway.
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Main line power disconnects are labeled for the controller they power.
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Jumper log is posted on each controller.
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Machine guards on moving equipment are installed.
Contractor and other Trades
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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.
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?
