4X Industrial Safety Assessment

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Foreman

WORK PRACTICES

• Are the appropriate 4X Industrial PPE signs posted?

  Yes

  No

  N/A

• Is the Job Briefing/JSA complete and signed by all employees?

  Yes

  No

  N/A

• Do ALL employees know what is on the Job Briefing/JSA?

  Yes

  No

  N/A

• Are best safety practices being followed?

  Yes

  No

  N/A

EMERGENCY ACTION/RESPONSE PLAN

• Is the Emergency Action/Response Plan posted?

  Yes

  No

  N/A

• Are the certified First-Aid/CPR employees listed? 1910.151(b)

  Yes

  No

  N/A

• Are Biohazard (Bloodborne Pathogens) kits available? 1910.1030

  Yes

  No

  N/A

• Are the first aid kits provided adequately stocked? 1910.266(d)(2)(iv)

  Yes

  No

  N/A

• Does the eye-wash station have two unopened bottles?

  Yes

  No

  N/A

• Is there extra spill material available in the event of a spill? (i.e. Two bundles of pads & boom)

  Yes

  No

  N/A

HYGIENE

• Are there toilet and washing facilities available? 1910.120(n)(3)(i), 1910.120(6)

  Yes

  No

  N/A

• Are cool-down areas available for the employees?

  Yes

  No

  N/A

• Is adequate water available? 1910.141(b)(1)(i)

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Are hard hats worn as required? 1910.135(a)(1)

  Yes

  No

  N/A

• Are ANSI z87.1 approved safety glasses being utilized? 1910.133(a)(1)(2)(3)(4)(5)

  Yes

  No

  N/A

• Is hearing protection available and being utilized when required? 1910.95(i)(1)

  Yes

  No

  N/A

• Are steel toe boots with defined heel being worn? If in the Railroad Division, are the boots lace up with a minimum of 8" above the ankle?

  Yes

  No

  N/A

• Is proper hand protection being used for the task at hand? 1910.138(a)

  Yes

  No

  N/A

• Is High-Visibility clothing being worn? MUTCD-FHWA (Section 6E.02)

  Yes

  No

  N/A

• Is FRC clothing required for task being performed?

  Yes

  No

  N/A

HOUSEKEEPING

• Are all walking-working surfaces well maintained? 1910.22(a)

  Yes

  No

  N/A

• Are work trucks clean and organized?

  Yes

  No

  N/A

• Are company vehicles on or near location? If not, are the keys on the approved driver?

  Yes

  No

  N/A

• Are any floor openings covered, identified, or barricaded?

  Yes

  No

  N/A

• Is all equipment being used free of any leaks?

  Yes

  No

  N/A

• Are there trash containers available?

  Yes

  No

  N/A

FIRE PROTECTION/PREVENTION

• Are the portable fire extinguishers incompliance? Fully charged, current on monthly & annual inspections? 1910.157(e)

  Yes

  No

  N/A

• Does every piece of heavy equipment have a fire extinguisher?

  Yes

  No

  N/A

• Are fire-retardant welding blankets used when required?

  Yes

  No

  N/A

• Are fuel tanks staged in a safe location and have secondary containment?

  Yes

  No

  N/A

• Are portable fuel cans DOT approved and are they stored properly (Metal only)? 1926.125(a)(1)

  Yes

  No

  N/A

OXYGEN/ACETYLENE

• Do the Oxygen & Acetylene regulators have flashback arrestors? 1910.253(e)(5)

  Yes

  No

  N/A

• Are bottles stored correctly? 1910.253(b)(2)(iv)

  Yes

  No

  N/A

• Is the quantity of bottles appropriate for the job?

  Yes

  No

  N/A

• Are empty bottles removed or identified? 191.253(b)(2)(iii)

  Yes

  No

  N/A

• Are all hoses in safe working condition? 1910.253(e)(5)

  Yes

  No

  N/A

WELDING/HOT WORK

• Are welding machines in good working condition?

  Yes

  No

  N/A

• Are the welding leads protected from contact and in good condition? 1910.254(b)(4)(iv)

  Yes

  No

  N/A

• Are Welders utilizing the proper PPE? 1910.252(b)

  Yes

  No

  N/A

FALL PROTECTION/PREVENTION

• Is there a minimum of two harnesses and lanyards available for use? 1910.140

  Yes

  No

  N/A

• Has the PFAS been inspected and documented? 1910.140(c)(18)

  Yes

  No

  N/A

• Is fall protection being utilized when working over 4 Ft.? 1910.28(b)(6)(ii)

  Yes

  No

  N/A

• Is fall protection being utilized when working 4 Ft.(1.2 m) from a leading edge? 1910.28(b)(6)(i)

  Yes

  No

  N/A

• Are tool lanyards being used when required?

  Yes

  No

  N/A

• Is there an Aerial Work Platform on the jobsite? Has the AWP been inspected & documented?

  Yes

  No

  N/A

LADDERS AND STAIRS

• Are ladders stored properly and free of defects?

  Yes

  No

  N/A

• Do ladders have daily inspection tag on them and are they up to date?

  Yes

  No

  N/A

• Is the proper ladder being used for the task? (i.e. Weight Rating)

  Yes

  No

  N/A

SAFETY DATA SHEETS

• Is there an SDS book available on-site? 1910.1200(g)

  Yes

  No

  N/A

• Does the book contain SDS for all chemicals on the job site? 1910.1200(g)(10)

  Yes

  No

  N/A

• Are all flammable chemicals stored correctly?

  Yes

  No

  N/A

MATERIAL HANDLING

• Is the ground bearing pressure adequate for the crane and loads? 1926.1402(b)

  Yes

  No

  N/A

• Has the daily Crane inspection been completed? If so, have all deficiencies been corrected? 1926.1412(d)(1)

  Yes

  No

  N/A

• Is the annual crane inspection current (note due date)? 1926.1412(f)(1),(f)(5),(f)(6)

  Yes

  No

  N/A

• Is the cab and the engine compartment kept clean?

  Yes

  No

  N/A

• Is there a fire extinguisher in the crane? If so, is it in compliance?

  Yes

  No

  N/A

• Is the Operator's Manual and Load Charts in the crane? 1926.1417(a)

  Yes

  No

  N/A

• Are the crane mats in good condition?

  Yes

  No

  N/A

RIGGING

• Has rigging been inspected and color coded/if needed? 1926.251(a)(1)

  Yes

  No

  N/A

• Does all rigging pass inspection and have the appropriate tags? 1926.251(a)(6)

  Yes

  No

  N/A

• Are the shackles inspected and fit for service? 1926.251(f)(1),(f)(2)

  Yes

  No

  N/A

• Do hooks have latches if required by manufacturer? 1926.251(f)(1)

  Yes

  No

  N/A

WORK/JOB SITE

• Have all underground utilities been located/identified? 1926.651(b)(1)

  Yes

  No

  N/A

• Are barricades and warning signs in place as required? 1926.651(f)

  Yes

  No

  N/A

• Are fuel tanks stored in a safe place with secondary containment?

  Yes

  No

  N/A

• Is the tool-room clean and organized?

  Yes

  No

  N/A

• Are overhead powerline hazards identified? 1910.333(c)(3)

  Yes

  No

  N/A

• Are employees protected from falling objects? 1910.28(b),(c)

  Yes

  No

  N/A

• Are light plans available if working in the dark? 1926.56(a),(b)

  Yes

  No

  N/A

EQUIPMENT OPERATORS

• Is employee(s) authorized to operate the piece of equipment? 1910.178(I)(5)

  Yes

  No

  N/A

• Are operators wearing seat belts when in use?

  Yes

  No

  N/A

• Is the daily equipment inspection complete? If so, were the deficiencies corrected? 1910.178(q)(7)

  Yes

  No

  N/A

• Is the Operator Manual available in the equipment?

  Yes

  No

  N/A

• Is the cab of the equipment clean?

  Yes

  No

  N/A

• Does the equipment have audible warning device for backing up? 1926.601(b)(3)

  Yes

  No

  N/A

HAND/POWER TOOLS

• Are hand/power tools free of defects? 1910.242

  Yes

  No

  N/A

• Are GFCI's being utilized?

  Yes

  No

  N/A

• Are come-alongs/chain hoist free of defects?

  Yes

  No

  N/A

• Are extension cords in compliance? 1910.334(a)(1)(2)(i)

  Yes

  No

  N/A

INSPECTION COMMENTS/SUMMARY

• Concerns/Comments

• Assessment reviewed with Foreman and Crew?

  Yes

  No

  N/A

• Signature

  Sign