AMS Safety Program Evaluation

• Document No.

• Project Name

• Conducted on

  Date

• Prepared by

• INSPECTION DATE

  Date

• PROJECT NAME

• Add location
  Address

• PROJECT MANAGER

• FRONTLINE SUPERVISOR

• SAFETY MANAGER

SUPPLEMENTAL WORK EXPOSURES

• Select the SUPPLEMENTAL WORK EXPOSURES covered under this evaluation

  Select Respiratory Protection Confined Space Hazardous Substances Training / Retraining of Miners Job Hazard Analysis Lock-Out Procedures Excavation/ Trenching Blood Borne Pathogens Fall Protection Heat Illness Prevention Hearing Conservation Arc Flash Prevention Other

  • Respiratory Protection
  • Confined Space
  • Hazardous Substances
  • Training / Retraining of Miners
  • Job Hazard Analysis
  • Lock-Out Procedures
  • Excavation/ Trenching
  • Blood Borne Pathogens
  • Fall Protection
  • Heat Illness Prevention
  • Hearing Conservation
  • Arc Flash Prevention
  • Other

• If 'OTHER' was selected please list the exposure here:

PROJECT MANAGEMENT EXPOSURES

• Are WEEKLY WORK AREA INSPECTIONS being documented?

  Yes

  No

  N/A

• Work Area Inspections are being documented by?

• Region/Area Managers (Responsibilities 2.4)?

• Project/Plant Managers (Responsibilities 3.5)?

• Equipment Managers (Responsibilities 3.5)?

• Superintendents (Responsibilities 4.6)?

• Are DAILY work area inspections documented by Frontline Supervisors/Foreman (Responsibilities 7.6)?

  Yes

  No

  N/A

• Are new employees wearing a RED HARD HAT or equivalent (Procedures 4.2.2)?

  Yes

  No

  N/A

• TOTAL number of Red Hard Hats (New Employees) on-site?

  0-5

  6-10

  11-15

  16-20

  20+

• Is the project/site documenting:

• Job Hazard Analysis (Procedures 4.1.3)?

• Site-specific training of employees (Procedures 4.2.2)?

• Training of employees when NEW hazards are introduced (Procedures 4.2.4)?

• Does the project/site have random drug & alcohol testing for all employees (Program Supplement 11: 5.1)?

  Yes

  No

  N/A

EMERGENCY RESPONSE PREPAREDNESS

• Are FIRST AID materials readily available on the site?

  Yes

  No

  N/A

• TOTAL number of first-aid kits available?

• Are emergency response contacts (doctors, hospitals, fire department and ambulance services) POSTED?

  Yes

  No

  N/A

• Are the telephone numbers of local Fire Fighting Agencies posted at each work location?

  Yes

  No

  N/A

• Are Fire Extinguishers inspected MONTHLY (Procedures 4.23.9)?

  Yes

  No

  N/A

• Has the Project/Area Manager been trained in Crisis Communication?

  Yes

  No

  N/A

EMPLOYEE EXPOSURES

• Is DRINKING WATER provided for all personnel (Procedures 4.4.1 & Program Supplement 12)?

  Yes

  No

  N/A

• Select the available type(s) of drinking water provided?

  Select Bottled Water Water Cooler Disposable Cups Personal Water Bottle

  • Bottled Water
  • Water Cooler
  • Disposable Cups
  • Personal Water Bottle

• Are adequate TOILET FACILITIES provided (or transportation readily available) for personnel (Procedures 4.4.4)?

  Yes

  No

  N/A

• Are HAND WASHING facilities (with soap and water) availble for personnel (Procedures 4.4.6 & 4.4.7)?

  Yes

  No

  N/A

• Are the following PERSONAL PROTECTIVE EQUIPMENT requirements followed:

• HEAD protection worn by all personnel at all jobsites and outdoor workplaces (Procedures 4.7.4)?

  Yes

  No

  N/A

• HEARING protection worn when noise levels exceed 85 decibles (Procedures 4.7.12 & Program Supplement 13)?

  Yes

  No

  N/A

• EYE protection worn by personnel exposed to dust, flying particles, splashes, chemical and/or radiation agents (Procedures 4.7.5)?

  Yes

  No

  N/A

• HAND protection worn when handling hazardous materials, hot objects, tools/equipment that cause hand injuries (Procedures 4.7.9)?

  Yes

  No

  N/A

• HIGH VISIBILITY shirts or vests worn by personnel exposed to mobile equipment or motor vehicle traffic (Procedures 4.7.7)?

  Yes

  No

  N/A

• FOOT protection worn by personnel exposed to impact or crushing foot injuries (Procedures 4.7.8)?

  Yes

  No

  N/A

• LEG protection worn by personnel operating chainsaws and cutoff saws (Procedures 4.8.15)?

  Yes

  No

  N/A

• RESPIRATORY protection worn for exposure to respiratory hazards, such as dusts, fumes, mists, vapors or gases (Procedures 4.7.10 & Program Supplement 1)?

  Yes

  No

  N/A

• Are logs for ENCLOSED/CONFINED SPACE entries completed daily showing that space was tested prior to personnel entering (Procedures 4.29 & Program Supplement 2)?

  Yes

  No

  N/A

• Are the locations of each "PERMIT Required Confined Space" clearly posted (Program Supplement 2, section 3)

  Yes

  No

  N/A

• TOTAL number of 'Permit Required Confined Space(s)'

POWER & HAND TOOLS

• Are all POWER TOOLS, including cords, inspected before use with guards & safety devices in place and functioning (Procedures 4.8.2 & 4.8.3)?

  Yes

  No

  N/A

• Is a DUST reduction system in place on tools used to cut, grind, drill or core (Procedures 4.8.17)?

  Yes

  No

  N/A

• Are gasoline and other Flammable Liquids stored in APPROVED portable tanks or safety cans (Procedures 4.23.13)?

  Yes

  No

  N/A

• Are TEMPORARY POWER SOURCES protected by either a GFCI or an assured equipment grounding program (Procedures 4.8.6)?

  Yes

  No

  N/A

• Are the CONNECTIONS of compressed air hoses (1/2" diameter or greater) provided with clips or chains to prevent whipping (Procedures 4.8.13 &4.8.14)?

  Yes

  No

  N/A

EXCAVATION & TRENCHING

• Is there a current OSHA Excavation & Trenching Permit (if required, see Program Supplement 8)?

  Yes

  No

  N/A

• Who is the individual designated as the COMPETENT PERSON (Procedures 4.16.3)?

• Are Soil Evaluations documented prior to beginning work by the competent person (Procedures 4.16.1)?

  Yes

  No

  N/A

• Are Excavations 4' or more in depth provided with a safe means of ingress and egress (Procedures 4.16.8 & 4.16.9)?

  Yes

  No

  N/A

• Are Excavations 5' or more in depth provided with shoring, sloping or benching as a means of protecting workers (Procedures 4.16.5)?

  Yes

  No

  N/A

• Do Excavations 20' or more in depth have a detailed plan prepared by a Professional Engineer (Procedures 4.16.7)?

  Yes

  No

  N/A

• Is there a system in place that allows employees to Cross Excavations (Procedures 4.16.10)?

  Yes

  No

  N/A

• Are employees only lifting from Manufacture Approved Pick Points on backhoes/excavators (Procedures 4.16.12 & 4.14.5)?

  Yes

  No

  N/A

WORK AREAS & STORAGE

• Are LADDERS inspected priot to their use (Procedures 4.20.4)?

  Yes

  No

  N/A

• Are all damaged ladders removed from service immediately (Procedures 4.20.5)?

  Yes

  No

  N/A

• Are the PORTABLE ladders in use:

• Extending at least 36 inches above the top landing (Procedures 4.20.7)?

  Yes

  No

  N/A

• Placed on a substantial footing and securely fastened (Procedures 4.20.6)?

  Yes

  No

  N/A

• Are all FIXED Ladders extending at least 42 inches above the top landing (Procedures 4.20.10)?

  Yes

  No

  N/A

• Are REBAR covers, rebar troughs or fall protection system used:

• To protect personnel working at grade or at the same surface from exposed projections (Procedures 4.21.1.1)?

  Yes

  No

  N/A

• To protect personnel working above grade and exposed to vertically protruding projections (Procedures 4.21.1.2)?

  Yes

  No

  N/A

• Are REBAR CAPS being used as vertical impalement protection (Procedures 4.21.1.3.1)?

  Yes

  No

  N/A

• Are TRAFFIC CONTROL devices compliant with the Manual on Uniform Traffic Control Devices (Procedures 4.24.8.1)?

  Yes

  No

  N/A

• Are work & storage areas maintained in a clean and orderly condition (Procedures 4.27.1, 4.27.4)?

  Yes

  No

  N/A

• Select the appropriate level of effort observed:

  No effort to comply

  Effort made, but much more is needed

  Effort was made, but not quite achieved

  Site needs some minimal attention

  Site is clean & orderly

HEAVY EQUIPMENT & HIGHWAY VEHICLES

• Are BACK-UP ALARMS functional on all equipment with restricted view to the rear (Procedures 4.11.12)?

  Yes

  No

  N/A

• Are Equipment Operators performing and documenting their PRE-SHIFT Inspection, before they place equipment into service (Procedures 4.11.6)?

  Yes

  No

  N/A

• Are conditions that effect the SAFE OPERATION of the equipment corrected before placing equipment into service (Procedures 4.11.7)?

  Yes

  No

  N/A

• Are personnel wearing SEAT BELTS, when provided and when the equipment has ROPS (Procedures 4.11.14)?

  Yes

  No

  N/A

• Are FORKLIFTS only operated by authorized, trained and properly certified personnel (Procedures 4.12.1)?

  Yes

  No

  N/A

• Are the wheels/tracks of all mobile equipment parked on a grade, properly CHOCKED or turned into a bank (Procedures 4.11.15 & 4.11.16)?

  Yes

  No

  N/A

• Are AERIAL LIFT personnel wearing a body harness and lanyard attached as indicated by equipment manufacturer (Procedures 4.19.7)?

  Yes

  No

  N/A

• Are aerial lift personnel standing on the floor of the basket without sitting or climbing on the edge (Procedures 4.19.8)?

  Yes

  No

  N/A

PUBLIC PROTECTION

• Are there sufficient number of WARNING SIGN & DEVICES to provide adequate warning to the general public (Procedures 4.25.1)?

  Yes

  No

  N/A

• Is the SPILLAGE of earth, rock, asphalt, mud or other materials removed and kept clear throughout the day (Procedures 4.25.9)?

  Yes

  No

  N/A

EVALUATION COMPLETION

• COMMENTS:

• EVALUATION COMPLETED BY:

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