ArcelorMittal

• Project/Job

  Select #11 Boiler Project

  • #11 Boiler Project

• Conducted on

  Date

• Prepared by

• Personnel

Permits/Job Safety Analysis (JSA)

• Permit reviewed and signed off from owner?

  Yes

  No

  N/A

• JSA reviewed with crews and signed off?

  Yes

  No

  N/A

• Hazard Recognition reporting

  Yes

  No

  N/A

• Near Miss reporting

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Hot Work

• Permit Completed

  Yes

  No

  N/A

• Fire Extinguisher Present/Fire Protection in Place?

  Yes

  No

  N/A

• Firewatch Required/Present?

  Yes

  No

  N/A

Work Areas

• General Housekeeping

  Safe

  At Risk

  N/A

• Walking - Working Surfaces

  Safe

  At Risk

  N/A

• Unprotected Sides or Holes

  Safe

  At Risk

  N/A

• Barricades and Signs in Place

  Safe

  At Risk

  N/A

• Water/Garbage Cans available

  Yes

  No

  N/A

• Sanitary Facilities

  Yes

  No

  N/A

• Impalement Hazards

  Safe

  At Risk

  N/A

• Other Crafts working in Area

  Yes

  No

  N/A

• Other

  Safe

  At Risk

  N/A

First Aid/Emergency

• First Aid Kit

  Yes

  No

  N/A

• Eye Wash Facilities in Field

  Safe

  At Risk

  N/A

• Access to Eye Wash

  Yes

  No

  N/A

• Evacuation and Assembly Points

  Yes

  No

  N/A

• Emergency Contacts / Numbers

  Yes

  No

  N/A

PPE

• Face Shield / Goggles (If Required)

  Yes

  No

  N/A

• Hard Hats

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Clothing ( FRC, Greens) In good condition

  Yes

  No

  N/A

• Gloves

  Yes

  No

  N/A

• Foot Protection

  Yes

  No

  N/A

• Safety Glasses with Side Shields

  Yes

  No

  N/A

• Respiratory Protection (If Required)

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Fall Protection

• Stored Properly

  Safe

  At Risk

  N/A

• Emergency Rescue Plan

  Safe

  At Risk

  N/A

• Trained Personnel

  Safe

  At Risk

  N/A

• Guardrail/ Midrail /Toe Boards

  Safe

  At Risk

  N/A

• Suitable Anchor Point

  Safe

  At Risk

  N/A

• Inspected/Color Coded

  Yes

  No

  N/A

• Proper Fit

  Yes

  No

  N/A

• Other

  Safe

  At Risk

  N/A

Confined Space Entry

• Trained Personnel (Entrant)

  Safe

  At Risk

  N/A

• Attendant Present (Trained)

  Safe

  At Risk

  N/A

• Permit in Place

  Yes

  No

  N/A

• Sign in Sheet (Entry)

  Yes

  No

  N/A

• Air Monitoring

  Safe

  At Risk

  N/A

• Emergency Rescue Plan

  Yes

  No

  N/A

• Permit Followed

  Safe

  At Risk

  N/A

Scaffold / Ladders

• Trained Personnel (User)

  Safe

  At Risk

  N/A

• Condition (Visual - hand rails, toe boards, mid-rails, Level ground, clean)

  Safe

  At Risk

  N/A

• Access / Egress

  Safe

  At Risk

  N/A

• Inspection / Tagged Correctly

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Tools and Equipment

• In Good Condition

  Yes

  No

  N/A

• Inspected / Color Coded

  Yes

  No

  N/A

• Tools (Guards in place, working condition)

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Mobile Equipment

• Pre-Operational Inspection (Documented)

  Yes

  No

  N/A

• Operator Trained/competent

  Yes

  No

  N/A

• Other

  Safe

  At Risk

  N/A

Cranes

• Operator Certified

  Yes

  No

  N/A

• Lift Plan-Completed/Signed

  Yes

  No

  N/A

• Inspections - Annual/Daily

  Yes

  No

  N/A

• Loads Properly Secured/Tag Lines Used

  Yes

  No

  N/A

• Other

  Safe

  At Risk

  N/A

Electrical

• Lockout/Tagout

  Yes

  No

  N/A

• GFCI in Place

  Yes

  No

  N/A

• Extension Cords (Inspected, Serviceable)

  Yes

  No

  N/A

• Other

  Safe

  At Risk

  N/A

HAZCOM

• MSDS (chemicals on site, location, up to date)

  Yes

  No

  N/A

• Training - Right to Know(GHS)

  Yes

  No

  N/A

• Other

  Safe

  At Risk

  N/A

Comments/Recommendations

Sign Off

• Safety Representative

  Sign

• Crew Personnel

  Sign