Balcony Liquid Membrane

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Work areas coordinated with site and PWL Superintendents?

  Yes

  No

  N/A

• Work area cleaned and prepared by site for liquid membrane application?

  Yes

  No

  N/A

• Is Personal Fall protection required to complete task?

  Yes

  No

  N/A

• Are Guardrails installed at the work area?

  Yes

  No

  N/A

• Have all workers reviewed and signed the Site Specific Fall Protection Plan?

  Yes

  No

  N/A

• Is there enough anchors to eliminate swing fall hazard?

  Yes

  No

  N/A

• Have workers inspected their Personal Fall Protection gear?

  Yes

  No

  N/A

• Are workers following the dropped object prevention plan?

  Yes

  No

  N/A

• Do all workers have a hard hat lanyard installed?

  Yes

  No

  N/A

Exposure Control

• Was mixing of materials done in an area with open air and away from other workers on site?

  Yes

  No

  N/A

• Are workers replacing lids on buckets prior to moving to new work area?

  Yes

  No

  N/A

• Is a control zone and signage required to prevent unauthorized workers from entering work area?

  Yes

  No

  N/A

• Are all workers using specialized PPE? Safety glasses, Nitril gloves, Half mask with OV filters

  Yes

  No

  N/A

• Is there replacement respirator filters and gloves?

  Yes

  No

  N/A

• Is mechanical ventilation required to prevent exposure to other workers on site?

  Yes

  No

  N/A

• Yes

  No

  N/A