Audit

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Type of work to be completed // Scope

Job Number ( If available / created yet)

A.. SAFETY : please describe control measures for any item checked yes or at risk.

1. Is barricading and or signage required protecting facilities, personnel or equipment ?
- electrical dangers posted - eye protection
- hard hat area - no smoking
- authorized personnel - other

2. Will work involve live systems or energized equipment?

3. Is lockout / tag-out of energized equipment required?

4. Will work involve falls greater than 6 feet or greater?

5. Are ladders, mechanical / electrical work platforms (MEWP) , scaffolds or work platforms needed to perform task?

6. Will the task involve the use of chemicals or be adjacent to process piping / equipment containing chemicals?

6a. Have material data safety sheets been provided to crew?
- hazcom
- container labeling
- proper chemical use
-

6b. Has a chemical approval request been completed for the use of the chemicals ?

6c. Does the work require disposal of chemicals?

6d. Will the work generate odors?

6e. Are chemicals stored properly ( double containment) ?

6f. Have personnel been trained in use and proper disposal of ppe?

7. Does this require the demolition of electrical / mechanical or chemical systems or equipment?

8. Does this work involve removing floor tile and or ceiling tiles?

9. Will weather conditions affect the completion of this task?

10. Does this work require awkward positions or static postures?

11. Can this work be assembled at waist height as opposed to overhead or below grade?

12. Is adequate material handling equipment available to move/ lift materials? (( forklift, pallet jack, chain fall, cable hoist)) ?

13. Will work involve employee exposure to hazardous noise levels ( exceeding 85 DBA)?

14. Housekeeping
- aisle ways, walkways - removal procedures
- nails - debris containers
- removal procedures - overall neat appearance
- materials tools, equipment

15. Fire Prevention
A. Extinguishers on site
B. storage of containers/ labeling
C. Compressed gas cylinders
D. Contaminated rag storage
E. welding/ cutting
F. Ventilation

16. Site Security
- fencing / lockable gates , doors
- locks/ lock box
- lighting

B. Potential Impacts
1. Will the work involve or have the potential to impact ::

A. Fire detection and or smoke detectors?

B. electrical systems ?

C. Plumbing systems ?

D. Roofing systems ?

E. Flooring systems?

G. Ceiling systems?

H. Doors and door frames?

I. Production tools?

J. Other security / Life safety systems ?

C. Permits required?

Hot work permit

At height work permit

Confined space permit

Critical lift plan

Mechanical Electrical Work Platforms ( MEWP) permits

Other

D. Personal Protective Equipment Requirements. PPE

Fall Protection

Eye

Respirators

Head

Foot / Toe

Face Shield

Hearing Protection

Others / Misc.

Type of Gloves required

Kevlar

Rubber

Leather

Cotton

Nitrile

Butyl / Chemical gloves

Mechanics / General purpose

Others

E. General

1. Has work area been walked by crew to identify safety and or impact concerns ?

2. Is the area safe to work in?

3. Has the work been coordinated with other trades in the area?

4. All tools and equipment in safe / good condition
* including extension cords, slings , hand tools etc...

5. All necessary training for this task has been completed?

6. All new employees familiarized with work area?

7. Sufficient personnel have been assigned to the task / tasks safely?

8. Emergency exits and equipment have been identified?
( phones, fire extinguishers, eyewash, etc..)

9. Contingency plans have been developed for unexpected events ?
( medical emergencies, and or equipment failure)

10. Certified first aid / CPR personnel on site along with First Aid Kits ?
- contents of kit
- kit available?
- trained employees

IF WORK CONDITIONS OR ACTIVITIES CHANGE , WORK MUST STOP!

UNTIL TASK PLAN IS REVISED AND REVIEWED BY CREW

PLEASE POST A COPY IN WORK AREA

Foreman

Project manager

Safety Officer

Estimator

BELFOR office assignment ( location)

System Owner (( If Required)) ( loss contact representative)

Created by: David Weaver
BELFOR USA
Regional Safety Manager
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Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.