Blaine Field Safety Survey

• Conducted on

  Date

• Prepared by

• Add location
  Address

Personal Protective Equipment (PPE)

• Safe

  At Risk

  N/A

Housekeeping / Slip / Trip / Impalement / Safe Access & Egress

• Safe

  At Risk

  N/A

Fall Protection / Fall Prevention / Guard Railings / Warning Lines

• Safe

  At Risk

  N/A

Excavation / Trenching

• Safe

  At Risk

  N/A

Scaffolding

• Safe

  At Risk

  N/A

Stairways / Ladders / Hand Railings

• Safe

  At Risk

  N/A

Hoisting / Lifting / Rigging / Qualifications & Certifications

• Safe

  At Risk

  N/A

Mobile Equipment / Vehicles / Pre-Shift Inspection

• Safe

  At Risk

  N/A

Tools - Hand / Power / Pneumatic

• Safe

  At Risk

  N/A

Electrical - LOTO / Cords / Inspection / Color Coding / GFCI / Adequate Lighting

• Safe

  At Risk

  N/A

Fire Protection / Fire Prevention / Flammable Storage / Compressed Cylinders

• Safe

  At Risk

  N/A

Confined Space Entry

• Safe

  At Risk

  N/A

Health - Industrial Hygiene / Labeling / Respiratory Protection / Hygiene Facilities / Dust Control

• Safe

  At Risk

  N/A

Falling Object Protection / Floor Hole Covers / Edge Protection / Toe boards / Tethering

• Safe

  At Risk

  N/A

Environmental - SWPP / Heat Illness / Cold / Shade / Water

• Safe

  At Risk

  N/A

Management Systems - Safety Inspections / Safety Meetings / Regulatory

• Yes

  No

  N/A

Praise & Accolades

• Yes

  No

  N/A