CAH 1023 SWA

• Client / Site

• Conducted on

  Date

• Prepared by

• M-231 @ Grand River; Ottowa Co.
  Address

• Personnel

Fall Prevention and Protection

• Is there a plan/method? (Controlled access zone)

  Yes

  No

  N/A

• Is there an equipment inspection?

  Yes

  No

  N/A

• Is there an anchor point?

  Yes

  No

  N/A

• Is there a fall clearance?

  Yes

  No

  N/A

• Are there connectors?

  Yes

  No

  N/A

• Is there 100% Tie-Off > 6' ?

  Yes

  No

  N/A

• Is there training?

  Yes

  No

  N/A

• Are there vertical lifelines?

  Yes

  No

  N/A

• Are there horizontal lifelines?

  Yes

  No

  N/A

• Are holes covered?

  Yes

  No

  N/A

• Are there guardrails?

  Yes

  No

  N/A

• Are there site specific items?

  Yes

  No

  N/A

Rigging and Crane Signals

• Has the weight/center of gravity been determined?

  Yes

  No

  N/A

• Is there a crane inspection?

  Yes

  No

  N/A

• Is there load control? Anti 2 block?

  Yes

  No

  N/A

• Has a critical lift plan been performed?

  Yes

  No

  N/A

• Is there a qualified rigger/signal person?

  Yes

  No

  N/A

• Are there safety laches on hooks?

  Yes

  No

  N/A

• Are there site specific items?

  Yes

  No

  N/A

Personal Protective Equipment

• Are here hard hats?

  Yes

  No

  N/A

• Are there glasses/face shields?

  Yes

  No

  N/A

• Is there Hi-Vis clothing?

  Yes

  No

  N/A

• Are there ear plugs/ear muffs?

  Yes

  No

  N/A

• Are there gloves/hand protection?

  Yes

  No

  N/A

• Is there hearing protection?

  Yes

  No

  N/A

• Are there protective work clothes?

  Yes

  No

  N/A

• Is there protective footwear?

  Yes

  No

  N/A

• Are there PFDs (life jackets) or life rings and rescue boat? (If requested)

  Yes

  No

  N/A

• Is there personal fall arrest system?

  Yes

  No

  N/A

• Do they have a respiratory/fit test? (If applicable)

  Yes

  No

  N/A

Access and Walkways

• Are there Ramos with guardrails?

  Yes

  No

  N/A

• Are they at least 18" wide?

  Yes

  No

  N/A

• Are there slippery surfaces?

  Yes

  No

  N/A

• Are steps > 19" ?

  Yes

  No

  N/A

• Are ladders secured 36" above?

  Yes

  No

  N/A

• Are there site specific items?

  Yes

  No

  N/A

Emergency Preparedness, Rescue and First Aid

• Is the site specific safety plan onsite?

  Yes

  No

  N/A

• Is there first aid/eye wash kit?

  Yes

  No

  N/A

• Are local EMS notified?

  Yes

  No

  N/A

• Is there stokes basket? (If requested)

  Yes

  No

  N/A

• Is there communication equipment?

  Yes

  No

  N/A

• Is there a rescue plan in place/discussed?

  Yes

  No

  N/A

• Is there fall arrest rescue?

  Yes

  No

  N/A

• Is there CPR/first aid training?

  Yes

  No

  N/A

• Are there site specific items?

  Yes

  No

  N/A

• Yes

  No

  N/A

Hazard Communication

• Are there training/written programs?

  Yes

  No

  N/A

• Are there material safety data sheets?

  Yes

  No

  N/A

• Are containers labeled?

  Yes

  No

  N/A

• Are there site specific items?

  Yes

  No

  N/A

Fire Protection

• Are there fire extinguishers?

  Yes

  No

  N/A

• Are there no smoking signs posted?

  Yes

  No

  N/A

• Is there binding and grounding?

  Yes

  No

  N/A

• Are flammable/combustible storage areas defined?

  Yes

  No

  N/A

• Are there site specific items?

  Yes

  No

  N/A

Hand and Power Tools, Welding and Cutting

• Is there a Pre-Op inspection?

  Yes

  No

  N/A

• Are there guards/handles in place?

  Yes

  No

  N/A

• Are there air hose connectors?

  Yes

  No

  N/A

• Are cylinders secured?

  Yes

  No

  N/A

• Are they grounded?

  Yes

  No

  N/A

• Are cords/leads inspected?

  Yes

  No

  N/A

• Is the circuit not overloaded?

  Yes

  No

  N/A

• Are there site specific items?

  Yes

  No

  N/A

House Keeping

• Are there waste containers?

  Yes

  No

  N/A

• Are there cords/cables/hoses?

  Yes

  No

  N/A

• Are there organization of work area(s)?

  Yes

  No

  N/A

• Are walkways clear?

  Yes

  No

  N/A

• Are there site specific items?

  Yes

  No

  N/A

Traffic Control and Protection

• Is there a step up per plan and/or MUTCD?

  Yes

  No

  N/A

• Is there a flagged needed/trained?

  Yes

  No

  N/A

• Are there sign/devices satisfactory?

  Yes

  No

  N/A

• Are there site specific items?

  Yes

  No

  N/A

Miscellaneous

• Is there drinking water?

  Yes

  No

  N/A

• Is there toilet/hand washing facilities?

  Yes

  No

  N/A

• Is there traffic control/flagger?

  Yes

  No

  N/A

• Are there any site specific items?

  Yes

  No

  N/A

Aerial Boom and Scissor Lifts

• Is there training?

  Yes

  No

  N/A

• Is there a Pre-Op inspection?

  Yes

  No

  N/A

• Are there personal fall arrest systems?

  Yes

  No

  N/A

• Is there 100% tie-off?

  Yes

  No

  N/A

• Are the ground conditions suitable?

  Yes

  No

  N/A

• Is there a power line clearance?

  Yes

  No

  N/A

• Is the capacity not exceeded?

  Yes

  No

  N/A

• Are feet on platform out rigger?

  Yes

  No

  N/A

• Are controls tested prior to each use?

  Yes

  No

  N/A

• Are there site specific items?

  Yes

  No

  N/A