Site Specific Safety Plan Form

BASIC SAFETY RULES

Are employees trained on the use of the STAC form?

are daily safety meetings being conducted?

Are employees trained on accident / incident reporting?

Are employees trained on how to fill out the accident / incident form?

Are employees trained on Corning Canton safety rules?

Drug & SUBSTANCE ABUSE PROGRAM

Are employees entered in the substance abuse program (tested) before starting work?

Is a facility selected to provided testing as required for the duration of the project?

Has a drug and substance abuse policy been created

LIFE SAFETY PROCEDURES

Who will author the Life Safety Plan for the job location?

Has a plan been created?

Does the plan address evacuation routs and gathering locations?

Does the plan address shelter in place

Does the plan assign responsibilities to individuals (management, supervision, employees)

HAZCOM

Are employees trained in hazard communication/GHS?

Did employees receive site specific HAZCOM training?

SDS provided to Contractor, and a copy easy to obtain at job site?

Storage and use meets all Contractor, NFPA, Fed and State Regulations?

FALL PROTECTION

Will fall protection be required?

Are employees trained on the Corning requirement to use fall protection at four (4) feet?

Competent/qualified person to perform system and equipment inspections, identify hazards, and anchor points as needed?

Are employees trained on how to recognize fall hazards?

Has a fall protection rescue plan been accomplished?

BARRICADES

Will barricades be used to protect employees from fall hazards?

Who will be responsible for ensuring barricades are properly installed and remain effective

Are employees trained in the use of Yellow Caution tape and Red Danger tape?

Are employees trained on the use and hazards associated with the placement of Radiation Danger tape?

ELEVATED WORKING PLATFORMS

Are employees trained in the use of elevated working platforms?

Do employees know the 4 foot or shorter length requirement for lanyards?

Are employees trained on fall protection use?

Do employees know the requirement to use PFAS when working from a scissor lift?

LADDERS

Will ladders be required?

Are employees trend on the proper use of ladders?

Are employees trained on the Corning 10foot max working height for steep ladders?

Will scaffolding be required?

Who will perfume the daily inspection of scaffolding?

Vehicles

Are employees trained on the proper use of vehicles and mobile equipment?

Do employees know how to complete the daily inspection sheet

OVERHEAD LIFTING, RIGGING, & MOBILE CRANES

Do employees have Signal Person training?

Do employees have the required rigging training from a third party certifier?

Are crane inspections current and a copy filed with the PM?

Are operators trained and licensed?

will rigging plans be accomplished before the lift?

Are rigging plans submitted to Corning at least five (5) days before the lift

PERSONAL PROTECTIVE EQUIPMENT

PPE to be utilized on this project? What type?

Will any special PPE be required?

Have employees received training for special PPE requirements? (high visibility clothing, safety glasses, hard hat, safety toe boots)

Will respirators be worn on a voluntary use? (Half mask, paper, etc.)

WORK PERMITS:

Will Hot Work permits be required?

Will any excavation permits be required?

Will any Confined Space Entry permits be required?

Will any Fire System Sprinkler/Alarm Out-of-Service Permits be required?

LOCKOUT/TAG OUT (LOTO)

Will LOTO be conducted?

Are LOTO procedures available?

Has a responsible person been assigned for overseeing LOTO requirements?

EXCAVATIONS

Will any work activities involve excavations greater than four feet?

Will a trench box/shoring be needed?

Does fencing/barricade need to be installed?

Type of equipment to be brought onsite? (Gas, diesel, etc.)

CONFINED SPACES

Will any confined space work be performed

Have affected personnel been trained

how will confined space recuse be conducted

If the space is identified as permit required, will a permit be issued?

Are employees trained on permit required confined space?

LADDERS/SCAFFOLDING
HOT WORK

Are hot work activities to be performed? (Any flame or spark producing task.)

Will any special PPE be required?

Will fire blankets/protective shields/screens be required?

Fire watch personnel have received the required training?

POWDER ACTUATED TOOLS

Operators trained in operations?

PAINTING, ADHESIVES, EPOXIES

Quantity and job type of sealant to be applied on this job?

Will this require off-hours application?

Additional exhaust or fans needed during application/curing time?

Special PPE/precautions for this job?

COMPRESSED GAS:

Will cylinders be brought on site?

Plan for safe use and storage on site?

FLAMMABLE GASES/LIQUID

Will any flammable gases and/or liquids be used?

Provisions for their storage have been made?

Appropriate containers utilized? (Safety can, original container)

Secondary containment and spill kits required?

SIGNS, SIGNALS, AND BARRICADES

Will yellow or red barricade tape be used? (Barricades will be built in accordance with Contractor policy)

Will perimeter barricades be used?

Will any caution/danger signs be needed?

Will flammable gas/liquid labels be needed?

Will material labels be needed? HMIS or NFPA

FALL PROTECTION, LEADING EDGE
POWERED INDUSTRIAL FORK TRUCKS/MAN LIFTS/BOOMS:

Will any mobile powered equipment be required? Type to be brought on site?

Operators trained/certified for operations of equipment?

Plan for fuel transfer/storage or battery changes?

ROOF WORK

Will roof access be required?

Materials on roof will be secured to prevent "blow offs"?

Chemicals or flammable/combustible materials going on roof?

CRANES & RIGGING

Will crane operations be required?

Will any special lifting devices be needed?

Will any special lifting devices be needed?

Will any Critical Lifts take place?

Has all rigging equipment been inspected?

Equipment is appropriate for the task(s)?

Have all required safety inspections been completed?

Will traffic control be provided (pedestrian & vehicular)?

WASTE MANAGEMENT

Plan for waste disposal in place?

Characterization, containerization, segregation, storage and disposal requirements understood?

Plan for water/wastewater discharges in place? (Describe or attach plan)

Spill plan in place?

Special permit(s) needed? Type?

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.