Information

  • Carmel- Belmont

  • Project/Job

  • Conducted on

  • Prepared by

  • Location
  • Personnel

BEHAVIOR

  • A. JHA reviewed and signed?

  • B. JHA for each task?

  • C. Hard hat stickers visible?

  • D.

  • F. Other

WORK AREAS

  • A. General Housekeeping

  • B. Walking - Working Surfaces

  • C. Unprotected Sides or Holes

  • D. Impalement Hazards

  • E.. Sanitary Facilities

  • F.. Water -- Trash Receptacles

  • G. Material Storage/Lay Down

  • H. Convex, Box 4 U, Gang Box

JOB SITE POSTERS

  • A. All OSHA Required Posters

  • B. Emergency Evacuations

  • C. Emergency Contacts List

HEALTH/FIRST AID

  • A. CPR/First AidTraining

  • B. First Aid Kit (No Expired Items)

  • C. Eye Wash Facilities in Field

  • D. Access to Eye Wash

  • E. Other

PERSONAL PROTECTIVE EQUIPMENT

  • A. Hard Hats

  • B. Safety Glasses with Side Shields

  • C. Face Shield / Goggles (If Required)

  • D. Respiratory Protection (If Required)

  • E. Hearing Protection (If required)

  • F. Clothing (FRC etc. if required)

  • G. Gloves

  • H. Foot Protection

FALL PROTECTION

  • A. Trained Personnel (Competent Person)

  • B. Worn Properly

  • C. Suitable Anchorage Points

  • D. Inspected/Color Coded

  • E. Stored Properly

  • F. Emergency Rescue Plan

LADDERS

  • A. Base/Footing/Set Up

  • B. Inspections/Color Coded

  • C. Proper Type for Task

TOOLS AND EQUIPMENT

  • A. In Good Condition

  • B. Inspected/Color Coded

  • D. Other:

EXCAVATIONS

  • B. Access/Egress

  • C. Soil Condition

  • D. Water Accumulating

  • E. Shoring/Shielding/Sloping

  • F. Barricades

  • G. Spoil Pile

  • H. Air Monitoriing

ELECTRICAL

  • A. G.F.C.I.'s

  • B. Extension Cords

  • C. Power Tools

  • D. Lock Out/Tag Out

FIRE SAFETY

  • A. Hot Work Permit (if required)

  • B. Fire Watch Assigned (Competent Person)

  • C. Fire Extinguisher/Inspected

  • D. Combustibles removed/isolated

  • E. Hot Work Barricade (if required)

  • F. Gas Can(s)

RIGGING AND HOISTING

  • A. Capacity Tags

  • B. Hooks and Latches

  • D. Tag Lines

  • E. Inspected/Color Coded

  • F. Designated Qualified Rigger

  • G. Damage

SCAFFOLD

  • A. Trained Personnel (Competent Person)

  • B. Hand and Mid-rails, Toeboards

  • C. Platform Decked/Secured

  • D. Level Footing/Set up

  • E. Access/Egress

  • F. Away from Powerlines

  • G. Barricades

  • H. Inspection/Tagged Correctly

CRANE EQUIPMENT

  • A. Crane Inspection

  • B. Operator Manual

  • C. Crane Setup

  • D. Crane Swing Radius

  • E. Flagman with Vest

  • F. Operator Qualified and Certified

  • G. Designated Qualified Signaller

  • H. Fall Zone Procedures

  • I. Lift Plan (if required)

EQUIPMENT

  • A. Equipment Inspections

  • D. Flagman with Vest

  • E. Proper setup and use

HAZCOM

  • A. Training - Right to Know

  • B. MSDS on Site

  • C. MSDS for all Chemicals on Site

  • D. Proper Storage of Chemicals

  • E. Proper PPE for Handling Chemicals

OTHER

  • A.

  • B.

  • C.

  • D.

Comments/Recommendations

  • Enter any corrective actions that will be undertaken

Sign Off

  • Safety Representative

  • Construction Supervisor

  • Project Rep

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