Merck WP
-
Site conducted
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Document No.
-
Project Name
-
Auditor
-
Location
-
Conducted on
-
Contractors
Administrative Job Site Requirements
-
Active construction area clearly barricaded or identified in field?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Emergency contacts, egress routes and evacuation muster points identified and in project binder?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Project signage posted and easily identified?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Project-specific documentation (SHE, EAP, HASP, SWP, Fall Plan, Etc) available?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Procedure 12 signed off?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
JSA COMPLIANCE
-
JSAs readily accessible and up to date?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Onsite Contractor JSA Audit Review; audit at least one JSA per active contractor.
-
Name of Contractor?
-
Name of JSA?
-
Is the JSA signed by the contractors working on the job?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Onsite Contractor JSA Audit Review; audit at least one JSA per active contractor.
-
Name of Contractor?
-
Name of JSA?
-
Is the JSA signed by the contractors working on the job?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Onsite Contractor JSA Audit Review; audit at least one JSA per active contractor.
-
Name of Contractor?
-
Name of JSA?
-
Is the JSA signed by the contractors working on the job?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Training and Competency
-
Contractor Foreman/ Competent Persons OSHA 30-Hour Construction Trained?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Do all contractors have a minimum of OSHA 10-Hour Construction?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Daily Safe Plan of Action (SPA); audit minimum of one SPA per active contractor.
-
Daily SPA accurately reflects work, means/ methods, and precautions?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Daily SPA reviewed and signed by Superintendent and Safety Professional?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Daily SPA readily accessible in the field?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Daily SPA completed and signed by contractor foreman and contractors performing the work?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Housekeeping
-
Are materials stored properly?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are the walking and working surfaces clear, clean, trip hazards eliminated?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is trash being centered piled and collected routinely throughout work day?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Has construction dumpster been designated and located for the project?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is dumpster door secured open and cover removed if workers must access dumpster?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is the dumpster safely accessible with secure ramps in place?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Dumpsters are covered if needed?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
PPE
-
ANSI Z87 compliant safety glasses, or equivalent, in use by everyone on the project?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
ANSI Z41 compliant safety toe footwear in use by everyone on the project?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Cut resistant gloves meeting ANSI Cut Level 4 or higher in use by everyone on the project?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Hard hats in use by everyone on the project?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
ANSI Class 2 high visibility outerwear in use when required: around mobile equipment, in active lots and roads and in low light situations?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
All PPE is in safe working condition and fit for use?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Additional PPE identified in JSA or SPA in use? i.e. hearing protection
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is respiratory protection in use? (voluntarily or required)
- Yes
- N/A (Not Applicable or Not in Use)
-
Is Medical Clearance and Fit testing verified for tight fitting cartridge respirator users?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Respiratory users have a clean shave?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Voluntary users of respirators provided with 1910.134, Appendix D, Information for Employees using Respirators When Not Required?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Voluntary users of respirators signed voluntary respirator form?
Fall Protection
-
Is elevated work 4' or more above a lower level detailed in a Elevated Work Permit or Fall Protection Plan (NOT including LADDERS/MEWPs)?
- Yes
- N/A (Not Applicable or Not in Use)
-
Are contractors compliant with Elevated Work Permit or Fall Protection Plan?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Post fall-event response identified and documented in Fall Protection Work Plan?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Adequate fall height clearance and swing fall clearance confirmed?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
PFAS components are compatible, inspected and in safe working order?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
PFAS anchorage points are properly rated and are either engineered or evaluated by a Qualified Person?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Suspension trauma straps are in use when PFAS is used?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Leading edges, hole openings, excavation, etc. greater than 4' from a lower level protected by compliant guardrail, warning line system or covered and identified as required?
- Yes
- N/A (Not Applicable or Not in Use)
-
Guardrail meet 1926.502(b) and rails are capable of withstanding 200lbs at the top rail with top rail at 42" (+/-3") and middle railing at 21" or midway between surface and top rail?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Warning Lines meet 1926.502(f)(2) with flags every 6' at a height 34-39" and a breaking strength of 500LBS.
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Warning Lines are erected at 15' (6' for roofing activity) from unprotected edge and access routes within 15' (6' for roofing activity) of unprotected edge are protected by guardrail?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Where applicable, Leading Edge rated PFAS equipment is in use?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Holes or openings in walking and working surfaces are covered with covers secured in place, marked 'HOLE' or 'COVER' and meeting or exceeding CD&A/Merck additional requirements?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Fire Safety and Hot Work
-
10LBS ABC fire extinguishers available with in 50 feet of work with one extinguisher for every 3000 square feet of project area?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are all fire extinguishers current with annual and monthly inspections documented on tag or decal?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are the sprinkler heads and fire protection systems unobstructed ( sprinkler heads clear by 18'' or greater)?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Fire system (fire/ smoke detection, horns/ strobes) impairments are managed with Fire Protection System Impairment Permit?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Egress routes and stairwells clear of combustible or flammable materials?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are flammable and combustible materials stored properly?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is hot work being performed?
- Yes
- N/A (Not Applicable or Not in Use)
-
Is all work involving flame/sparks detailed on the daily Hot Work Permit for each contractor performing hot work activities?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
All precautions detailed on Hot Work Permit are in place, addendum attached and the permit is properly executed?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are fire watches trained on proper extinguisher use and is documentation available in PIMS?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are fire watches trained on their responsibilities and documentation available in PIMS?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Combustibles including paper, plastic, wood, drywall, cardboard, etc. are moved at least 35' from hot work or protected with fire blankets?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Hot work equipment in safe working order with cylinders secured upright, functional gauges, flash back arrestors in place, etc.
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Compressed gas cylinders are secured upright, fuel separated from oxygen by 25' or fire rated divider, regulators removed and valve protector caps installed when in storage?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Welding equipment is in safe working order with intact leads, local disconnect, secure electrical connections, etc.?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
General Safety
-
Is work area properly illuminated?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Temporary lighting properly installed with guards/ cages in place, if applicable?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is equipment guarding in place as per manufacturers instructions?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are tools and equipment inspected and in good condition prior to use?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are powder/fuel actuated tools in use?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are employees properly trained in use?
-
Has the appropriate powder/fuel actuated tool permit been completed?
Ladders/ Stairs/ Scaffolds.
-
Is any scaffolding in use?
- Yes
- N/A (Not Applicable or Not in Use)
-
Is scaffolding built by a qualified competent erector, built correctly, secured, tagged correctly? (check mudsills or locked wheels)
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Does the scaffolding have safe access and egress for workers?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are all scaffold inspected daily by a Competent Person?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are mobile/ rolling scaffold wheels locked?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are Holes/penetrations protected with secured covers labeled "HOLE" or barricaded?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
GES-specific hole and cover guidelines adhered to?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are platforms protected by handrail, midrail and toe board?ZA
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are ladders in use?
- Yes
- N/A (Not Applicable or Not in Use)
-
Are ladders in good condition? Labels, rungs, feet...
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are all A frame ladders podium type?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are all ladder labels and warnings present and legible?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are ladders in use being used safely, as intended and stored correctly?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are ladders setup on solid ground with braces fully engaged and locked with all four feet supported on flat surface?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Ladders are NOT placed in front of doorway, emergency exit route or in the way of any other construction equipment.
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
The waist of the ladder user is NOT above the top step and workers are not twisting body excessively reaching to work while on ladder?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are extension ladders being used safely with proper pitch, ladder secured and a 36 inch overhang?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Crane Lifting / Rigging.
-
Is there a scheduled lift today?
- Yes
- N/A (Not Applicable or Not in Use)
-
Has the lift plan and permit been completed and reviewed with all affected personnel?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is there a trained signal person in "line of sight" of operator or other means of communication with operator?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Has the qualified rigger inspected all lifting equipment prior to use? Is it in safe working order, tagged, compatible and properly rated?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Has the crane set up area been properly barricaded?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Has the crane erection area been surveyed for subsurface utilities or installations?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is crane equipped with Load Management Information System (if applicable)?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is crane equipped with wind speed monitor (anemometer) or is wind speed being monitored in real time?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Anti-two block safety device present and functional?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Have all the areas within the swing radius been evacuated and notified, with proper signage , barricaded with danger tape and evacuated?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are tag lines being used to control the load?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Spill containment kit available, tarp under crane and drains protected (if needed)?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is crane erected level with proper outrigger cribbing?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Outrigger safety pins present?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Has the crane inspection been completed and documented?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Health Exposures
-
Is hearing protection being utilized for noise exposures above 85db?
-
Have silica exposures been assessed and addressed in accordance with the OSHA silica standard?
-
Have potential asbestos exposures been assessed?
-
Have potential lead exposures been assessed?
-
Has the potential for residual materials been assessed in ductwork, pipes, laboratories, etc?
Core Drill and Saw Cutting
-
Has the surface been scanned to identify utilities?
-
Has an applicable core drill permit been initiated and addendum attached?
Excavation and Trenching
-
Is there an active excavation on the project?
- Yes
- N/A (Not Applicable or Not in Use)
-
Has Excavation Competent Person been identified and documented?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Has Competent Person classified the soil as Class C?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Has utility Pa One Call/ Miscellaneous Utility notification been made by excavator? (Verify on permit)
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Utility mark out is clear with field marks being properly maintained?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Has the excavation permit been reviewed and completed?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Has utility location taken place? 25 feet outside the perimeter of the excavation? Verify report
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are the trenches/ excavations sloped properly or shored and barricaded?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is shoring and shielding properly selected, compatible and inspected by a competent person?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Tabulated data onsite?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Structural stability of adjacent structures maintained?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Spoils and heavy materials not stored within 24" of excavation?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is this a PSA area?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are all workers properly trained in Hazwoper ( Hazwoper Sup, etc.)?
-
Is continuous air monitoring being conducted per site requirements?
-
Has a weather event occurred since initial evaluation from a Competent Person?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is trench/ excavation greater than 4ft?
- Yes
- N/A (Not Applicable or Not in Use)
-
Is there proper egress in place, ladders within a 25' lateral travel distance?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Confined Space
-
Are all confined spaces on the project identified and labeled by the site?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is there a confined space entry being performed during this audit?
- Yes
- N/A (Not Applicable or Not in Use)
-
Entrants, Attendants and Entry Supervisors confined space trained?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are permit required confined spaces being reclassified or Alternate Procedure entries made being using CDA documented process?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Confined Space Permit in place and properly executed for permit required entries?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Confined Space Attendant maintaining Entrant log properly?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Confined Space Attendant has radio, cell phone or other means of communicating with site security or emergency services?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Has SSPR been contacted prior to entry?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Has SSPR been contacted after all entrants have exited the confined space?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Confined Space Attendant maintaining atmospheric monitoring log properly?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Non-entry rescue system in place for permit required entries?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Entry rescue team or service confirmed available (SSPR)?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Pre-entry 4 gas atmospheric testing conducted at various levels (top, middle, bottom) / areas in permit required confined space?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
4 gas atmospheric testing conducted (top, middle, bottom) before and continuously during entry?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Atmospheric monitor calibrated and bump tested properly?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Proper forced air ventilation in place before and continuously throughout entry?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Ventilation intake appropriate distance away from space exhaust or other sources of contamination?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Confined spaces are locked and tagged out, drained/ purged, pumped out, cleaned, etc. prior to entry (if applicable)?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Material Handling and Heavy Equipment
-
Is there motorized heavy equipment being used?
- Yes
- N/A (Not Applicable or Not in Use)
-
Has the proper pre-operational inspection been performed and documented?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Spill kit onsite and available in equipment operation area?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Do the operators have the proper training for the equipment being used?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are seat belts used by all operators?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Do the motorized vehicles have proper back up alarm?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are flaggers in place where needed?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are there an adequate number of flaggers per site requirements?
-
Is the rollover protection system (ROPS) in place and maintained?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
No field or owner made modifications made to equipment or attachments?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Forklift/ telehandler attachments are approved in writing by forklift/ telehandler manufacturer?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Equipment capacity is adequate for intended loads or does the contractor have appropriate documentation?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is the equipment operated more than 20' away from power lines?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Equipment turned off and keys removed when unattended?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Fueling of equipment detailed in approved JSA?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Mobile Elevated Work Platforms (MEWPs)
-
Is Mobile Elevated Work Platforms(MEWPs) in use?
- Yes
- N/A (Not Applicable or Not in Use)
-
Has the proper pre-use inspection and functional tests been performed and documented?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Does the operator have the proper training for the equipment being used?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is the operator using the proper harness and tie-off points? (i.e. approved engineered anchor points)
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
MEWPs being used safely? Feet on surface, not using mid rail or toe board to stand on, not leaning outside lift?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Do MEWPs have proper travel alarms or indicators?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
MEWPs path is clear and free of clutter, holes, etc.?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
MEWPs operational area is level?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is the chain or gate closed on MEWPs?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is the equipment operated more than 20' away from power lines?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are the materials being carried or stored on MEWP within the confinement of the platform?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Barricades or spotters in place when needed?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Electrical Safety.
-
Electrical tools and equipment left in a safe state if unattended?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Temporary power provided and inspected by Qualified Person?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Extension/ power cords routed to avoid creating a trip hazard?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are cords in good condition, no cuts or repairs?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is there a 3ft clear distance around electrical panel?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are GFCI's being used and closest to the power source?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
All electrical tools are double Insulated or third-prong grounded?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Extension cords not daisy chained?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Control of Hazardous Energy/ LOTO
-
Are sources of hazardous energy locked and tagged out?
- Yes
- N/A (Not Applicable or Not in Use)
-
All employees involved in LOTO are properly trained in hazardous energy control?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Employees exposed to hazardous energy each have their own tag and lock and with separate key on energy control points?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
LOTO permit or plan implemented to document control of hazardous energy?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
CD&A Superintendent participating in LOTO with locks and tags at energy control points?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are tags legible with name, company and contact information listed?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Has all residual or potential energy been released or secured?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Hazard Communication/ GHS
-
Are SDSs submitted and reviewed in PIMS?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are paper copy of SDSs available for review onsite?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are all chemicals properly labeled and stored?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Chemical quantities onsite acceptable?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Chemicals stored in secondary containment?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are personnel trained in the chemicals they are handling?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Spill kit stocked and present?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Environmental/ Waste Stream
-
Have all proper barricades been put in place to minimize cross contamination?
-
Is the waste handling and disposal of hazardous waste being executed properly?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Is secondary containment in place where needed?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Are storm sewers and drains protected?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Contaminated areas identified and assessed?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
Residual waste properly labeled and stored?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
Corrective actions and supplemental comments.
-
Safety and health observations were reviewed in the field with appropriate contractors when possible?
- Yes
- Yes W/Immediate Fix
- Good Practice to Recognize
- Needs Improvement
- No
- N/A
-
General Comments
Stakeholders
-
Project Superintendent
-
Project Superintendent Optional Comments:
-
Auditor
-
Auditor Optional Comments:
Approval
-
Date and time of approval
-
Approver's signature