CIS K Stone Inspection Checklist V3

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Protective Equipment

• Gas Monitors Being Worn When Required

  Safe

  At Risk

  N/A

• Head protection (brim to front)

  Safe

  At Risk

  N/A

• Eye Protection (proper type)

  Safe

  At Risk

  N/A

• Employees are using Forester Helmet and Chaps When Necessary.

  Safe

  At Risk

  N/A

• Hearing Protection

  Safe

  At Risk

  N/A

• Minimum 6 inch Leather Safety Toed Work Shoes

  Safe

  At Risk

  N/A

• Fall Protection, When Necessary

  Safe

  At Risk

  N/A

• FR Clothing When Required

  Safe

  At Risk

  N/A

• Material Handling Gloves

  Safe

  At Risk

  N/A

• Hi-Viz Clothing/Reflective Vests

  Safe

  At Risk

  N/A

General Workplace

• General Housekeeping

  Safe

  At Risk

  N/A

• Spill Kit / Pads at Site

  Safe

  At Risk

  N/A

• Secondary Containments

  Safe

  At Risk

  N/A

• Bulk Fuel Storage

  Safe

  At Risk

  N/A

• Barricades/Fencing/Bales

  Safe

  At Risk

  N/A

• Sanitation

  Safe

  At Risk

  N/A

Excavations

• Shoring/Sloping

  Safe

  At Risk

  N/A

• All underground/overhead utilities been identified/located and properly marked.

  Yes

  No

  N/A

• Access/Egress Provided

  Safe

  At Risk

  N/A

• Barricades as Required

  Safe

  At Risk

  N/A

• Daily Inspections Foreman

  Safe

  At Risk

  N/A

• Spoils / Rocks Min 2 ft back

  Safe

  At Risk

  N/A

• Encumbrances Supported

  Safe

  At Risk

  N/A

• Equipment maintaining proper distance from trench?

  Safe

  At Risk

  N/A

• Personnel Clear of Equipment

  Yes

  No

  N/A

Electrical Hazards, Power Tools and Hand Tools

• Cords Inspect/Safe Condition

  Safe

  At Risk

  N/A

• GFCI's Inspected and In Use

  Safe

  At Risk

  N/A

• Grinders, Guarding, Covers

  Safe

  At Risk

  N/A

• Hammer Handles and Hand tool Handles

  Safe

  At Risk

  N/A

• Junction boxes are secure and closed off.

  Safe

  At Risk

  N/A

• No exposed wires

  Safe

  At Risk

  N/A

• Stationary Mechanical Units are properly grounded

  Safe

  At Risk

  N/A

Rigging

• Chokers / Slings / Chains

  Safe

  At Risk

  N/A

• Proper Technique Used

  Safe

  At Risk

  N/A

• Chain Falls / Com-a-longs

  Safe

  At Risk

  N/A

• Ratchet Straps/Binders

  Safe

  At Risk

  N/A

• Hooks and Safety Latches

  Safe

  At Risk

  N/A

• Inspections / Proper Lifting

  Yes

  No

  N/A

Ladders / Stairs and Rails

• Properly Used and Secured

  Safe

  At Risk

  N/A

• Handrails are Properly Constructed and Capable of Withstanding 200#'s of Downward/Outward Force?

  Safe

  At Risk

  N/A

• Handrails in place where required

  Safe

  At Risk

  N/A

• General Condition

  Safe

  At Risk

  N/A

• Proper Angle and 3 ft above upper landing

  Safe

  At Risk

  N/A

• Inspections Completed

  Yes

  No

  N/A

Materials

• Stacking / Storage of Materials

  Safe

  At Risk

  N/A

• Proper Signage

  Safe

  At Risk

  N/A

• Lifting / Hauling

  Safe

  At Risk

  N/A

• Equipment / Tool Storage

  Safe

  At Risk

  N/A

• Fuels / Propane / Storage

  Safe

  At Risk

  N/A

• Proper Handling / Carrying

  Safe

  At Risk

  N/A

Equipment / Vehicle

• PreShift Inspections Completed

  Yes

  No

  N/A

• Safe Operation

  Safe

  At Risk

  N/A

• Does the equipment have a safe means of access?

  Yes

  No

  N/A

• Are the door seals in good condition?

  Yes

  No

  N/A

• Is the backup horn functioning properly?

  Yes

  No

  N/A

• Are there any excessive oil or fuel leaks?

  YES

  NO

  N/A

• Is there an excessive buildup of oil/grease?

  YES

  NO

  N/A

• Does the equipment have the operator's manual?

  Yes

  No

  N/A

• Does the cab have an excessive amount of dust and trash?

  YES

  NO

  N/A

• Seat Belts in use

  Yes

  No

  N/A

• Fire Extinguishers

  Safe

  At Risk

  N/A

• Load Secured

  Safe

  At Risk

  N/A

• Spotters When Required

  Yes

  No

  N/A

Miscellaneous / Training

• Employees have customer required training

  Safe

  At Risk

  N/A

• JSA being completed before each shift

  Safe

  At Risk

  N/A

• Orientations

  Yes

  No

  N/A

• Confined Space Training

  Yes

  No

  N/A

• Excavations Competent Person Training

  Yes

  No

  N/A

• Weekly Safety Meetings Conducted

  Yes

  No

  N/A

• Rock Truck Qualified

  Yes

  No

  N/A

• Employees Controlling Traffic Have Flagger Training

  Yes

  No

  N/A

• MSHA / Respirators

  Yes

  No

  N/A

• Employees Have Received Silica Exposure Control Program Training.

  Yes

  No

  N/A

• Are employees aware of the location of the muster point

  Yes

  No

  N/A

Hazard Controls

• Welding / Cutting / Guages

  Safe

  At Risk

  N/A

• Compressed Gases Are Stored Properly

  Safe

  At Risk

  N/A

• Flashback Arrestors Are Present and Installed Properly

  Yes

  No

  N/A

• SDS Books / Labels

  Safe

  At Risk

  N/A

• Traffic Signs Barricades

  Safe

  At Risk

  N/A

• Chemical Exposure Control

  Safe

  At Risk

  N/A

• Environmental Issues

  Safe

  At Risk

  N/A

• Fire Extinguisher Available

  Safe

  At Risk

  N/A

First Aid

• Are first aid boxes properly supplied

  Yes

  No

  N/A

• Eyewash Supplies Are Available

  Yes

  No

  N/A

• Are First Aid Supplies Expired

  YES

  NO

  N/A

• Are employees aware of the First Aid Kit location

  Yes

  No

  N/A

• Is the box easily accessible

  Yes

  No

  N/A

• Is the first aid kit location properly marked/identified?

  Yes

  No

  N/A

Corrections

Corrections

• Item Description

• Person Responsible

• Time And Date

  Date

Comments

• Comments

Signatures

• Person Performing Inspection

• Signature

  Sign

• Date and Time

  Date