Information
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Conducted on
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Project Name
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Project Number
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Prepared by
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Location
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Comments
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FOR INTERNAL USE ONLY
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FOR INTERNAL USE ONLY.
ALL ITEMS PERTAIN TO STELLAR J AND ALL SUBCONTRACTORS.
1. Work at Heights and Fall Protection
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1.1. Critical - Improper, or failure to use of fall protection equipment?
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1.2. Critical - Lack of edge protection (guard rails and barricades)?
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1.3. Unsafe or incomplete edge protection (guard rails and barricades)?
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1.4. Lack of, or inadequate, formal training for affected employees?
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1.5. Unsafe or damaged harness or equipment?
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1.6. Incompatible hooks/equipment?
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1.7. Unlabelled or does not meet regulations?
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1.8. Unsafe or uncertified anchor points?
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1.9. Lack of inspection protocol for equipment?
2. Tools and Heavy Equipment
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2.1. Unsafe or damaged tools? (including missing or damaged guards)
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2.2. Incorrect tool/equipment for job? (e.g. grinding discs for cutting, including incompatible attachments used with tool/equipment?
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2.3. Unauthorized operator of powder actuated tools?
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2.4. Unsafe or damaged heavy equipment? (including missing or damaged glass, etc)
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2.5. High Risk - Unqualified operators or unsafe operation (including use of cell phone or failure to use seatbelt)?
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2.6. Lack of operators manual?
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2.7. Lack of training in safe operation, clean-up and maintenance?
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2.8. Lack of LOTO procedures for cleaning, servicing and maintenance?
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2.9. Lack of inspection regime?
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2.10. Lack of, or inadequate backup alarm?
3. Scaffolds
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Does this project have any scaffolding?
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3.1. Critical - Unsafe or incomplete scaffold?
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3.2. High Risk - Lack of competent persons supervision for erection of scaffold?
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3.3. Lack of inspection protocol for scaffold?
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3.4. Incompatible scaffold components? Unlabelled or do not meet code?
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3.5. Safe Work Load (SWL) exceeded? (tools, stored materials, number of persons)
4. Lifting Equipment - Rigging and Cranes
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4.1. High Risk - Unsafe or damaged lifting equipment, including ropes, slings, chains, hooks?
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4.2. Lack of daily inspection protocol for rigging?
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4.3. Lifting equipment unlabelled, no Safe Working Load (SWL) information displayed?
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4.4. Unsafe or improper storage of lifting equipment?
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4.5. SWL of any lifting equipment exceeded?
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4.6. Does this project have a crane on site?
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Critical - Improper operation of crane?
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Lack of daily inspection protocol for cranes?
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Lack of monthly inspection protocol for cranes (documentation)?
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Lack of current Annual Inspection Documentation?
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Lack of certified crane operators, qualified riggers, or qualified signal person?
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Loads lifted over persons, close proximity to obstacles incl. overhead power lines?
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Are any pinch/crush hazards created by swing radius barricaded properly?
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Lack of LOTO procedures for cleaning, servicing and maintenance?
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SWL of crane exceeded (does the operator know the weight of the load)?
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If crane is in use, are ground conditions adequate for support of crane, outriggers and load?
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Lack of, or inadequate, appropriate equipment used to hoist personnel?
5. Excavation and Trenching
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5.1. Does this project have any trenching 4' or greater?
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Critical - Lack of, or inadequate, trench shoring/benching?
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Lack of competent person (in writing in job file)?
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Failure to properly assess soil condition and type?
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Lack of, or inadequate, appropriate access to trench?
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Lack of daily inspection protocol for safety equipment, soil conditions and atmosphere monitoring?
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Lack of, or inadequate trench edge protection?
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Spoils or equipment located too close to trench?
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Lack of engineering design for trenches 20' or deeper?
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Lack of, or inadequate, appropriate rescue plan?
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5.2. Does this project have any excavation 4' or greater?
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Critical - Lack of, or inadequate, excavation shoring/benching?
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Lack of competent person (in writing in job file)?
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Failure to properly assess soil condition and type?
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Lack of, or inadequate, appropriate access to excavation??
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Lack of daily inspection protocol for safety equipment, soil conditions and atmosphere?
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Lack of, or inadequate excavation edge protection?
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Spoils or equipment located too close to excavation?
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Lack of engineering design for excavations 20' or deeper?
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Lack of, or inadequate, appropriate rescue plan?
6. Ladders
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6.1. Critical - Improper use of ladder?
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6.2. Unsafe positioning of ladders?
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6.3. Ladder not properly secured?
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6.4. Ladder unsuitable for job? (e.g. metal ladder used for electrical work)
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6.5. Unsafe or damaged ladders?
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6.6. Improper storage of ladder?
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6.7. Lack of ladder load rating information?
7. Hazardous Manual Tasks
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7.1. Lack of identification hazardous manual tasks (Site Specific JSA)?
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7.2. Lack of assessment of hazardous manual tasks?
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7.3. Inadequate risk controls? (examples: no job rotation, lighter loads, trolleys, lifting equipment, etc)
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7.4. Lack of training in risk controls and safe lifting/ team lifting techniques?
8. Hazardous Chemical (including fuel and oil)
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8.1. Unsafe storage location? (e.g. flammables near ignition sources, spills could enter stormwater drains, etc)
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8.2. Incompatible chemicals stored near each other?
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8.3. Incomplete, or not posted, Hazard Communication List and training?
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8.4. Material Safety Data Sheets not accessible on site?
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8.5. Lack of emergency procedures for injury/spills/fire etc?
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8.6. Excessive quantities stored on site or in vehicles?
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8.7. Insufficient ventilation?
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8.8. Insufficient, or incorrect, PPE?
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8.9. Unsuitable storage containers? (unlabeled or stored in improper containers)
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8.10. Are fire extinguishers available, properly mounted, fully charged and inspected routinely?
9. Emergency Response
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9.1. Lack of, or inadequate, Emergency Plan posted (including directions to nearest emergency room and occupational health clinic and Superintendent's Injury Checklist)?
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9.2 Lack of, or inadequate, Evacuation Plan (posted, including designated safety zones)?
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9.3. Lack of training/rehearsal of emergency plans?
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9.5. Insufficient access to formally trained First Aid Responders for all shifts?
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9.6. Unsuitable or inadequate communication equipment?
10. Traffic Management
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10.1. Lack of, or inadequate, Traffic Control Plan in place?
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10.2. Lack of training in TCP for all persons on site? <br>(contractors and visitors)
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10.3. Inadequate controls for TCP? (physical barriers, bollards, speed limits, flashing lights, spotters, etc)
11. Personal Protective Equipment (PPE) and Engineering Controls
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11.1. Critical - Failure to properly use minimum PPE (100% utilization: hard hat, safety glasses, work shoes)?
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11.2. Lack of system to issue, inspect, replace and monitor PPE?
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11.3. Lack of training in safe use, clean-up and inspection of PPE?
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11.4. Lack of, or inadequate PPE available on site (including sun and heat stress protection)?
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11.5. Failure to properly use situational PPE (as needed utilization: hearing protection, face shield, coveralls)?
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11.6. Failure to use wet grinding on concrete?
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11.7. Respiratory Protection in compliance with program?
12. Work Environment
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12.1. Lack of, or inadequate, amenities? (toilets, wash areas, lunch rooms, etc)
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12.2. Insufficient lighting?
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12.3. Inadequate housekeeping?
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12.4. Lack of, or inadequate noise/ vibration control?
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12.5. Unmarked confined space?
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12.6. Lack of, or inadequate, site safety signage and postings?
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12.7. Lack of, or inadequate materials handling?
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12.8. Uncovered or unmarked holes?
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12.9. Unprotected implement hazards (rebar, etc)?
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12.10. Lack of, or inadequate masonry or concrete wall bracing?
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12.11. Lack of, or inadequate Limited Access Zone during masonry wall construction?
13. Electrical Hazards
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13.1. Unsafe electrical cords or spider boxes? (damaged, out of date tape or untested)
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13.2. Lack of GFC protection?
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13.3. Potential contact with underground assets?
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13.4. Potential contact with overhead electrical lines?
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13.5. Overloading outlets?
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13.6. Cords placed on over sharp edges, in area with high probability of damage or on metal structures?
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13.7. Electrical equipment near water?
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13.8. Electrical equipment near flammables?
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13.9. Electrical equipment near chemicals that could cause damage?
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13.10. Electrical cords that may be damaged from contact with moving machinery parts?
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13.11. Electrical cords on work surfaces?
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13.12. Lack of Lock-out/tag-out (LOTO) procedures for electrical equipment?
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13.13. Lack of, or inadequate, labeling of electrical breaker panel?
14. Environmental Hazards
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14.1. Lack of, or inadequate, dust suppression system?
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14.3. Lack of, or inadequate, systems to prevent contaminants entering stormwater drains?
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14.4. Lack of, or inadequate erosion control measures (silt fence, rock access areas etc)?
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14.5. Lack of, or inadequate, protection of access/egress due to weather (snow, ice, etc)?
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14.6. Lack of, or inadequate, protection of Outsiders (public, owners, etc)?
15. Administrative Procedures
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15.1. Lack of/or inadequate Site Specific Safety Plan?
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15.2. Failure to obtain permits (Hot Works, Confined Space, etc.)
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15.3. High Risk - Not all employees and subcontractors received a Site Specific Orientation (completed form in file and stickers on hard hat)?
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15.4. Lack of, or inadequate, current weekly toolbox meeting minutes?
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15.5. Lack of, or inadequate, training, licenses, skills, experience?
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15.6. Lack of, or inadequate, Fall Protection Work Plan with rescue plan (up to date for current work and posted where employees can review it)?
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15.7. Critical - Failure to follow Lock Out/Tag Out program (overall)?
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15.8. Critical - Failure to comply with Confined Space Program?
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15.9. Lack of, or inadequate, routine inspections, monitoring, audits?
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15.10. Lack of, or inadequate two week schedule?
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15.11. Failure to post OSHA 300 log?
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15.12. Failure to post Fire Prevention Plan?
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15.13. Failure to post most recent safety committee meeting minutes?
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15.14. Failure to post superintendent's Injury Instructions?
Corrective Actions
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Critical - Were any of the current deficiencies a repeat violation from previous inspections?
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Have all corrections been completed from most recent inspection?
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Have all deficiencies found during this inspection been corrected immediately?
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Enter corrective actions that remain to be completed.
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Enter date by which all corrections must be completed.
Sign Off
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On site representative
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Auditor's signature
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For final copy, attach additional photos and distribute.
Distribution List: President, Vice President, Project Manager, Superintendent, General Superintendent, a safety Officer, Project Engineer, Shop Superintendent.