Comprehensive Site Safety Observation Form

• Conducted on

  Date

• Project Name

• Project Number

• Prepared by

• Location
  Address

• Comments

• FOR INTERNAL USE ONLY

• FOR INTERNAL USE ONLY.
  ALL ITEMS PERTAIN TO STELLAR J AND ALL SUBCONTRACTORS.

1. Work at Heights and Fall Protection

• 1.1. Critical - Improper, or failure to use of fall protection equipment?

  Safe

  At Risk

  N/A

• 1.2. Critical - Lack of edge protection (guard rails and barricades)?

  Safe

  At Risk

  N/A

• 1.3. Unsafe or incomplete edge protection (guard rails and barricades)?

  Safe

  At Risk

  N/A

• 1.4. Lack of, or inadequate, formal training for affected employees?

  Safe

  At Risk

  N/A

• 1.5. Unsafe or damaged harness or equipment?

  Safe

  At Risk

  N/A

• 1.6. Incompatible hooks/equipment?

  Safe

  At Risk

  N/A

• 1.7. Unlabelled or does not meet regulations?

  Safe

  At Risk

  N/A

• 1.8. Unsafe or uncertified anchor points?

  Safe

  At Risk

  N/A

• 1.9. Lack of inspection protocol for equipment?

  Safe

  At Risk

  N/A

2. Tools and Heavy Equipment

• 2.1. Unsafe or damaged tools? (including missing or damaged guards)

  Safe

  At Risk

  N/A

• 2.2. Incorrect tool/equipment for job? (e.g. grinding discs for cutting, including incompatible attachments used with tool/equipment?

  Safe

  At Risk

  N/A

• 2.3. Unauthorized operator of powder actuated tools?

  Safe

  At Risk

  N/A

• 2.4. Unsafe or damaged heavy equipment? (including missing or damaged glass, etc)

  Safe

  At Risk

  N/A

• 2.5. High Risk - Unqualified operators or unsafe operation (including use of cell phone or failure to use seatbelt)?

  Safe

  At Risk

  N/A

• 2.6. Lack of operators manual?

  Safe

  At Risk

  N/A

• 2.7. Lack of training in safe operation, clean-up and maintenance?

  Safe

  At Risk

  N/A

• 2.8. Lack of LOTO procedures for cleaning, servicing and maintenance?

  Safe

  At Risk

  N/A

• 2.9. Lack of inspection regime?

  Safe

  At Risk

  N/A

• 2.10. Lack of, or inadequate backup alarm?

  Safe

  At Risk

  N/A

3. Scaffolds

• Does this project have any scaffolding?

  Yes

  No

• 3.1. Critical - Unsafe or incomplete scaffold?

  Safe

  At Risk

  N/A

• 3.2. High Risk - Lack of competent persons supervision for erection of scaffold?

  Safe

  At Risk

  N/A

• 3.3. Lack of inspection protocol for scaffold?

  Safe

  At Risk

  N/A

• 3.4. Incompatible scaffold components? Unlabelled or do not meet code?

  Safe

  At Risk

  N/A

• 3.5. Safe Work Load (SWL) exceeded? (tools, stored materials, number of persons)

  Safe

  At Risk

  N/A

4. Lifting Equipment - Rigging and Cranes

• 4.1. High Risk - Unsafe or damaged lifting equipment, including ropes, slings, chains, hooks?

  Safe

  At Risk

  N/A

• 4.2. Lack of daily inspection protocol for rigging?

  Safe

  At Risk

  N/A

• 4.3. Lifting equipment unlabelled, no Safe Working Load (SWL) information displayed?

  Safe

  At Risk

  N/A

• 4.4. Unsafe or improper storage of lifting equipment?

  Safe

  At Risk

  N/A

• 4.5. SWL of any lifting equipment exceeded?

  Safe

  At Risk

  N/A

• 4.6. Does this project have a crane on site?

  Yes

  No

• Critical - Improper operation of crane?

  Safe

  At Risk

  N/A

• Lack of daily inspection protocol for cranes?

  Safe

  At Risk

  N/A

• Lack of monthly inspection protocol for cranes (documentation)?

  Safe

  At Risk

  N/A

• Lack of current Annual Inspection Documentation?

  Safe

  At Risk

  N/A

• Lack of certified crane operators, qualified riggers, or qualified signal person?

  Safe

  At Risk

  N/A

• Loads lifted over persons, close proximity to obstacles incl. overhead power lines?

  Safe

  At Risk

  N/A

• Are any pinch/crush hazards created by swing radius barricaded properly?

  Safe

  At Risk

  N/A

• Lack of LOTO procedures for cleaning, servicing and maintenance?

  Safe

  At Risk

  N/A

• SWL of crane exceeded (does the operator know the weight of the load)?

  Safe

  At Risk

  N/A

• If crane is in use, are ground conditions adequate for support of crane, outriggers and load?

  Safe

  At Risk

  N/A

• Lack of, or inadequate, appropriate equipment used to hoist personnel?

  Safe

  At Risk

  N/A

5. Excavation and Trenching

• 5.1. Does this project have any trenching 4' or greater?

  Yes

  No

• Critical - Lack of, or inadequate, trench shoring/benching?

  Safe

  At Risk

  N/A

• Lack of competent person (in writing in job file)?

  Safe

  At Risk

  N/A

• Failure to properly assess soil condition and type?

  Safe

  At Risk

  N/A

• Lack of, or inadequate, appropriate access to trench?

  Safe

  At Risk

  N/A

• Lack of daily inspection protocol for safety equipment, soil conditions and atmosphere monitoring?

  Safe

  At Risk

  N/A

• Lack of, or inadequate trench edge protection?

  Safe

  At Risk

  N/A

• Spoils or equipment located too close to trench?

  Safe

  At Risk

  N/A

• Lack of engineering design for trenches 20' or deeper?

  Yes

  No

  N/A

• Lack of, or inadequate, appropriate rescue plan?

  Safe

  At Risk

  N/A

• 5.2. Does this project have any excavation 4' or greater?

  Yes

  No

• Critical - Lack of, or inadequate, excavation shoring/benching?

  Safe

  At Risk

  N/A

• Lack of competent person (in writing in job file)?

  Safe

  At Risk

  N/A

• Failure to properly assess soil condition and type?

  Safe

  At Risk

  N/A

• Lack of, or inadequate, appropriate access to excavation??

  Safe

  At Risk

  N/A

• Lack of daily inspection protocol for safety equipment, soil conditions and atmosphere?

  Safe

  At Risk

  N/A

• Lack of, or inadequate excavation edge protection?

  Safe

  At Risk

  N/A

• Spoils or equipment located too close to excavation?

  Safe

  At Risk

  N/A

• Lack of engineering design for excavations 20' or deeper?

  Safe

  At Risk

  N/A

• Lack of, or inadequate, appropriate rescue plan?

  Safe

  At Risk

  N/A

6. Ladders

• 6.1. Critical - Improper use of ladder?

  Safe

  At Risk

  N/A

• 6.2. Unsafe positioning of ladders?

  Safe

  At Risk

  N/A

• 6.3. Ladder not properly secured?

  Safe

  At Risk

  N/A

• 6.4. Ladder unsuitable for job? (e.g. metal ladder used for electrical work)

  Safe

  At Risk

  N/A

• 6.5. Unsafe or damaged ladders?

  Safe

  At Risk

  N/A

• 6.6. Improper storage of ladder?

  Safe

  At Risk

  N/A

• 6.7. Lack of ladder load rating information?

  Safe

  At Risk

  N/A

7. Hazardous Manual Tasks

• 7.1. Lack of identification hazardous manual tasks (Site Specific JSA)?

  Safe

  At Risk

  N/A

• 7.2. Lack of assessment of hazardous manual tasks?

  Safe

  At Risk

  N/A

• 7.3. Inadequate risk controls? (examples: no job rotation, lighter loads, trolleys, lifting equipment, etc)

  Safe

  At Risk

  N/A

• 7.4. Lack of training in risk controls and safe lifting/ team lifting techniques?

  Safe

  At Risk

  N/A

8. Hazardous Chemical (including fuel and oil)

• 8.1. Unsafe storage location? (e.g. flammables near ignition sources, spills could enter stormwater drains, etc)

  Safe

  At Risk

  N/A

• 8.2. Incompatible chemicals stored near each other?

  Safe

  At Risk

  N/A

• 8.3. Incomplete, or not posted, Hazard Communication List and training?

  Safe

  At Risk

  N/A

• 8.4. Material Safety Data Sheets not accessible on site?

  Safe

  At Risk

  N/A

• 8.5. Lack of emergency procedures for injury/spills/fire etc?

  Safe

  At Risk

  N/A

• 8.6. Excessive quantities stored on site or in vehicles?

  Safe

  At Risk

  N/A

• 8.7. Insufficient ventilation?

  Safe

  At Risk

  N/A

• 8.8. Insufficient, or incorrect, PPE?

  Safe

  At Risk

  N/A

• 8.9. Unsuitable storage containers? (unlabeled or stored in improper containers)

  Safe

  At Risk

  N/A

• 8.10. Are fire extinguishers available, properly mounted, fully charged and inspected routinely?

  Safe

  At Risk

  N/A

9. Emergency Response

• 9.1. Lack of, or inadequate, Emergency Plan posted (including directions to nearest emergency room and occupational health clinic and Superintendent's Injury Checklist)?

  Safe

  At Risk

  N/A

• 9.2 Lack of, or inadequate, Evacuation Plan (posted, including designated safety zones)?

  Safe

  At Risk

  N/A

• 9.3. Lack of training/rehearsal of emergency plans?

  Safe

  At Risk

  N/A

• 9.5. Insufficient access to formally trained First Aid Responders for all shifts?

  Safe

  At Risk

  N/A

• 9.6. Unsuitable or inadequate communication equipment?

  Safe

  At Risk

  N/A

10. Traffic Management

• 10.1. Lack of, or inadequate, Traffic Control Plan in place?

  Safe

  At Risk

  N/A

• 10.2. Lack of training in TCP for all persons on site? <br>(contractors and visitors)

  Safe

  At Risk

  N/A

• 10.3. Inadequate controls for TCP? (physical barriers, bollards, speed limits, flashing lights, spotters, etc)

  Safe

  At Risk

  N/A

11. Personal Protective Equipment (PPE) and Engineering Controls

• 11.1. Critical - Failure to properly use minimum PPE (100% utilization: hard hat, safety glasses, work shoes)?

  Safe

  At Risk

  N/A

• 11.2. Lack of system to issue, inspect, replace and monitor PPE?

  Safe

  At Risk

  N/A

• 11.3. Lack of training in safe use, clean-up and inspection of PPE?

  Safe

  At Risk

  N/A

• 11.4. Lack of, or inadequate PPE available on site (including sun and heat stress protection)?

  Safe

  At Risk

  N/A

• 11.5. Failure to properly use situational PPE (as needed utilization: hearing protection, face shield, coveralls)?

  Safe

  At Risk

  N/A

• 11.6. Failure to use wet grinding on concrete?

  Safe

  At Risk

  N/A

• 11.7. Respiratory Protection in compliance with program?

  Safe

  At Risk

  N/A

12. Work Environment

• 12.1. Lack of, or inadequate, amenities? (toilets, wash areas, lunch rooms, etc)

  Safe

  At Risk

  N/A

• 12.2. Insufficient lighting?

  Safe

  At Risk

  N/A

• 12.3. Inadequate housekeeping?

  Safe

  At Risk

  N/A

• 12.4. Lack of, or inadequate noise/ vibration control?

  Safe

  At Risk

  N/A

• 12.5. Unmarked confined space?

  Safe

  At Risk

  N/A

• 12.6. Lack of, or inadequate, site safety signage and postings?

  Safe

  At Risk

  N/A

• 12.7. Lack of, or inadequate materials handling?

  Safe

  At Risk

  N/A

• 12.8. Uncovered or unmarked holes?

  Safe

  At Risk

  N/A

• 12.9. Unprotected implement hazards (rebar, etc)?

  Safe

  At Risk

  N/A

• 12.10. Lack of, or inadequate masonry or concrete wall bracing?

  Safe

  At Risk

  N/A

• 12.11. Lack of, or inadequate Limited Access Zone during masonry wall construction?

  Safe

  At Risk

  N/A

13. Electrical Hazards

• 13.1. Unsafe electrical cords or spider boxes? (damaged, out of date tape or untested)

  Safe

  At Risk

  N/A

• 13.2. Lack of GFC protection?

  Safe

  At Risk

  N/A

• 13.3. Potential contact with underground assets?

  Safe

  At Risk

  N/A

• 13.4. Potential contact with overhead electrical lines?

  Safe

  At Risk

  N/A

• 13.5. Overloading outlets?

  Safe

  At Risk

  N/A

• 13.6. Cords placed on over sharp edges, in area with high probability of damage or on metal structures?

  Safe

  At Risk

  N/A

• 13.7. Electrical equipment near water?

  Safe

  At Risk

  N/A

• 13.8. Electrical equipment near flammables?

  Safe

  At Risk

  N/A

• 13.9. Electrical equipment near chemicals that could cause damage?

  Safe

  At Risk

  N/A

• 13.10. Electrical cords that may be damaged from contact with moving machinery parts?

  Safe

  At Risk

  N/A

• 13.11. Electrical cords on work surfaces?

  Safe

  At Risk

  N/A

• 13.12. Lack of Lock-out/tag-out (LOTO) procedures for electrical equipment?

  Safe

  At Risk

  N/A

• 13.13. Lack of, or inadequate, labeling of electrical breaker panel?

  Safe

  At Risk

  N/A

14. Environmental Hazards

• 14.1. Lack of, or inadequate, dust suppression system?

  Safe

  At Risk

  N/A

• 14.3. Lack of, or inadequate, systems to prevent contaminants entering stormwater drains?

  Safe

  At Risk

  N/A

• 14.4. Lack of, or inadequate erosion control measures (silt fence, rock access areas etc)?

  Safe

  At Risk

  N/A

• 14.5. Lack of, or inadequate, protection of access/egress due to weather (snow, ice, etc)?

  Safe

  At Risk

  N/A

• 14.6. Lack of, or inadequate, protection of Outsiders (public, owners, etc)?

  Safe

  At Risk

  N/A

15. Administrative Procedures

• 15.1. Lack of/or inadequate Site Specific Safety Plan?

  Safe

  At Risk

  N/A

• 15.2. Failure to obtain permits (Hot Works, Confined Space, etc.)

  Safe

  At Risk

  N/A

• 15.3. High Risk - Not all employees and subcontractors received a Site Specific Orientation (completed form in file and stickers on hard hat)?

  Safe

  At Risk

  N/A

• 15.4. Lack of, or inadequate, current weekly toolbox meeting minutes?

  Safe

  At Risk

  N/A

• 15.5. Lack of, or inadequate, training, licenses, skills, experience?

  Safe

  At Risk

  N/A

• 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)?

  Safe

  At Risk

  N/A

• 15.7. Critical - Failure to follow Lock Out/Tag Out program (overall)?

  Safe

  At Risk

  N/A

• 15.8. Critical - Failure to comply with Confined Space Program?

  Safe

  At Risk

  N/A

• 15.9. Lack of, or inadequate, routine inspections, monitoring, audits?

  Safe

  At Risk

  N/A

• 15.10. Lack of, or inadequate two week schedule?

  Safe

  At Risk

  N/A

• 15.11. Failure to post OSHA 300 log?

  Safe

  At Risk

  N/A

• 15.12. Failure to post Fire Prevention Plan?

  Safe

  At Risk

  N/A

• 15.13. Failure to post most recent safety committee meeting minutes?

  Safe

  At Risk

  N/A

• 15.14. Failure to post superintendent's Injury Instructions?

  Safe

  At Risk

  N/A

Corrective Actions

• Critical - Were any of the current deficiencies a repeat violation from previous inspections?

  Yes

  No

• Have all corrections been completed from most recent inspection?

  Yes

  No

  N/A

• Have all deficiencies found during this inspection been corrected immediately?

  Yes

  No

  N/A

• Enter corrective actions that remain to be completed.

• Enter date by which all corrections must be completed.

  Date

Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign

• 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.

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