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.
  DISCREPANCIES IN ANY CRITICAL ITEM REPRESENT AN AUTOMATIC FAILURE OF THE AUDIT.

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. Unlabeled 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 or improper storage?

  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 and documentation 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 unlabeled, 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

• Lack of current Annual Inspection Documentation?

  Safe

  At Risk

  N/A

• Critical - Improper operation of crane?

  Safe

  At Risk

  N/A

• Lack of daily inspection protocol and documentation for cranes?

  Safe

  At Risk

  N/A

• Lack of monthly inspection protocol and documentation for cranes?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Lack of crane operator log book?

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• Lack of or inadequate tag line?

  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?

  Safe

  At Risk

  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

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

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

  Safe

  At Risk

  N/A

• 14.5. 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

16. Corrective Actions

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

  Yes

  No

• 16.2. Have all corrections been completed from most recent inspection?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 16.3.1 Enter corrective actions that remain to be completed.

• 16.3.2 Enter date by which all corrections must be completed.

  Date

• 16.3.3 Corrections:
  
  
  
  

• If the answer to 16.3 is “No”, follow this section to complete this audit once the corrections have been made:
  1. Print this page of the audit form.
  2. In Section 16.3.3 - List the deficiency, the date of correction and sign the sheet.
  3. Email that sheet to the Project Manager, Receptionist, and Safety Team. Please include the project name and audit date in the subject line of the email. This will help greatly.
  4. Be sure to have these all completed by the “date by which all corrections must be completed” noted on your audit.
  5. Please include one or two pictures of each correction, as applicable, with the email.
  

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.

Other Comments