Title Page
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GC Name:
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Jobsite Contact:
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Project Name:
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Site Address:
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Contact Phone #
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Assessed By:
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Date:
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Branch:
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Eastridge Staff Currently On-Site:
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Current ExMod
A. General
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1. Eastridge has provided the client with the Workers Compensation Client Packet?
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2. Eastridge has reviewed the Workers Compensation packet with the client to ensure they understand it?
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3. Are supervisors aware of the location of the nearest hospital?
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4. Is there a first aid kit available?
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5. Are SDS (Safety Data Sheets) readily available to all employees on site?
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6. Are there sanitation and hand washing facilities on-site?
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7. Does the site have First Aid and CPR responders
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8. Are Walking-working surfaces maintained free of hazards such as sharp or protruding objects, loose boards,<br>corrosion, leaks, spills, snow and ice?
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9. Are employees protected from accidental injury or impalement by sharp or slender objects (protruding nails,<br>rebar, etc.?
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10. Are GFCI's used for all portable electric tools?
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11. Are ladders free from obvious defects?
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12. Are workers provided enough water and appropriate rest breaks?
B. Site Specific Safety Training
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1. Have employees taken part in a JSA / JHA discussion for their particular work task within the last week?
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2. Are employees made aware of the emergency evacuation plan?
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3. Are employees required to attend a site specific new hire orientation?
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4. Does the site conduct an all hands safety meeting periodically?
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5. Are employees made aware of the site specific Personal Protective Equipment required on-site?
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6. Does the client have an Environmental Health & Safety Plan in place?
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7. Have employees operating a power tool been trained on that specific tool?
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8. Have workers been trained on preventing and recognizing heat-related illness?
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9. Do employees conduct stretch and flex activities prior to the beginning of work?
C. Required Personal Protective Equipment based on hazards EE's would encounter
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1. Hard Hat / ANSI Z89.1
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2. Eye Protection appropriate for their task / ANSI Z87.1
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3. Safety Vest / ANSI 107 – 2015
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4. Ear Protection appropriate to their task / ear plugs, ear muffs
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5. Gloves appropriate to their task / Leather, Kevlar, Mechanic
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6. Proper footwear appropriate for their task / Street shoes, Normal work boots / Steel toe or Composite boots
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7. Dust masks available when task involves dusty conditions0?
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8. Are jeans, long pants, T-shirt or Long sleeve shirts being worn by all employees0? Shorts, Sandals, Tank tops<br>are NOT ALLOWED
D. Fire Protection
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1. Flammable liquids stored in approved safety cans
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2. Flammable liquids storage containers labeled appropriately
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3. Fire extinguishers readily available, inspected monthly, and maintained annually
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4. Is there a hot work permit procedure in place ?
Additional Pictures / Recommendations
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Add media
Appendices
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Would you like to access Appendix 1 - Excavations
A1. Evaluations
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1. Are excavations 5 feet or deeper?
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Any employee in an excavation must be protected from cave-ins by an adequate protective system except when: The excavation is made entirely in stable rock or the excavation is less than 5 feet deep and inspection by competent person reveals no cave-in hazard. If an excavation is 5 feet or deeper please contact JorgeLegarreta at 858-245-7032
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2. Is there an excavation competent person on-site?
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One who is capable of identifying existing and predictable hazards in the surroundings, or working conditions which are unsanitary, hazardous, or dangerous to employees and who has the authority to take prompt corrective measures to eliminate them. 1926.32(f) Every excavation must be inspected on a daily basis by a competent person prior to work starting, and as needed throughout the shift. Inspections must also be made after rainstorms or other hazard increasing occurrences. CalOSHA 1541 (K)(1)
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3. Have all underground utilities been identified?
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811 National locate number"
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4. Has the soil type been identified?
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Type A, B, or C Soil
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5. Are spoil piles and other materials or equipment at least 2 feet away from the edge of the excavation and<br>or retaining devices used to prevent material / equipment from rolling into the excavation?
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6. Is there proper access and egress?
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Only required if excavation is 4 feet or more. Items such as ramps, runways, stairways, ladders at a maximum of 25 feet of lateral travel.
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Additional Comments:
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Would you like to access Appendix 2 - Fall Protection?
A2. Fall Protection
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1. Is fall protection provided for heights 6ft. Or more?
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(7 1/2 feet in California ) As a general matter, each worker on a walking or working surface 6 feet or more above a lower level must be protected from falling by a guardrail system, a safety net system, or a personal fall arrest system 1926.501 (b) (15) / CalOSHA 1670. 1671. 1671.1 1671.2
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2. Are personal fall arrest systems (harnesses) being inspected prior to each use for wear, damage, and<br>other deterioration, and are defective components removed from service?
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1926.502 (d) (21) / CalOSHA 1670. 1671. 1671.1 1671.2
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3. Are proper anchorages being used to attached personal fall arrest systems?
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Anchorages used to attach personal fall arrest systems must be designed, installed, and used under the supervision of a qualified person. Must be capable of supporting at least 5,000lbs per worker attached or be capable of supporting at least twice the expected impact load. 1926.502 (d) (15). / CalOSHA 1670. 1671. 1671.1 1671.2
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4. Are employees protected from falling thorough holes?
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Each worker on walking or working surfaces must be protected from falling through holes that are more than 6 feet above lower levels, by personal fall arrest systems, covers, or guardrail systems erected around such holes. 1926.501 (b) (4) (i) / CalOSHA 1670. 1671. 1671.1 1671.2
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5. Are deep excavations protected ?
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Each worker at the edge of a well, pit, shaft, and similar excavation 6 feet or more deep must be protected from falling by guardrail systems, fences, or barricades, or covers. 1926.501(b)(7)(ii) / CalOSHA 1670. 1671. 1671.1 1671.2
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6. Are wall openings protected ?
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Each worker working on, at, above, or near wall openings, where the outside bottom edge of the wall opening is 6 feet or more above lower level and the inside bottom edge of the wall opening is less than 39 inches above the walking or working surface, must be protected with a guardrail system, a safety net system, or a personal fall arrest system. 1926.501(b)(14) / CalOSHA 1670. 1671. 1671.1 1671.2
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7. Is there a fall protection competent person on-site ?
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8. Have employees been trained on fall hazards ?
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1926.503(a)(1).
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9. Is there a record employees have been trained on fall hazards ?
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1926.503(b)(1)
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Additional Comments:
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Would you like to access Appendix 3 - Roof Top?
A3. Roof Top
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1. Is a scaffold being used for access and egress to the roof?
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2. Are the scaffolds and scaffold components been inspected daily by a competent person for visible defects before each work shift, and after any occurrence which could affect the structural integrity and to authorize prompt corrective actions?
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1926.451 (f)(3) / CalOSHA 1637.
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3. Are skylight floor openings and holes being guarded by a standard skylight screen or a fixed standard<br>railing on all exposed sides?
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1910.23 (a) (4). (If instead of skylight screens they are using guardrails to cover skylights refer to the rules in #5 below) / CalOSHA 3212.
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4. If skylight screens are used, do they meet the following requirements?
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Skylight screens shall be of such construction and mounting that they are capable of withstanding a load of at least 200 pounds applied perpendicularly at any one area on the screen. They shall also be of such construction and mounting that under ordinary loads or impacts, they will not deflect downward sufficiently to break the glass below them. The construction shall be of grillwork with openings not more than 4 inches long or of slatwork with openings not more than 2 inches wide with length unrestricted. CalOSHA 3212.
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5. Is there guardrails around the perimeter of the roof?
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Top edge height of top rails, or equivalent guardrail system members, shall be 42 inches (1.1 m) plus or minus 3 inches (8 cm) above the walking/working level. 1926.502 (b) (1) Midrails, when used, shall be installed at a height midway between the top edge of the guardrail system and the walking/working level. 1926.502 (b)(2)(i) Guardrail systems shall be capable of withstanding, without failure, a force of at least 200 pounds applied within 2 inches of the top edge, in any outward or downward direction, at any point along the top edge. 1926.502(b)(3) When guardrail system are used at holes, they shall be erected on all unprotected sides or edges of the hole. 1926.502(b)(10) Guardrail system shall be so surfaced as to prevent injury to an employee from punctures or lacerations, and to prevent snagging or clothing. 1926.502(b)(5) / CalOSHA 3212.
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6. Are they using warning line systems around the perimeter of the roof?
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Warning line systems consist of ropes, wires, or chains, and supporting stanchions as follows: Flagged at least every 6 feet, lowest point no less than 34 inches, highest point no more than 39 inches, capable of resisting a force of at least 16 lbs. applied against stanchion, the line to have a minimum tensile strength of 500lbs. Must be erected around all sides of roof area. The warning line system must be 15 feet back from the edge. CalOSHA 1730.
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7. Are they utilizing the safety monitoring systems? Safety monitoring systems not allowed unless<br>employees are doing roofing work.
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Additional Comments:
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Would you like to access Appendix 4 - Aerial Lifts?
A4. Aerial Lifts
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1. Is fall protection provided for heights 6ft. Or more?
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(7 1/2 feet in California ) As a general matter, each worker on a walking or working surface 6 feet or more above a lower level must be protected from falling by a guardrail system, a safety net system, or a personal fall arrest system 1926.501 (b) (15) / CalOSHA 1670. 1671. 1671.1 1671.2
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2. Have employees been trained on fall hazards?
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1926.503(a)(1).
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3. Are employees standing firm on the floor of the bucket or work platform?
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4. (Working near Power Lines) Are employees maintaining a minimum clearance of at least 10 feet away<br>from the nearest overhead line?
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Any conductive object that can be contacted must be maintained at least 10 feet from over head lines. Always treat overhead lines as energized.
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5. Are employees tied off to the boom or basket to prevent the worker to being ejected or pulled from the basket ?
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6. Is there an assigned authorized person to operate the aerial lift on-site?
Scissor Lifts
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1. Have employees been trained on fall hazards ?
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1926.503(a)(1).
Osha does not require employees to be tied-off if the scissor lift has a properly designed and maintained guardrail system. The guardrails themselves serve as the necessary fall protection. If however the guardrail system is not adequate the employee shall wear fall protection. -
Additional Comments: