Information
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Project Name
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Prepared by
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Title
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Project Manager
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Conducted on
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Add location
A. Personnel Safe Work Practices
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1. Personnel in areas where concrete is being poured are wearing PPE as required.
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2. Protruding rebar is adequately guarded to control impalement hazards.
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3. Personnel do not ride concrete buckets or position themselves in lifting areas.
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4. Personnel maintain safe distance from formwork, shoring, precast, and lift-slab operations.
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5. Personnel do not enter limited access zones during masonry wall construction
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6. Personnel are not permitted under loads being lifted or walls being jacked.
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7. Personnel access is limited in areas where post-tension operations are performed.
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8. Scaffolding conforms to the requirements of SOP HS-73 prior to use.
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9. Excavations conform to the requirements of SOP HS-32 prior to entry.
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10. Lifting and rigging devices conform to the requirements of SOP HS-44.
B. General
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11. All concrete structures where loads are to be placed have been inspected, as required.
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12. All protruding rebar, onto which employees could fall, are guarded.
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13. No employee is permitted to be behind the jack during tensioning operations except those employees essential to the post-tensioning operations. <br>
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14. Signs and barriers are erected to limit employee access to the post-tensioning area during tensioning operations<br>
C. Tools, Materials & Equipment
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15. Requirements for confined space entry and lockout/tagout are met, where required.
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16. Concrete mixers have clearing devices and guardrails installed, as required.
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17. Portable concrete mixers have an interlock switch on the hopper gates (required).
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18. Powered/rotating concrete troweling machines have appropriate shutoff devices installed.
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19. Concrete buggy handles do not extend beyond the wheels on either side of the buggy.
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20. Concrete pumping systems using discharge pipes are provided with supports, as required.
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21. Concrete buckets w/hydraulic or pneumatic gates have positive safety devices, as required.
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22. Employees are not permitted to work under concrete buckets during lifting and lowering.
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23. Elevated concrete buckets are routed so that no employees are exposed to overhead loads.
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24. Employees are not permitted to ride concrete buckets.
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25. Sections of tremies and similar concrete conveyances are secured with wire rope.
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26. Bull float handles used where they might contact conductors are nonconductive or insulated.
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27. Masonry saws are guarded with a semicircular enclosure over the blade.
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28. Wet cutting methods or respiratory protection is used for masonry saw operation
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29. Employees are not permitted to apply a cement, sand, and water mixture through a pneumatic hose unless the employee is wearing protective head and face equipment.<br>
D. Formwork & Shoring
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30. Formwork is capable of supporting loads that may be reasonably anticipated to be applied.
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31. Drawings and plans required to be at the jobsite are available.
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32. All shoring equipment is inspected prior to erection.
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33. Damaged shoring equipment is not used.
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34. Erected shoring is inspected prior to, during, and immediately after concrete placement.
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35. The sills for shoring are sound, rigid, and capable of carrying the maximum intended load.
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36. All base plates, shore heads, extension devices, and adjustment screws are installed correctly.
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37. Eccentric loads on shore heads and similar are prohibited unless designed for such loading.
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38. Whenever single-post shores are tiered, shoring is designed and inspected, as required.
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39. Tiered single-post shores are vertically aligned and adequately braced, as required.
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40. Adjustment of single-post shores to raise formwork is not made after placement of concrete.
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41. Re-shoring is erected when concrete is required to support loads in excess of its capacity.
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42. Forms/shores are only removed when concrete has gained sufficient strength as needed.
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43. Re-shoring is not removed until the concrete being supported has attained adequate strength to support its weight and all loads placed upon it.<br>
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44. Precast concrete wall units, structural framing and tilt-up wall panels are adequately supported to prevent overturning and to prevent collapse until permanent connections are completed.<br>
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45. All masonry walls over 8 feet in height are adequately braced.
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46. Positioning devices/fall protection for workers on formwork 6’ or more above ground
E. Limited Access Zones (LAZ)
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47. A LAZ is established whenever a masonry wall is being constructed
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48. The LAZ is established prior to the start of the wall
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49. The LAZ is equal to the height of the wall to be constructed plus 4' and runs the entire length of the wall
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50. The LAZ is established on the unscaffolded side of the wall
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51. The LAZ restricts entry to only authorized employees
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52. the LAZ remains in place until the wall is adequately braced as required
Corrective Action Taken
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Corrective actions & dates corrected
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Signature