Corporate Safety Services

• Project Name

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. General

• 1.1 Was company representative on site?<br>

  Yes

  No

  N/A

• 1.2 Are all Safety/HazCom Programs on site? (1926.59)

  Yes

  No

  N/A

• 1.3 Are OSHA posters/emergency numbers posted? (1903.2)

  Yes

  No

  N/A

• 1.4 Are safety meetings held/documented? (1926.21[a][2])

  Yes

  No

  N/A

• 1.5 Are first aid kits available & properly stocked? (1926.50[d])

  Yes

  No

  N/A

• 1.6 Are fire extinguishers available/charged/inspected? (1926 .150[a])

  Yes

  No

  N/A

• 1.7 Are all rebar/pipe & other impalement hazards capped/protected? (1926.701[b])

  Yes

  No

  N/A

• 1.8 Are gas cylinders properly used & stored? (1926.55)

  Yes

  No

  N/A

• 1.9 Is housekeeping and sanitation proper & enforced? (1926.25)

  Yes

  No

  N/A

• 1.10 Are flammable materials in approved containers, properly labeled and stored? (1926.152)

  Yes

  No

  N/A

• 1.11 Are barricades/traffic control/flagmen through & around site proper? (1926 Subpart G)

  Yes

  No

  N/A

• 1.12 Are all silica exposures in compliance?

  Yes

  No

  N/A

2. Equipment

• Is equipment involved?

  Yes

  No

  N/A

• 2.1 Are parts/equipment free from damage? (1926.300[a])

  Yes

  No

  N/A

• 2.2 Are all guards in place & working properly? (1926.300[b][1])

  Yes

  No

  N/A

• 2.3 Do backup alarms work? (1926.601[b][4][i])

  Yes

  No

  N/A

• 2.4 Are equipment operators properly trained? (1910.178[l][2])

  Yes

  No

  N/A

• 2.5 Are seatbelts operative & used? (1926.601[b][9])

  Yes

  No

  N/A

• 2.6 Are aerial/scissors lifts properly used? (1926.453)

  Yes

  No

  N/A

• 2.6 Are forklifts being properly used/operated? (1910.178)

  Yes

  No

  N/A

3. Personal Protective Equipment

• Is PPE involved?

  Yes

  No

  N/A

• 3.1 Is all PPE provided by the employer? (1926.95[d][6])

  Yes

  No

  N/A

• 3.2 Is respiratory protection proper? (1926.103)

  Yes

  No

  N/A

• 3.3 Is hearing protection used & proper? (1926.101)

  Yes

  No

  N/A

• 3.4 Is proper head/eye/foot protection worn? (1926.96)

  Yes

  No

  N/A

• 3.5 Is hand protection/clothing proper? (Common sense)<br>

  Yes

  No

  N/A

• 3.6 Is PPE hazard assessment complete & on file? (1910.132[d][1])

  Yes

  No

  N/A

• 3.7 Is Appendix D on file for voluntary respirator use? (1910.134/1926.103)

  Yes

  No

  N/A

4. Electrical

• Is electrical involved?

  Yes

  No

  N/A

• 4.1 Are GFCI's or AEG Program in use? (1926.404[b][1][i])

  Yes

  No

  N/A

• 4.2 Is temporary lighting used & proper? (1926.405[a][2][ii][F])

  Yes

  No

  N/A

• 4.3 Are Lockout/Tagout procedures in place & used? (1926.417)

  Yes

  No

  N/A

• 4.4 Are temporary cords properly used & maintained? (1926.405[a][2])

  Yes

  No

  N/A

• 4.5 Do all boxes/panels have covers & are all circuits labeled? (1926.405[b])

  Yes

  No

  N/A

• 4.6 Are generators over 5kv properly grounded? (1926.404[b][1][ii])

  Yes

  No

  N/A

• 4.7. Are all operations performed at least 10 feet from overhead power lines? (1926 Subparts L and CC)

  Yes

  No

  N/A

5. Fall Protection

• Is fall protection involved?

  Yes

  No

  N/A

• 5.1. Is fall protection provided at heights over 6 feet? (1926.501[b])

  Yes

  No

  N/A

• 5.2 Is fall protection equipment inspected & maintained? (1926.502[d][21])

  Yes

  No

  N/A

• 5.3 Are stairways properly protected & used? (1926.1051)

  Yes

  No

  N/A

• 5.4 Are ladders properly used & maintained? (1926.1051)

  Yes

  No

  N/A

• 5.5 Are all floors holes properly covered or protected? (1926.502[i])

  Yes

  No

  N/A

• 5.6 Is the roofer's warning line system/roof monitor system proper? (1926.502[f]&[h])

  Yes

  No

  N/A

6. Steel Erection/Cranes

• Is steel erection/cranes involved?

  Yes

  No

  N/A

• 6.1 Is crane setup proper/annual inspection on site? (1926.1403) & (1926.1412[f][7])

  Yes

  No

  N/A

• 6.2 Are loads properly rigged/carried? (1926.753[d][2][iii])

  Yes

  No

  N/A

• 6.3 Are areas under swinging loads properly barricaded & enforced? (1926.753[d])

  Yes

  No

  N/A

• 6.4 Are rigger & signalperson trained/qualified? (1926.1428[a])

  Yes

  No

  N/A

• 6.5 Are connector requirements in compliance? (1926.760[b])

  Yes

  No

  N/A

• 6.6 Does Controlled Decking Zone meet standards. (1926.760[c])

  Yes

  No

  N/A

• 6.7 Are employees using fall protection above 15 feet? (1926.760[a][1])

  Yes

  No

  N/A

• 6.8 Are oxygen & acetylene bottles properly used & stored? (1910.101[b])

  Yes

  No

  N/A

• 6.9 Is perimeter safety cable properly installed & used? (1926.760[a][2])

  Yes

  No

  N/A

7. Masonry/Scaffolding

• Is masonry/scaffolding involved?

  Yes

  No

  N/A

• 7.1 Is scaffold competent person on site? (1926.451[a][6])

  Yes

  No

  N/A

• 7.2 Are all scaffold users properly trained? (1926.454)

  Yes

  No

  N/A

• 7.3 Are scaffold erection/disassembly procedures proper? (1926.451[b])

  Yes

  No

  N/A

• 7.4 Are baseplates/mud sills stable & proper? (1926.451[c][2][i])

  Yes

  No

  N/A

• 7.5 Are all scaffold frames pinned together? (1926.452[c][4])

  Yes

  No

  N/A

• 7.6 Is scaffold tied to structure using stiffbacks? (1926.451[c][1])

  Yes

  No

  N/A

• 7.7 Are scaffold frames/planks/parts free of damage & defects? (1926.451[f][3])

  Yes

  No

  N/A

• 7.8 Are guardrails properly installed & used? (1926.451[g][1][v])

  Yes

  No

  N/A

• 7.9 Are toe boards/warning line properly installed & used? (1926.451[h])

  Yes

  No

  N/A

• 7.10 Is scaffold access proper? (1926.451[e])

  Yes

  No

  N/A

• 7.11 Are masonry walls properly braced? (1926.706[b])

  Yes

  No

  N/A

• 7.12 Is the Limited Access Zone set & enforced? (1926.706[a])

  Yes

  No

  N/A

• 7.13 Are mixer operations proper? (1926.702[b])

  Yes

  No

  N/A

• 7.14 Is wet-cutting or respiratory protection in place? (1910.134)

  Yes

  No

  N/A

• 7.15 Is scaffolding properly tagged in/out of service?

  Yes

  No

  N/A

8. Trenching/Excavating

• Is trenching/excavating involved?

  Yes

  No

  N/A

• 8.1 Is the trench competent person on site? (1926 Subpart P)

  Yes

  No

  N/A

• 8.2 Is the trench/excavation inspected daily? (1926.651[k][1])

  Yes

  No

  N/A

• 8.3 Has a proper soils analysis been conducted? (1926 Subpart P)

  Yes

  No

  N/A

• 8.4 What is the soil type? (1926 Subpart P, Appendix A)

  Type A

  Type B

  Type C

  Stable rock

• 8.5 Is employee protection proper for soil type & depth? (1926.652[a])

  Yes

  No

  N/A

• 8.6 What type of employee protection is in place? (1926.652[a])

  Sloping

  Benching

  Trenchbox

  Shoring

  None

• 8.7 Is safe access/egress provided? (1926.651[c])

  Yes

  No

  N/A

• 8.8 Are water removal procedures proper? (1926.651[h])

  Yes

  No

  N/A

• 8.9 Has the trench been evaluated as a confined space? (1926 Subpart P)

  Yes

  No

  N/A

9. Confined Spaces

• Are confined spaces involved?

  Yes

  No

  N/A

• 9.1. Are confined spaces identified/signs posted?

  Yes

  No

  N/A

• 9.2 Do all contractors have a written confined space program?

  Yes

  No

  N/A

• 9.3. All all employees trained/documentation available?

  Yes

  No

  N/A

• 9.4. Is all equipment on hand (air/gas monitor, rescue, etc)?

  Yes

  No

  N/A

• 9.5. Are all confined space rules being followed?

  Yes

  No

  N/A

10. Summary

• Comments

• Photographs

  Media