CRH Fundamentals for Fatality Elimination Report

• Company

• Date

  Date

• Prepared by

• Other Person(s) Present During the Audit

• Location
  Address

• a) Documented Risk Assessment Policy in place and accessible to all employees

  Yes

  No

  N/A

• b) Risk Assessment Process addresses non-routine and high hazard tasks

  Yes

  No

  N/A

• c) Evidence that the Risk Assessment Progam is being followed

  Yes

  No

  N/A

• d) Specific Risk Assesssment Process for off-site delivery (if applicable)

  Yes

  No

  N/A

• e) Weekly toolbox talks / safety topics discussed and a copy of this documentation kept at your site/local office

  Yes

  No

  N/A

• f) Site safety briefings conducted and documented with contractors when they arrive at facility

  Yes

  No

  N/A

• g) Temporary personnel training is provided commensurate with the risks and this training is documented

  Yes

  No

  N/A

• h) AMAT Contractor Checklist is being fully utilized to determine contractor qualifications

  Yes

  No

  N/A

• i) Does the company have a process in place to evaluate "Risks that Kill"?

  Yes

  No

  N/A

• j) Diesel fuel or gasoline IS NOT allowed to be used for any cleaning purposes at any time.

  Yes

  No

  N/A

• k) Are tanks properly labeled?

  Yes

  No

  N/A

• l) Are fire extinguishers inspected regularly with an current annual inspection?

  Yes

  No

  N/A

• m) Are first aid kits stocked with current products?

  Yes

  No

  N/A

• Risk Assessment - overall review

  Excelling

  Practicing

  Implementing

  Developing

  N/A

• Additional comments / notes

• Pedestrian / Vehicle Segregation measures have been implemented at this Site / Facility and it is adequately signed to provide direction regarding pedestrian walkways, traffic patterns, parking areas, prohibited conduct, etc.

  Yes

  No

  N/A

• Are visitors and employees observed following the VPS plan?

  Yes

  No

  N/A

Facility

• Do you have the following at your facility:

• a) Sign indicating where mobile phones are allowed or not allowed?

  Yes

  No

  N/A

• b) Sign prohibiting trucks from either entering or leaving the facility overloaded?

  Yes

  No

  N/A

• c) Sign(s) indicating vehicle travel routes, designated parking areas, pedestrian crossings, etc?

  Yes

  No

  N/A

• d) Sign indicating speed limit are posted near the entrance to the property?

  Yes

  No

  N/A

• e) If an asphalt plant, is a sign posted listing the req'd PPE during the loading/offloading of liquid asphalt cement?

  Yes

  No

  N/A

• f) If an asphalt plant, is a sign in place to warn of H2S hazards and are measures in place to protect against it?

  Yes

  No

  N/A

Mobile Equipment:

• a) All equipment operators are adequately task trained prior to operating mobile equipment?

  Yes

  No

  N/A

• b) Daily or pre-use inspections are documented on all equipment and off road vehicles prior to use?

  Yes

  No

  N/A

• c) Powered industrial truck (lift truck / forklift / moffett) operator training is current for all qualified operators? Trained in accordance with OSHA 1910.178 prior to operation of a forklift and at least once every 3 years?

  Yes

  No

  N/A

• d) All vehicle/equipment lights are working properly?

  Yes

  No

  N/A

• e) Are "flexible steps" on equipment sturdy/durable?

  Yes

  No

  N/A

• f) Are seat belts current?

  Yes

  No

  N/A

Company Vehicles

• Company Vehicles

• a) All drivers are trained in company safe driving program (i.e. Smith System) before they drive and at least annually?

  Yes

  No

  N/A

• b) Motor vehicle records (MVR's) are reviewed prior to a new employee driving and at least annually?

  Yes

  No

  N/A

• c) Do drivers have a current proof of insurance card and vehicle registration?

  Yes

  No

  N/A

DOT regulated vehicles

• DOT regulated vehicles (Below are federal regulations which most states have adopted. Check to ensure that these are applicable in the State(s) of the audit.)

• a) Daily or post trip inspections are documented on all DOT regulated vehicles (>10,000lbs)?

  Yes

  No

  N/A

• b) If over 10,001, drivers have a current medical card and annual inspection?

  Yes

  No

  N/A

• c) If over 26,001, is fire extinguisher charged with a current annual inspection?

  Yes

  No

  N/A

• Is the AMAT Tire Policy being adhered to?

  Yes

  No

  N/A

• Have you observed that seat belts are used by all contractors and operators, drivers and passengers of company vehicles and equipment?

  Yes

  No

  N/A

• Are keys removed from vehicles/equipment?

  Yes

  No

  N/A

• 3-point of contact decal is in place on steps on equipment?

  Yes

  No

  N/A

• All back up alarms are working?

  Yes

  No

  N/A

• At MSHA regulated facilities, are equipment/vehicle tires chocked when not in use?

  Yes

  No

  N/A

• Ramps are of adequate height and edges are adequately protected?

  Yes

  No

  N/A

• AMAT drivers have been trained in tie down / load securement requirements for the loads they carry, as applicable.

  Yes

  No

  N/A

• Employees understand and comply with mobile phone policy?

  Yes

  No

  N/A

• AMAT drivers know where to find and/or how to determine the maximum weight of the vehicles they operate, as applicable, and maximum weights are strictly complied with?

  Yes

  No

  N/A

• Can the Plant Operator demonstrate that trucks cannot be overloaded?

  Yes

  No

  N/A

• Do you periodically check vehicle weights to ensure that loads are within vehicle weight limits (AMAT operated vehicles)

  Yes

  No

  N/A

Summary

• Mobile Plant Safety - overall review

  Excelling

  Practicing

  Implementing

  Developing

  N/A

• Additional comments / notes

• a) AMAT lock-out/tag-out policy in place. Posted or accessible to all employees.

  Yes

  No

  N/A

• b) Machine specific lock-out/tag-out procedures or isolation rules in place. Accessible to all employees.

  Yes

  No

  N/A

• c) Sufficient numbers of locks, tags, hasps, etc on site to conduct all anticipated maintenance activities. Accessible to all authorized employees.

  Yes

  No

  N/A

• d) All authorized or affected employees have been trained in the lock-out/tag-out or isolation policy and this training documented?

  Yes

  No

  N/A

• e) A list of Close Proximity Maintenance (CPM) procedures specific to your facility has been created, as applicable?

  Yes

  No

  N/A

• f) If CPM is used, a Job Safety Analysis (JSA) has been created outlining the planned step by step procedure?

  Yes

  No

  N/A

Electrical Safety - NFPA 70E

• a) Has an arc flash survey been completed by a qualified person for this facility? Have electrical labels warning of arc flash (and containing all other required information) been installed on electrical enclosures, as applicable?

  Yes

  No

  N/A

• b) All work over 600 volts is performed by a third party certified electrical contractor?

  Yes

  No

  N/A

• c) Prior to working, all electrical contractors provide a letter of certification confirming that the attending electrician(s) are properly trained (NFPA 70E) to work around the respective voltage?

  Yes

  No

  N/A

• d) All employees who troubleshoot electrical systems, perform voltage testing, operate circuit breakers with covers off or are otherwise exposed to live or potentially live circuits have been trained in NFPA 70E?

  Yes

  No

  N/A

• e) All qualified and/or affected employees wear appropriate arc rated PPE during electrical tasks?

  Yes

  No

  N/A

• f) All Authorized employees and contractors who work on electrical equipment perform lock-out / tag-out on the energy source AND verify disconnection through the use of a voltage testing?

  Yes

  No

  N/A

• g) All electrically authorized employees have or have access to a voltage tester for verification of electrical LOTO

  Yes

  No

  N/A

LOTO Annual Integrity

• a) All LOTO authorized employees are observed at least annually by a competent person who watches them conduct a task involving lock-out/tag-out or isolation to ensure that the system is operated as per rules, and this is documented.

  Yes

  No

  N/A

• b) Have all machine specific procedures been inspected at least annually for correctness and to ensure equipment additions and changes have been implemented? This inspection is documented? The goal is to ensure that the component and energy specific procedures are correct and provide adequate protection and information.

  Yes

  No

  N/A

• c) Arc flash gloves have current certification?

  Yes

  No

  N/A

• d) Arc flash gear is appropriate for the voltage exposure?

  Yes

  No

  N/A

• e) Are component specific procedures for mobile equipment in place?

  Yes

  No

  N/A

• LOTO Annual Integrity - overall review

  Excelling

  Practicing

  Implementing

  Developing

  N/A

• Additional comments / notes

• a) System for regular checking of machinery guarding in place.

  Yes

  No

  N/A

• b) Are tail pulleys, exposed shafts, pinch points and other moving parts sufficiently guarded?

  Yes

  No

  N/A

• c) Are pad-mounted electrical transformers and propane tanks away from travel-ways and adequately protected by bollard, barrier or other measures so they cannot be struck by trucks and/or mobile equipment?

  Yes

  No

  N/A

• d) Are conveyor return rollers within 7 feet of the ground (or an adjacent working surface) guarded? Generally return rollers should be guarded when employees are exposed to injury during work or travel activities. For instance, when cleaning or working under, or crossing under an operating belt conveyor that is not guarded by location.

  Yes

  No

  N/A

• Additional comments / notes

• a) Documented confined space entry policy in place. Posted or accessible to all employees.

  Yes

  No

  N/A

• b) Safe entry procedures or rules have been developed (in accordance with OSHA 1910.146) for each confined space on site and all affected employees are aware of these procedures?

  Yes

  No

  N/A

• c) All employees who may perform duties as confined space entrants, attendants or supervisors have been trained in the confined space program and all applicable entry procedures and this is documented

  Yes

  No

  N/A

• d) Are confined space procedures used for excavations whenever exposure to a hazardous atmosphere could exist? An example would be an internal combustion engine near the top of the excavation used for dewatering.

  Yes

  No

  N/A

• e) Are permits used for entry into baghouses, cold feed bins, mixer drums, tanks, silos, etc?

  Yes

  No

  N/A

• f) All permit required confined spaces have signs posted at the entryway indicating "permit required confined space"?

  Yes

  No

  N/A

• g) Completed or canceled permits are retained for at least 1 year?

  Yes

  No

  N/A

• h) Calibration gas bottle is current (not expired)?

  Yes

  No

  N/A

• i) Confined space air tester is available and used for all permit confined space entries?

  Yes

  No

  N/A

• j) Confined space air tester is calibrated in accordance with the manufacturer's information?

  Yes

  No

  N/A

• Confined Space Entry - overall review

  Excelling

  Practicing

  Implementing

  Developing

  N/A

• Additional comments / notes

• a) Documented Fall Protection policy in place. Posted or accessible to all employees.

  Yes

  No

  N/A

• b) All employees who may work at heights have been trained in the fall protection policy as well as all applicable means and methods for preventing falls at their location and this training documented.

  Yes

  No

  N/A

• c) A fall hazard risk assessment is conducted whenever employees are exposed to non-routine fall hazards and require fall protection beyond what is outlined in the fall protection policy?

  Yes

  No

  N/A

• d) Employees are aware of the various tools and devices that can be used to help them achieve 100% fall protection such as retractable lanyards, beam straps, double lanyards, etc. and such devices are available?

  Yes

  No

  N/A

• e) All ladders have a visible capacity rating?

  Yes

  No

  N/A

• f) Fall harnesses/lanyards inspections are conducted as per manufacturer specifications and documented as required?

  Yes

  No

  N/A

• g) All ladders are in good shape and being used appropriately?

  Yes

  No

  N/A

• h) 3 Point Contact stickers or signs are positioned at the ladderways or access points of all plants and mobile equipment

  Yes

  No

  N/A

• Working at Heights - overall review

  Excelling

  Practicing

  Implementing

  Developing

  N/A

• Additional comments / notes

• a) Operators of Cranes >2,000 lbs capacity have received training from an outside third party (i.e. truck mounted cranes, overhead and gantry cranes, etc.) including rigging and lifting training.

  Yes

  No

  N/A

• b) Operators of Hoists of any capacity have received training from a competent person in the use of the specific device as well as rigging and lifting training?

  Yes

  No

  N/A

• c) Operators of loaders and excavators, where buckets are used for lifting, have received training in rigging and lifting.

  Yes

  No

  N/A

• d) Are employees trained and understand that 50 lbs is the maximum weight of any object that one employee should attempt to lift manually by themselves. Heavier objects require lifting by mechanical means or with assistance. Tasks which require >50 lb objects to be lifted by one person should be reviewed and, if possible, redesigned.

  Yes

  No

  N/A

• e) All cranes greater than 2,000 lbs capacity are inspected annually by a qualified outside third party.

  Yes

  No

  N/A

• f) Lifting equipment and hoists of any capacity are inspected on at least an annual basis by a competent person.

  Yes

  No

  N/A

• g) All lifting equipment, hoists and cranes have their safe working load limit identified on the lifting device

  Yes

  No

  N/A

• h) All lifting implements such as straps, cables and chains have their load limit identified, as applicable.

  Yes

  No

  N/A

• i) All employees know to never use chains to pull out stuck trucks or equipment (i.e. stuck in the mud). Tow ropes, recovery straps or other devices of sufficient strength designed for this purpose should be used - NEVER Chains.

  Yes

  No

  N/A

• j) If chains are used for lifting, they are visually inspected before each use and then monthly with a documented inspection record which includes the date of the inspection, the signature of the person who performed the inspection and an identity of the chain which was inspected.

  Yes

  No

  N/A

• Lifting Operations - overall review

  Excelling

  Practicing

  Implementing

  Developing

  N/A

• Additional comments / notes

• a) Documented policy and/or risk assessment for underground and overhead work in place.

  Yes

  No

  N/A

• b) A site survey for utility lines is always conducted and documented before underground work is carried out on-project or facility sites

  Yes

  No

  N/A

• c) All employees and operators are aware to stay at least 10 feet away from power lines. As such, spotters are used in situations where power lines are nearby to observe and warn operators to stay at least 10 feet away.

  Yes

  No

  N/A

• Underground and Overhead Utility Dangers - overall review

  Excelling

  Practicing

  Implementing

  Developing

  N/A

• Additional comments / notes

• a) Documented Personal Protective Equipment (PPE) Policy in place for all areas of operation/tasks.

  Yes

  No

  N/A

• b) Employees are wearing Class III vests.

  Yes

  No

  N/A

• c) Do you inform contractors of our PPE requirements and do you periodically observe that they are wearing it.

  Yes

  No

  N/A

• d) Are daily visual inspections of PPE are carried out by employees at your facility/location prior to use.

  Yes

  No

  N/A

• e) If the exposure to live or potentially live electrical conductors exists, then NFPA 70E compliant PPE is made available and used.

  Yes

  No

  N/A

• f) If an asphalt plant: PPE is available and used per policy for exposure to hot liquid asphalt cement during line breaking, line connecting, sampling, loading and offloading activities, etc. (both employees and contractors)

  Yes

  No

  N/A

• g) If an asphalt plant: All affected employees understand and adhere to the AMAT Guidance and Control Strategies regarding Hydrogen Sulfide (H2S) exposure? (as outlined in the Reference Bulletin)

  Yes

  No

  N/A

• h) If respirators are required to be used (other than dust masks worn on a voluntary basis) employees are medically qualified, trained and fit tested for respirator use.

  Yes

  No

  N/A

• i) Arc flash gear is currently certified (gloves) and apparel matches exposure.

  Yes

  No

  N/A

• Use of Personal Protective Equipment (PPE) - overall review

  Excelling

  Practicing

  Implementing

  Developing

  N/A

• Additional comments / notes

• a) Facility compressed air systems are inspected / checked periodically by a qualified third party inspector and have current certifications.

  Yes

  No

  N/A

• b) Regular documented checks of pressure relief systems on pressurized conveying systems are conducted by a competent person at your facility / location, as applicable.

  Yes

  No

  N/A

• c) Compressed gas tanks are separated and stored properly.

  Yes

  No

  N/A

• d) Are employees aware that compressed air should not be used for cleaning personnel or clothing, and that compressed air used for cleaning other surfaces or objects must be regulated down to less than 30 psi.

  Yes

  No

  N/A

• e) All employees who work with pressurized systems have been trained in the proper usage of that system and the training documented.

  Yes

  No

  N/A

• Conveyance and Storage of Materials under Pressure - overall review

  Excelling

  Practicing

  Implementing

  Developing

  N/A

• Additional comments / notes

• a) Documented "Safe Blast Policy" in place.

  Yes

  No

  N/A

• b) Contractors have signed acknowledgement stating that they have received the AMAT Blasting Policy

  Yes

  No

  N/A

• c) Employees have received blasting awareness training,

  Yes

  No

  N/A

• d) Pre-blast reviews are being conducted/documented.

  Yes

  No

  N/A

• e) All personnel carrying out blasting operations are trained in site specific rules (employees and contractors).

  Yes

  No

  N/A

• f) Blasting records are kept on site and operating records of all blasts are maintained.

  Yes

  No

  N/A

• Blasting Operations (if applicable)- overall review

  Excelling

  Practicing

  Implementing

  Developing

  N/A

• Additional comments / notes

• a) Employees are involved in a Safety Leadership Team (SLT), Safety Committee, Employee Workgroup or similar effort where problem solving is performed through employee ideas and input?

  Yes

  No

  N/A

• b) Employee engagement efforts such as near miss reporting, behavior observations, leading training, mentoring others, etc, are robust.

  Yes

  No

  N/A

• Employee Operations - overall review

  Excelling

  Practicing

  Implementing

  Developing

  N/A

• Additional comments / notes

• a) All road crews have knowledge of and understand the AMAT Backer Spotter policy.

  Yes

  No

  N/A

• b 0 MOT personnel and flaggers have been trained according to their duties.

  Yes

  No

  N/A

• c) All equipment is outfitted with sufficient retro-reflective tape to be seen at night and the tape is clean and in working order.

  Yes

  No

  N/A

• d) A copy of the most current MUTCD/state/local/project specific traffic control standards are immediately available for review on all projects.

  Yes

  No

  N/A

• e) All equipment operating in a work zone is equipment with flashing lights as applicable.

  Yes

  No

  N/A

• f) All work zone traffic control is inspected and documented by a competent person.

  Yes

  No

  N/A

• g) All work zone employees have received workzone awareness training.

  Yes

  No

  N/A

• h) All reverse systems, echo location systems, back-up alarms, including those of contractors, are working properly.

  Yes

  No

  N/A

• i) Work zone employees are familiar with the Work Zone Intrusion Prevention Manual.

  Yes

  No

  N/A

• j) An ITCP has been created and is being used to control internal movement.

  Yes

  No

  N/A

• k) Employees are aware of the 10-foot rule when working around equipment and the 20-foot rule for safe distance from roller to paver.

  Yes

  No

  N/A

• Workzone Safety - overall review

  Excelling

  Practicing

  Implementing

  Developing

  N/A

• Additional comments / notes

• a) Employees are aware of the company's 5S program?

  Yes

  No

  N/A

• b) Is the 5S program being sustained? Is it an ongoing process? Are your ratings current and posted at the facility?

  Yes

  No

  N/A

• Additional comments / notes

• Inspected by:

  Sign