CWC Site Safety Evaluation

• Job Name:

• Division:

• Personnel Involved:

• Conducted on:

  Date

• Prepared by:

• Overall impression of the site:

  Great

  Good

  Fair

  Poor

  N/A

• Estimated/Possible Citation Severity:

  $0

  $100-$500

  $500-$2,500

  $2,500- $5000

  Over $5,000

• Estimated/Possible Citations

General Requirements and Posting

• Have any Incidents occurred this month other than an injury?

  Yes

  No

  N/A

• Has anyone reported an Injury this week?

  Yes

  No

  N/A

• Is this site participating in Stretch & Flex?

  Yes

  No

  N/A

• Is a First Aid kit on site and well stocked?

  Yes

  No

  N/A

• Is there someone on site with a valid First Aid/CPR certification? (within 2 years)

  Yes

  No

  N/A

• Was a Safety Meeting held yet this week?

  Yes

  No

  N/A

• Is an SDS Packet on site?

  Yes

  No

  N/A

• Is there proper Eye Wash on site? Is it full, in the correct location?

  Yes

  No

  N/A

• Are Labels provided on all containers?

  Yes

  No

  N/A

• Are enough toilets provided on site?

  Yes

  No

  N/A

• Is there a way for workers to wash their hands?

  Yes

  No

  N/A

• Are Signs and Barricades used to protect the public set up properly & in good condition?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Coronavirus

• Have workers been asked if they have any COVID-19 symptoms prior to starting work?

  Yes

  No

  N/A

• Is 6’ Social Distancing being followed?

  Yes

  No

  N/A

• Are workers wearing face coverings?

  Yes

  No

  N/A

• Can workers wash or sanitize their hands?

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• Are all workers wearing Hardhats as needed or required?

  Yes

  No

  N/A

• Are all workers wearing the proper Eye Protection as needed or required?

  Yes

  No

  N/A

• Are workers wearing Face Shield when using a Grinder or Chop Saw?

  Yes

  No

  N/A

• Are workers wearing Hearing Protection as needed or required?

  Yes

  No

  N/A

• Are workers wearing the proper Gloves for the task?

  Yes

  No

  N/A

• Are workers wearing proper Work Boots?

  Yes

  No

  N/A

• Do workers have Steel Toe Boots or Metatarsal Guards on during required tasks?

  Yes

  No

  N/A

• Are workers wearing High Visibility as needed or required?

  Yes

  No

  N/A

• Did workers inspect PPE prior to the start of their shift?

  Yes

  No

  N/A

• Are workers wearing respirators?

  Yes

  No

  N/A

• Have they completed a Medical Questionnaire and been cleared?

  Yes

  No

  N/A

• Have they been fit tested?

  Yes

  No

  N/A

• Is it appropriate for their task?

  Yes

  No

  N/A

• Are they using the proper filters?

  Yes

  No

  N/A

• Is it being stored properly?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Fall Protection

• Are workers exposed to falls of 6' or more?

  Yes

  No

  N/A

• Are they protected by Guard Rails, Personal Fall Arrest, or other system?

  Yes

  No

  N/A

• Is the equipment installed correctly?

  Yes

  No

  N/A

• Is the equipment dated within 5 years old &/or in good condition?

  Yes

  No

  N/A

• Are proper tie-off points used?

  Yes

  No

  N/A

• Rope lines are anchored properly & protected from abrasion?

  Yes

  No

  N/A

• Have workers been trained in the use of these systems and using them correctly?

  Yes

  No

  N/A

• Has a Control Line been installed 15’ from leading edges?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Silica

• CWC Silica Exposure Control Plan on site?

  Yes

  No

  N/A

• Work is following Table 1?

  Yes

  No

  N/A

• Equipment & Attachments are being used according to manufacturer's instruction?

  Yes

  No

  N/A

• Signage posted?

  Yes

  No

  N/A

• Housekeeping done by wet sweeping or HEPA vacuum?

  Yes

  No

  N/A

• Workers understand Health Hazards associated with Silica exposure?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Fire Protection

• Do Safety Fuel Cans have flash arresting screen, self closing lid, pressure relief, and are properly labeled?

  Yes

  No

  N/A

• Is there a fire extinguisher immediately available for flammable supplies, materials, gas powered equipment, or tasks creating heat/sparks? 25’-100’

  Yes

  No

  N/A

• Are extinguishers charged, have current inspections, and are an adequate size?

  Yes

  No

  N/A

• Are adequate "NO SMOKING" signs provided in fuel storage areas?

  Yes

  No

  N/A

• Are flammables or incompatible materials stored properly?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Signs and Barricades

• Are Signs and Barricades adequate?

  Yes

  No

  N/A

• Is caution and danger tape being used properly and removed when not needed?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Rigging

• Is rigging inspected daily and in good condition when in use?

  Yes

  No

  N/A

• Is Defective Rigging marked & removed from service?

  Yes

  No

  N/A

• Are workers involved Certified Riggers?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Tools

• Are tools being inspected prior to use and used properly for the task?

  Yes

  No

  N/A

• Are tools requiring guards equipped with guards and in good condition?

  Yes

  No

  N/A

• Are accessory handles present on drills, grinders as required?

  Yes

  No

  N/A

• Are extension cords in approved condition?

  Yes

  No

  N/A

• Are workers using two hands when required?

  Yes

  No

  N/A

• Are workers trained to operate powder actuated tools & have their card?

  Yes

  No

  N/A

• Are hoses on air compressors secured with safety device?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Electrical

• Are GFCIs being being used for workers using power tools?

  Yes

  No

  N/A

• Are all electrical boxes, cords, receptacles, breakers, etc. being used for their intended use and UL rating?

  Yes

  No

  N/A

• Are cords & conductors protected from abbrasion?

  Yes

  No

  N/A

• Are generators grounded properly & using GFCI protection?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Ladders

• Are ladders inspected and in good condition with all required labels?

  Yes

  No

  N/A

• Are workers using ladders properly?

  Yes

  No

  N/A

• Step Ladders have the spreader bars locked & no worker is using the top 2 steps?

  Yes

  No

  N/A

• Extension Ladders are secured, extend 36 inches above landings or have grab bars installed, and have their ropes installed?

  Yes

  No

  N/A

• Is the ladder placed at the proper angle (1-4)?

  Yes

  No

  N/A

• Are job made ladders built properly (no double-headed nails)?

  Yes

  No

  N/A

• Are buckets being used to gain height?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Excavations

• Is the Competent Person present?

  Yes

  No

  N/A

• Do excavations 4 feet or deeper have proper access and egress within 25' of workers?

  Yes

  No

  N/A

• Are excavations 5 feet or deeper properly sloped, benched, or shored?

  Yes

  No

  N/A

• Have excavations 20’ feet or more been designed by a PE?

  Yes

  No

  N/A

• Spoils are kept a minimum of 2' from the excavation edge?

  Yes

  No

  N/A

• Are workers protected from falling into an excavation over 6 feet deep?

  Yes

  No

  N/A

• Trench boxes are in good condition, have all spreader bars & pins installed, sit 18” above grade, and aren’t more than 2’ from the excavation bottom?

  Yes

  No

  N/A

• Water is not accumulating in the excavation?

  Yes

  No

  N/A

• Have provisions been made to control water accumulation?

  Yes

  No

  N/A

• Is excavation properly barricaded and signs posted?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Floor and Wall Openings

• Do all Holes (2" or more) have covers?

  Yes

  No

  N/A

• Are Hole Covers secured, marked "Hole" or "Cover" and are capable of supporting intended loads?

  Yes

  No

  N/A

• Are workers/civillians protected from falling objects?

  Yes

  No

  N/A

• Do guardrails and stair rails meet OSHA requirements?

  Yes

  No

  N/A

• Are guardrail safety cables tight, flagged every 6' with high visibility material, & have properly installed U-clips?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Stairs

• Are steel stair pans & landings filled?

  Yes

  No

  N/A

• Is there access/egress for changes in elevation 19" or more?

  Yes

  No

  N/A

• Are stairs clear of debris?

  Yes

  No

  N/A

• Is there adequate lighting?

  Yes

  No

  N/A

• Are Stair Rails installed?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Equipment & Forklifts

• Does equipment have mirrors, fire extinguishers and required manufacturer labels?

  Yes

  No

  N/A

• Does equipment have a functional back-up alarm?

  Yes

  No

  N/A

• Are the operators driving equipment at safe speeds?

  Yes

  No

  N/A

• Are seat belts being used when required?

  Yes

  No

  N/A

• Is parking brake set and all forks and buckets lowered to ground when equipment is not in use?

  Yes

  No

  N/A

• Are the proper attachments being used and have approval from the manufacturer?

  Yes

  No

  N/A

• Are operators properly trained?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Welding and Cutting

• Are all cylinders secured in an upright position?

  Yes

  No

  N/A

• Are oxygen and acetylene bottles stored 20 feet apart or have a 5’ approved separator?

  Yes

  No

  N/A

• Is there at least one 10 lb. extinguisher within 50 feet of oxygen and acetylene storage areas?

  Yes

  No

  N/A

• Is there a fire watch for welding or cutting around combustible materials such as walls & floors?

  Yes

  No

  N/A

• Is there a 20# fire extinguisher available for welding activities?

  Yes

  No

  N/A

• Are welding leads free of repairs at least 10 feet from the stinger?

  Yes

  No

  N/A

• Are combustibles moved away or protected?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Scaffolds

• Is fall protection provided for workers erecting or dismantling scaffold?

  Yes

  No

  N/A

• Are scaffold set on firm, secure footings with base plates and mud sills?

  Yes

  No

  N/A

• Are scaffold components inspected and in good condition?

  Yes

  No

  N/A

• Has the scaffold been tied off every 25 feet in height (ties must be installed when the height of the scaffold is more than 4 times than the minimum base width)

  Yes

  No

  N/A

• Are scaffold boards properly overlapped and secured? (12")

  Yes

  No

  N/A

• Are the wheels locked on mobile scaffold?

  Yes

  No

  N/A

• Are rolling scaffolds moved correctly? (Not being surfed from platform)

  Yes

  No

  N/A

• Is fall protection and falling object protection provided?

  Yes

  No

  N/A

• Is there proper access/egress for scaffold platforms where reach is 2’ or more?

  Yes

  No

  N/A

• Is the area below the scaffolding barricaded or toe-boards erected?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Swing Stage Scaffold

• Are all workers properly tied off?

  Yes

  No

  N/A

• Is GFCI protection used for tools on the rig?

  Yes

  No

  N/A

• Motor cable guides are in good condition?

  Yes

  No

  N/A

• Emergency release control is in good condition?

  Yes

  No

  N/A

• Scaffold is properly grounded?

  Yes

  No

  N/A

• Tie backs are installed properly?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Aerial Lifts

• Has the equipment been inspected prior to use?

  Yes

  No

  N/A

• Are lifts set on level ground, per manufacturer's recommendations?

  Yes

  No

  N/A

• Are workers using proper fall protection?

  Yes

  No

  N/A

• Are lanyards/retractables attached to proper anchorage points?

  Yes

  No

  N/A

• Are workers remaining on the platform at all times?

  Yes

  No

  N/A

• Is the gate or chain closed when occupied?

  Yes

  No

  N/A

• Is operator trained?

  Yes

  No

  N/A

• Are tools and materials secured from displacement?

  Yes

  No

  N/A

• Do riders or workers nearby know what to do in an emergency?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Confined Spaces

• Are workers in a Confined Space?

  Yes

  No

  N/A

• Has a Confined Space Evaluation been done?

  Yes

  No

  N/A

• Are workers trained for Confined Space?

  Yes

  No

  N/A

• Is the space Permit Required?

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Completion

• Items marked Red/Failed must be addressed and corrected right away to mitigate injuries and/or non compliance with OSHA standards.

• Notes

• Necessary to follow up with written documentation, discipline, or training?

  Yes

  No

  N/A

• Where there any critical deficiencies?

  Yes

  No

  N/A

• Foreman's Name

  Sign

• Inspector's Name

  Sign

• "CWC IS COMMITTED TO MAINTAINING A HEALTHY WORKPLACE FREE OF INJURY FOR ALL EMPLOYEES"