Audit

CWP Plan

Cost code:

Plan Number:

Start Date:

Select date

Expiration Date:

Select date

Plan Creator:

Engineer:

EHS Professional:

Site Specific Hazards and Controls

This section is designated for Site Specific Hazards & Controls, meaning hazards that are present for every task on the project. Therefore, the entered information will appear on all plans for the jobsite.

A typical example would be biological hazards at a sewage treatment plant job. All plans at this job site should address the health risk for working near sewage, and how to address.

Further detailed information would be found in the hazard analysis section. This area allows you to bring to everyone's attention some key concerns on the front page of the plan. Please note that unused spaces can be left blank.

Revision Notes

Notes

Access to Area

This access section is for existing safe pathways to the work area. if access needs to be created, then that work should be put in the Scope of Work ( below ) of this plan or a separate plan.

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PPE & Safety Equipment

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Specific PPE
Emergency Action Plan
Superintendents Name:

For medical attention, alert supervisor. Call 911 if needed.

EHS Manager's Name:

Engineer's Name:
Muster Points:
Clinics Name:

EMERGENCY CONTACT INFORMATION:

4510 Executive Drive #107,
San Diego, CA
(858) 457 4717

EMERGENCY CONTACT INFORMATION:

354 Santa Fe Drive
Encinitas CA
(760) 633-6501

Scope of Work
Step

Describe the step-by-step sequence of work that will accomplish the task at hand. Keep the text simple and direct. Include work needed to: Create access to the work area and other prep work Make the area safe at the end of each day Leave the area in its final state Don't leave gaps in your work plan. Have another person read the plan to see if they can follow the steps without questions. If you need more than 5 steps, consider whether the task may require more than one plan.

Scope of Work Categories

Triggers
Task Environment
Equipment
Tools
Materials
Hazard Awareness Acknowledgment
Risk Control Adequacy Statement

SUPPORT - Is the type / amount / capability / condition of support adequate to carry out the activity?

Personnel

Supplies

Equipment & Materials

STANDARDS - Is guidance adequately clear / practical / specific to control the hazards?

TRAINING - Is training adequately thorough and recent to control the hazards?

LEADERSHIP - Is the project management team ready, willing, and able to enforce the standards required to control the hazards?

CWP Acceptance
Project Manager
Superintendent
EHS Professional
Foreman
Crew Members
Crew Member
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Hazards Identified


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Environmental Aspects

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Unforeseen Conditions
New Job Steps
Step

Describe the step-by-step sequence of work that will accomplish the task at hand. Keep the text simple and direct. Include work needed to: Create access to the work area and other prep work Make the area safe at the end of each day Leave the area in its final state Don't leave gaps in your work plan. Have another person read the plan to see if they can follow the steps without questions. If you need more than 5 steps, consider whether the task may require more than one plan.

Triggers
Additional PPE
Additional Controls Checklist
Additional Controls Checklist

Approvals
If conditions exist beyond the printed plan which are written here, each employee involved in the job will review and sign this analysis before beginning work.

Crew Member
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Lessons Learned

Things Done Well - - Keep Doing

Things That Didn't Contribute - - Stop Doing

Things We Could Do Better - - Start Doing

Please note that this checklist is a hypothetical example and provides basic information only. It is not intended to take the place of, among other things, workplace, health and safety advice; medical advice, diagnosis, or treatment; or other applicable laws. You should also seek your own professional advice to determine if the use of such checklist is permissible in your workplace or jurisdiction.