Cyma Builders and Construction Managers- Site Safety and Health Audit - 5/6/2021

• Document No.

• Project Name

• Auditor

• Location
  Address

• Conducted on

  Date

• Contractors

Administrative Job Site Requirements

• Active construction area clearly barricaded or identified in field?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Emergency contact information, egress routes and evacuation muster points posted and identified?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Area urgent and emergency healthcare facilities posted?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Standard Cyma construction area warning signage posted at project entry points?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Client or facility-specific construction signage or notifications posted?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Project-specific Safe Work Plans (SWP), Health and Safety Plans (HASP), etc. in place and properly implemented?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

JSA COMPLIANCE

• JSAs readily accessible in the field?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are all JSAs reviewed and approved by Cyma EHS?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Onsite Contractor JSA Audit Review; audit at least one JSA per active contractor.

• Name of Contractor?

• Name of JSA?

• Does the JSA adequately capture the scope of work?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• What is missing from JSA or what needs expanded in JSA?

• Is the JSA signed by the contractors working on the job?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Onsite Contractor JSA Audit Review; audit at least one JSA per active contractor.

• Name of Contractor?

• Name of JSA?

• Does the JSA adequately capture the scope of work?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• What is missing from JSA or what needs expanded in JSA?

• Is the JSA signed by the contractors working on the job?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Onsite Contractor JSA Audit Review; audit at least one active JSA per active contractor.

• Name of Contractor?

• Name of JSA?

• Does the JSA adequately capture the scope of work?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• What is missing from JSA or what needs expanded in JSA?

• Is the JSA signed by the contractors working on the job?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Training and Competency

• Client site safety orientation process in place?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Cyma contractor safety orientation process implemented?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Contractor Foreman/ Competent Persons OSHA 10-Hour Construction Safety Trained?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Competent Persons identified in writing by contractors?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Daily Safe Plan of Action (SPA); audit minimum of one SPA per active contractor.

• Daily SPA accurately reflects work, means/ methods, and precautions?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Daily SPA reviewed and signed by Superintendent or representative?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Daily SPA readily accessible in the field?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Daily SPA completed and signed by contractor Competent Person and contractors performing the work?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Daily SPAs are closed and end of day affirmation signed?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Identified changes to means/ methods/ precautions on SPA reviewed and approved by Cyma representative?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

COVID-19 Mitigation

• COVID-19 Management Plan for project/ site approved and current?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Client COVID-19 screening process implemented for contractors?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Cyma Daily Pandemic Self-Assessment completed by all contractors and visitors?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• COVID-19 signage posted clearly?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Sanitation facilities and hand washing facilities available and stocked?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Routine (3-4 times daily) touchpoint sanitization being conducted?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• All workers and visitors wearing fabric or surgical mask face-covering? Bandanas and neck gaiters prohibited.

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• All workers maintaining 6' distance at all times?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Proximity Work Guidance being implemented for work requiring workers to be within 6' of others?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Do workers have a COVID-19 Pre-Task Safety Planning in place for activities which are infeasible to complete while maintaining 6' of distancing at all times?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Break and lunch accommodations made to maintain 6' distance?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Tools not being shared or being sanitized between users?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Housekeeping

• Are materials stored properly?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is trash being centered piled and collected routinely throughout work day?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Has construction dumpster been designated and located for the project?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is the dumpster appropriately sized and properly managed for pick ups?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is the dumpster safely accessible with secure ramps in place?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is dumpster door secured open if workers must access dumspter?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Dumpsters are covered each night or when not in use?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are the walking and working surfaces clear, clean, trip hazards eliminated?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

PPE

• ANSI Z87 compliant safety glasses, or equivalent, in use by everyone on the project?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• ANSI Z41 compliant safety toe footwear in use by everyone on the project?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Cut resistant gloves meeting ANSI Cut Level 3 or highre in use by everyone on the project?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Hard hats in use by everyone on the project?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Multi-directional impact rated hard at with chin-strap in use during PFAS use where required?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• ANSI Class 2 high visibility outerwear in use when required: around mobile equipment, in active lots and roads and in low light situations?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Additional PPE identified in JSA or SPA in use? i.e. hearing protection

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• All PPE is in safe working condition and fit for use?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• PPE available for visitors to active construction site?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is respiratory protection in use? (voluntarily or required)

  Yes

  N/A (Not Applicable or Not in Use)

• Is Medical Clearance and Fit testing verified for tight fitting cartridge respirator users?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Respiratory users clean shaving?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Lack of airborne hazard verified by Cyma EHS prior to implementation of voluntary use respirators?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Voluntary users of respirators provided with 1910.134, Appendix D, Information for Employees using Respirators When Not Required?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Fall Protection

• NOT including LADDERS/MEWPs. Is elevated work 6' or more above a lower level detailed in a Fall Protection Work Plan approved by Cyma EHS?

  Yes

  N/A (Not Applicable or Not in Use)

• Post fall-event response identified and documented in Fall Protection Work Plan?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Working at Height/ Elevated Work Permit in place and properly excuted?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Adequate fall height clearance and swing fall clearance confirmed?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Personal Fall Arrest Systems use is compliant with approved Fall Protection Work Plan and applicabl permits?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• PFAS components are compatible, inspected and in safe working order?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• PFAS anchorage points are properly rated and are either engineered or evaluated by a Qualified Person?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Suspension trauma straps are in use when PFAS is used?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Leading edges, hole openings, excavation, etc. greater than 6' from a lower level protected by compliant guardrail, warning line system or covered and identified as required?

  Yes

  N/A (Not Applicable or Not in Use)

• Guardrail meet 1926.502(b) and rails are capable of withstanding 200lbs at the top rail with top rail at 42" (+/-3") and middle railing at 21" or midway between surface and top rail?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Warning Lines meet 1926.502(f)(2) with flags every 6' at a height 34-39" and a breaking strength of 500LBS.

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Warning Lines are erected at 15' (6' for roofing activity) from unprotected edge and access routes within 15' (6' for roofing activity) of unprotected edge are protected by guardrail?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Where applicable, Leading Edge rated PFAS equipment is in use?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Holes or openings in walking and working surfaces are covered with covers secured in place, marked 'HOLE' or 'COVER' and meeting or exceeding Cyma's additional requirements?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Overhead hazards have been identified, secured, removed or protected (debris nets, toe boards, etc.) have been implemented?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Fire Safety and Hot Work

• 10LBS ABC fire extinguishers available with in 50 feet of work with one extinguisher for every 3000 square feet of project area?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are all fire extinguishers currently inspected, tagged and located prominently in work area?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are contractors trained in proper fire extinguisher use?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is hot work being performed?

  Yes

  N/A (Not Applicable or Not in Use)

• Is all work involving flame/sparks detailed on the daily Hot Work Permit for each contractor performing hot work activities?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• All precautions detailed on Hot Work Permit are in place and permit is properly excecuted?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Combustibles including paper, plastic, wood, drywall, cardboard, etc. are moved at least 35' from hot work or protected with fire blankets?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Hot work equipment in safe working order with cylinders secured upright, functional gauges, flash back arrestors in place, etc.

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Compressed gas cylinders are secured upright, fuel separated from oxygen by 25' or fire rated divider, regulators removed and valve protector caps installed when in storage?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Welding equipment is in safe working order with intact leads, local disconnect, secure electrical connections, etc.?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Dedicated and trained fire watch on duty during and for one hour after Hot Work?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Periodic fire watch on duty for required duration after dedicated fire watch?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are the sprinkler heads and fire protection systems unobstructed ( sprinkler heads clear by 18'' or greater)?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Fire system (fire/ smoke detection, horns/ strobes) impairments are managed with Fire System Impairment Permit?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Egress routes and stairwells clear of combustible or flammable materials?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are flammable and combustible materials stored properly?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

General Safety

• Have findings from the previous weeks audit been corrected or addressed?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• List any outstanding safety violations from previous audits:

• Is work area properly illuminated?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Temporary light properly installed with guards/ cages in place, if applicable?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is equipment guarding in place as per manufacturers instructions?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are tools and equipment inspected and in good condition prior to use?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Ladders/ Stairs/ Scaffolds.

• Are stairs provided where there is a change in elevation >19'' ( EU >0.5m), and secured?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are stairs greater than 4 risers all equipped with a hand rail?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is any scaffolding in use?

  Yes

  N/A (Not Applicable or Not in Use)

• Is scaffolding built by a qualified competent erector, built correctly, secured, tagged correctly? (check mudsills or locked wheels)

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Does the scaffolding have safe access and egress for workers?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are all scaffold inspected daily by a Competent Person?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are system or supported scaffolds Green Tagged?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are mobile/ rolling scaffold wheels locked?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are Holes/penetrations protected with secured covers labeled "HOLE" or barricaded?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Cyma-specific hole and cover guidelines adhered to?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is the scaffolding protected for use by unauthorized persons, is there a swing gate which can be locked when no one is working?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are ladders in use?

  Yes

  N/A (Not Applicable or Not in Use)

• Are ladders in good condition? Labels, rings, feet...

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are all ladders fiberglass and rated minimum Type 1A?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are all ladder labels and warnings present and legible?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are ladders being stored correctly?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are ladders in use being used safely and as intended?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are ladders setup on solid ground with braces fully engaged and locked with all four feet supported on flat floor?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Ladders are NOT placed in front of doorway, emergency exit route or in the way of any other construction equipment.

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• The waist of the ladder user is NOT above the top step and workers are not twisting body excessively reaching to work while on ladder?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are extension ladders being used safely with proper pitch, ladder secured and a 36 inch overhang?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are platforms protected by handrail, midrail and toe board?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Crane Lifting / Rigging.

• Is there a scheduled Lift today?

  Yes

  N/A (Not Applicable or Not in Use)

• Has the lift plan and permit been completed and reviewed with all affected personnel?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are there trained signalperson in "line of sight" of operator or other means of communication with operator?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Has the qualified rigger inspected all lifting equipment prior to use?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• All rigging (standard and specialty or custom) is in safe working order, tagged, compatible and properly rated?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Has the crane set up area been properly barricaded?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Has the crane erection area been surveyed for subsurface utilities or installations?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is crane equipped with Load Management Information System (LMIS)?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is crane equipped with wind speed monitor (anemometer) or is wind speed being monitored in real time?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Anti-two block safety device present and functional?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Have all the areas within the swing radius been evacuated and notified, with proper signage , barricaded with danger tape and evacuated?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are tag lines being used to control the load?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Spill containment deployed or kit available?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is crane erected level with proper outrigger cribbing?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Outrigger safety pins present?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Has the crane inspections been completed and documented?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Excavation and Trenching

• Is there an active Excavation on site during audit?

  Yes

  N/A (Not Applicable or Not in Use)

• Has Excavation Competent Person been identified and documented?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Has Competent Person classified the soil?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Has utility One Call/ Miss Utility notification been made by excavator? (Verify)

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Utility mark out is clear with field marks being properly maintained?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is the excavation laid out in white paint?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Has the excavation permit been reviewed and completed?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Has utility location taken place? 25 feet outside the perimeter of the excavation? Verify report

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are the trenches/ excavations sloped properly or shored and barricaded?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is shoring and shielding properly selected, compatible, inspected and installed?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Tabulated data onsite?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Structural stability of adjacent structures maintained?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Spoils and heavy materials not stored within 24" of excavation?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is trench/ excavation greater than 4ft?

  Yes

  N/A (Not Applicable or Not in Use)

• Are there proper egress in place, ladders no more than 25' apart?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is this a HAZWOPER site and if yes is training verified?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Has a weather event occurred since initial evaluation from a Competent Person?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Confined Space

• Are all confined spaces on the project identified and labeled by the site and/ or Cyma?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are all permit required confined spaces identified and labeled by the site and/ or Cyma?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is confined space being performed and applicable for this audit?

  Yes

  N/A (Not Applicable or Not in Use)

• Entrants, Attendants and Entry Supervisors confined space trained?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are permit required confined spaces being reclassified or Alternate Procedure entries made being using Cyma documented process?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Confined Space Permit in place and properly executed for permit required entries?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Confined space Attendant maintaining Entrant log properly?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Confined space Attendant has radio, cell phone or other means of communicating with site security or emergency services?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Confined space Attendant maintaining atmospheric monitoring log properly?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Non-entry rescue system in place for permit required entries?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Entry rescue team or service confirmed available? Explain answer.

• Pre-entry 4 gas atmospheric testing conducted at various levels/ areas in permit required confined space?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• 4 gas atmospheric testing conducted before and continuously during entry?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Atmospheric monitor calibrated and bump tested properly?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Proper forced air ventilation in place before and continuously throughout entry?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Ventilation intake well away from space exhaust or other sources of contamination?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Confined spaces are locked and tagged out, drained/ purged, pumped out, cleaned, etc. prior to entry?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Material Handling and Heavy Equipment

• Is there motorized heavy equipment being used?

  Yes

  N/A (Not Applicable or Not in Use)

• Has the proper pre-operational inspection been performed and documented?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Pre-mobilization equipment inspection documentation provided?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Spill kit onsite and available in equipment operation area?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Do the operators have the proper training for the equipment being used?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are seat belts used by all operators?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Do the motorized vehicles have proper back up alarm?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Equipment has visible or audible operational travel indictor?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are flaggers in place where needed?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Equipment operation area barricaded?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is the rollover protection system (ROPS) in place and maintained?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• No field or owner made modifications made to equipment or attachments?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Forklift/ telehandler attachments are approved in writing by forklift/ telehandler manufacturer?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Equipment capacity rating recalculated with attachment use?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Equipment capacity is adequate for intended loads?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is the equipment operated more than 20' away from power lines?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Equipment tuned off and keys removed when unattended?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Fueling of equipment detailed in approved JSA?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• No onsite repair or maintenance of equipment?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Mobile Elevated Work Platforms (MEWPs)

• Is Mobile Elevated Work Platforms(MEWPs) in use?

  Yes

  N/A (Not Applicable or Not in Use)

• Has the proper pre-use inspection and functional tests been performed and documented?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Does the operator have the proper training for the equipment being used?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is the operator using the proper harness and tie-off points? (i.e. approved engineer anchor points)

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• MEWPs being used safely? Feet on surface, not using mid rail or toe board to stand on, not leaning outside lift?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Do MEWPs have proper travel alarms or indicators?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• MEWPs path is clear and free of clutter, holes, etc.?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• MEWPs operational area is level?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is the chain or gate closed on MEWPs?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is the equipment operated more than 20' away from power lines?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are the materials being carried or stored on MEWP within the confinement of the platform?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Barricades or spotter in place when needed?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Electrical Safety.

• Electrical tools and equipment left in a safe state if unattended?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Temporary power provided and inspected by Qualified Person?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Extension/ power cords routed to avoid creating a trip hazard?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are cords in good condition, no cuts or repairs?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is there a 3ft clear distance around electrical panel?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are GFCI's being used and closest to the power source?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• All electrical tools are Double Insulated or third-prong grounded?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Extension cords not plugged in to extension cords?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Control of Hazardous Energy/ LOTO

• Are sources of hazardous energy locked and tagged out?

  Yes

  N/A (Not Applicable or Not in Use)

• All employees involved in LOTO are properly trained in hazardous energy control?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Employees exposed to hazardous energy each have their own tag and lock and with separate key on energy control points?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• LOTO permit or plan implemented to document control of hazardous energy?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Cyma Superintendent participating in LOTO with locks and tags at energy control points?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are tags legible with name, company and contact information listed?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Has all residual or potential energy been released or secured?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Hazard Communication/ GHS

• Are SDSs submitted and reviewed with JSA?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are SDSs available for review onsite?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are all chemicals properly labeled?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Chemicals properly stored?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Chemical quantities onsite acceptable?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Chemical stored in secondary containment?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are personnel trained in the chemicals they are handling?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Spill kit stocked and present?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Environmental/ Waste Stream

• Have all proper barricades been put in place to minimize cross contamination?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Concrete washout containment available and serviced regularly?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are the concrete truck washout procedures being followed?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is the waste handling and disposal of hazardous waste being executed properly?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is secondary containment in place where needed?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Is threading machine catch box in place?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Are storm sewers and drains protected?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Contaminated areas identified and assessed?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• Residual waste properly labeled and stored?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

Corrective actions and supplemental comments.

• Safety and health observations were reviewed in the field with appropriate contractors when possible?

  Select Yes Yes W/Immediate Fix Good Practice to Recognize Needs Improvement No N/A

  • Yes
  • Yes W/Immediate Fix
  • Good Practice to Recognize
  • Needs Improvement
  • No
  • N/A

• General Comments

Stakeholders

• Project Superintendent

  Sign

• Project Superintendent Optional Comments:

• Auditor

  Sign

• Auditor Optional Comments: