Information
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Document No.
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Client / Site
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Date Prepared
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Work Conducted On
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Prepared By
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Reviewed By
HAZARDS
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List Potential Hazards;
- Noise
- Falling Debris
- Working at Heights
- Public in Work Area
- Hot Works
- Heavy Lifting
- Difficult Comunication
- Pinch Hazard
- Night Work
- Energized Equipment
- Dust Inhalation
- Open Excavation
- Restricted Vision
- Trip Hazard
- Water on Ground
- Buried Services
- Open Excavation
- Engineering Required
- Critical Lift
- Heavy Equipment
- Traffic in Work Area
- Asbestos Onsite
- Overloaded Equipment
- Fall Hazard
- Lead Paint
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Other;
ACTION TAKEN
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List Preventative Action Taken;
- Toolbox Meeting
- Safe Work Reviewed Daily
- Trained Operators
- Equipment Working Properly
- Maintain PPE
- Maintain Fencing and Hoarding
- Traffic Control Personel
- Follow Silica Control Policy
- Follow Asbestos Control Policy
- Asbestos Hazard Assessment Kept Onsite
- Maintain Proper Lighting Levels
- Follow Equipment Operating Instructions and Manufacturers Specifications
- Demolition Personnel are not Able to Cut Connected Cables
- Call to Locate Buried Wires
- Maintain Housekeeping
- Employees are Briefed on Emergency Policy and Evacuation Plan
- Wetting of Concrete
- Vacuuming of Slurry
- Negative Air Units
- Assure Discharge Air Does Not Effect Others
- Maintain Eye Contact with Operators
- Use of Fall Protection Equipment
- Use of Hot Work Procedure
- Load Calculations Completed
- Proper Lifting Procedure
- Use of Spotter
- Cover Open Holes
- No Excavations Over 4ft to be Entered
- Fall Protection Plan
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Other;
PERSONAL PROTECTIVE EQUIPMENT
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List PPE Required;
- Hard Hat
- Steel Toed Boots
- Eye Protection
- Face Sheild
- Hi Viz Vests
- Gloves
- Fall Protection Equipment
- Hearing Protection
- Half Mask Respirator
- Full Face Respirator
- Dust Mask
- P100 Filter
- Organic Vapors Filter
- Co Monitor
- Welding Glasses
- Welding Gloves
- Welders Smock
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Other;
EQUIPMENT ONSITE
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List Equipment Used;
- Negative Air Unit
- Crane
- Excavator
- Skidsteer
- Air Compressor
- Coping Fans
- Poly Sheeting
- Hoarding
- Site Fencing
- Slurry Vac
- Concrete Saw
- Site Fencing
- Gas Axe
- Telehandler
- Man Basket
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Other;
PROCEDURE
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List Procedure in Point Form;
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If needed
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If needed
SIGNATURES
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Div 2 Forman Signature
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Site Superintendent Signature
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Safe work procedure reviewed by workers?
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