DASHIELL JOB SITE SAFETY REVIEW

• Client / Site

• TO: (Department Head)

• Job Name/Number

• Foreman/Supervisor

• Select applicable response

  Complete

  Open

• Conducted on

  Date

• Prepared by

• Location
  Address

• 
  INSTRUCTIONS:
  -------------------------------------
  
  1. Fill out required fields and answer other questions as needed.
  2. Add photos and notes/remarks by clicking on the paperclip icon.
  3. To add a Corrective Measure, click on the paperclip icon then click on "Add Action". Provide a description, assign to a member, set priority and then set the due date.
  4. Complete audit by providing a digital signature.
  5. Share your report by exporting as PDF, Word, Excel or Web Link.
  
  
  LEGEND:
  
  • Yes = Satisfactory
  • IC = Immediately Corrected
  • CN = Correction Needed
  • N/A = Not Applicable/Not Observed
  
  

• TASK DESCRIPTION:

JOB SITE SAFETY

1. SAFETY MANUAL

• a. Safety Manual (On Site)

  YES

  IC

  CN

  N/A

2. EMERGENCY PLAN

• a. Emergency Plan in Place

  YES

  IC

  CN

  N/A

3. JSTA

• a. Job Safety Task Analysis in Place/Signed by All

  YES

  IC

  CN

  N/A

4. JOB BRIEFING/TAILBOARD

• a. Job Briefing/Tialboard

  YES

  IC

  CN

  N/A

5. PERSONAL PROTECTIVE EQUIPMENT

• a. Hard Hats

  YES

  IC

  CN

  N/A

• b. Eye Protection (All Levels)

  YES

  IC

  CN

  N/A

• c. Welding Helmet

  YES

  IC

  CN

  N/A

• d. Respiratory Protection

  YES

  IC

  CN

  N/A

• e. Proper Work Clothing

  YES

  IC

  CN

  N/A

• f. Proper Foot Wear

  YES

  IC

  CN

  N/A

• g. Proper Hand Protection

  YES

  IC

  CN

  N/A

• h. Hearing Protection

  YES

  IC

  CN

  N/A

• i. Other

  YES

  IC

  CN

  N/A

6. LOCKOUT/TAG OUT

• a. Required For The Task

  YES

  IC

  CN

  N/A

• b. Properly Installed/Effective Isolation

  YES

  IC

  CN

  N/A

7. ENERGIZED ELECTRICAL WORK

• a. Is Line/Equip. De-Energized/Grounded

  YES

  IC

  CN

  N/A

• b. Energized Work Permit Required

  YES

  IC

  CN

  N/A

• c. Gloves/Sleeves-Dielectrically Tested

  YES

  IC

  CN

  N/A

• d. Used As Required @ > or = to 50 Volts)

  YES

  IC

  CN

  N/A

• e. Rubber Blankets Or Dielectric Cover

  YES

  IC

  CN

  N/A

• f. Exposed Energized Parts Covered

  YES

  IC

  CN

  N/A

• g. Rubber Goods Properly Stored

  YES

  IC

  CN

  N/A

8. HAZ./FLAMMABLE MATERIAL

• a. Proper Storage

  YES

  IC

  CN

  N/A

• b. Properly Labeled

  YES

  IC

  CN

  N/A

• c. Plan/MSDS Available

  YES

  IC

  CN

  N/A

• d. Used Properly & Safely

  YES

  IC

  CN

  N/A

9. WELDING

• a. Proper Welding/Cutting Equipment

  YES

  IC

  CN

  N/A

• b. Fire Extinguisher Available

  YES

  IC

  CN

  N/A

• c. Gas Cylinders Properly Stored

  YES

  IC

  CN

  N/A

10. FALL PROTECTION

• a. Harness & Lanyard (Inspected/In use)

  YES

  IC

  CN

  N/A

• b. Proper Tie Off Used

  YES

  IC

  CN

  N/A

• c. Other Fall Protection Components

  YES

  IC

  CN

  N/A

11. LADDERS/SCAFFOLDS

• a. In Safe Working Condition

  YES

  IC

  CN

  N/A

• b. Used Properly (Tied Off)

  YES

  IC

  CN

  N/A

• c. Inspected/tagged/color coded

  YES

  IC

  CN

  N/A

12. WORKSITE CONDITIONS

• a. Barricades / Hole Covers

  YES

  IC

  CN

  N/A

• b. Housekeeping Adequate

  YES

  IC

  CN

  N/A

• c. Fire Extinguishers Inspected

  YES

  IC

  CN

  N/A

13. TEMPORARY POWER

• a. Temp. Panels (Adequate)

  YES

  IC

  CN

  N/A

• b. GFCI's (Installed & Tested)

  YES

  IC

  CN

  N/A

• c. Cords Inspected/color coded

  YES

  IC

  CN

  N/A

• d. Temp. Lighting (Adequate)

  YES

  IC

  CN

  N/A

14. EXCAVATIONS

• a. Competent Person Available

  YES

  IC

  CN

  N/A

• b. Checklist (In Use/Correct)

  YES

  IC

  CN

  N/A

• c. Shored Or Sloped Properly

  YES

  IC

  CN

  N/A

• d. Access Ladders Within 25'

  YES

  IC

  CN

  N/A

15. CONFINED SPACES

• a. Permit Required/Posted

  YES

  IC

  CN

  N/A

• b. Rescue Available

  YES

  IC

  CN

  N/A

• c. Monitor/Blower In Use

  YES

  IC

  CN

  N/A

16. HOISTING & RIGGING & CRANES

• a. Equipment Inspected

  YES

  IC

  CN

  N/A

• b. Critical Lift Checklist Used

  YES

  IC

  CN

  N/A

17. TOOLS (Observed)

• a. Safe Working Condition

  YES

  IC

  CN

  N/A

• b. Proper Storage

  YES

  IC

  CN

  N/A

18. PROTECTIVE GROUNDS

• a. Inspected/Test Date Current

  YES

  IC

  CN

  N/A

• b. Installed Properly (Equal potential In Use)

  YES

  IC

  CN

  N/A

19. VEHICLES/EQUIPMENT

• a. Inspected (In safe condition)

  YES

  IC

  CN

  N/A

• b. Operator authorized/qualified

  YES

  IC

  CN

  N/A

20. MISCELLANEOUS (Job Site)

• a. First Aid/BBP Kit Avail.

  YES

  IC

  CN

  N/A

• b. Eyewash available

  YES

  IC

  CN

  N/A

• c. Is Drinking Water Fresh

  YES

  IC

  CN

  N/A

ADDITIONAL COMMENTS

• leave additional comments here

COMPLETION

• Auditor's Name and Signature

  Sign

• Supervisor/Foreman's Name and Signature

  Sign