Devore Middle Management Safety Inspection - Audit

• Conducted on

  Date

• Prepared by

• Location
  Address

• Completed On

  Date

1. Subcontractor Inspected

• Subcontractor Name

• Work Performed / Location

• CWP/JHA Package for work being performed is on site and signed

  Yes

  No

  N/A

• PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  Safe

  At Risk

  N/A

• Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  Safe

  At Risk

  N/A

• Fall Protection (Anything over 6' - At heights or leading edges)

  Safe

  At Risk

  N/A

• Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  Safe

  At Risk

  N/A

• Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  Safe

  At Risk

  N/A

• Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  Safe

  At Risk

  N/A

• Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  Safe

  At Risk

  N/A

• Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  Safe

  At Risk

  N/A

• Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  Safe

  At Risk

  N/A

• Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  Safe

  At Risk

  N/A

• Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  Safe

  At Risk

  N/A

• Any additional observations (Note them here)

  Safe

  At Risk

  N/A

• Subcontractor Name

• Work Performed / Location

• CWP/JHA Package for work being performed is on site and signed

  Yes

  No

  N/A

• PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  Safe

  At Risk

  N/A

• Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  Safe

  At Risk

  N/A

• Fall Protection (Anything over 6' - At heights or leading edges)

  Safe

  At Risk

  N/A

• Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  Safe

  At Risk

  N/A

• Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  Safe

  At Risk

  N/A

• Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  Safe

  At Risk

  N/A

• Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  Safe

  At Risk

  N/A

• Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  Safe

  At Risk

  N/A

• Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  Safe

  At Risk

  N/A

• Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  Safe

  At Risk

  N/A

• Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  Safe

  At Risk

  N/A

• Any additional observations (Note them here)

  Safe

  At Risk

  N/A

• Subcontractor Name

• Work Performed / Location

• CWP/JHA Package for work being performed is on site and signed

  Yes

  No

  N/A

• PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  Safe

  At Risk

  N/A

• Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  Safe

  At Risk

  N/A

• Fall Protection (Anything over 6' - At heights or leading edges)

  Safe

  At Risk

  N/A

• Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  Safe

  At Risk

  N/A

• Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  Safe

  At Risk

  N/A

• Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  Safe

  At Risk

  N/A

• Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  Safe

  At Risk

  N/A

• Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  Safe

  At Risk

  N/A

• Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  Safe

  At Risk

  N/A

• Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  Safe

  At Risk

  N/A

• Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  Safe

  At Risk

  N/A

• Any additional observations (Note them here)

  Safe

  At Risk

  N/A

2. Atkinson Inspections

• Foreman's Name

• Work Performed / Location

• CWP/JHA Package for work being performed is on site and signed

  Yes

  No

  N/A

• PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  Safe

  At Risk

  N/A

• Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  Safe

  At Risk

  N/A

• Fall Protection (Anything over 6' - At heights or leading edges)

  Safe

  At Risk

  N/A

• Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  Safe

  At Risk

  N/A

• Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  Safe

  At Risk

  N/A

• Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  Safe

  At Risk

  N/A

• Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  Safe

  At Risk

  N/A

• Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  Safe

  At Risk

  N/A

• Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  Safe

  At Risk

  N/A

• Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  Safe

  At Risk

  N/A

• Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  Safe

  At Risk

  N/A

• Any additional observations (Note them here)

  Safe

  At Risk

  N/A

• Foreman's Name

• Work Performed / Location

• CWP/JHA Package for work being performed is on site and signed

  Yes

  No

  N/A

• PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  Safe

  At Risk

  N/A

• Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  Safe

  At Risk

  N/A

• Fall Protection (Anything over 6' - At heights or leading edges)

  Safe

  At Risk

  N/A

• Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  Safe

  At Risk

  N/A

• Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  Safe

  At Risk

  N/A

• Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  Safe

  At Risk

  N/A

• Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  Safe

  At Risk

  N/A

• Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  Safe

  At Risk

  N/A

• Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  Safe

  At Risk

  N/A

• Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  Safe

  At Risk

  N/A

• Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  Safe

  At Risk

  N/A

• Any additional observations (Note them here)

  Safe

  At Risk

  N/A

• Foreman's Name

• Work Performed / Location

• CWP/JHA Package for work being performed is on site and signed

  Yes

  No

  N/A

• PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  Safe

  At Risk

  N/A

• Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  Safe

  At Risk

  N/A

• Fall Protection (Anything over 6' - At heights or leading edges)

  Safe

  At Risk

  N/A

• Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  Safe

  At Risk

  N/A

• Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  Safe

  At Risk

  N/A

• Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  Safe

  At Risk

  N/A

• Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  Safe

  At Risk

  N/A

• Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  Safe

  At Risk

  N/A

• Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  Safe

  At Risk

  N/A

• Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  Safe

  At Risk

  N/A

• Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  Safe

  At Risk

  N/A

• Any additional observations (Note them here)

  Safe

  At Risk

  N/A

• Foreman's Name

• Work Performed / Location

• CWP/JHA Package for work being performed is on site and signed

  Yes

  No

  N/A

• PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  Safe

  At Risk

  N/A

• Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  Safe

  At Risk

  N/A

• Fall Protection (Anything over 6' - At heights or leading edges)

  Safe

  At Risk

  N/A

• Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  Safe

  At Risk

  N/A

• Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  Safe

  At Risk

  N/A

• Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  Safe

  At Risk

  N/A

• Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  Safe

  At Risk

  N/A

• Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  Safe

  At Risk

  N/A

• Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  Safe

  At Risk

  N/A

• Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  Safe

  At Risk

  N/A

• Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  Safe

  At Risk

  N/A

• Any additional observations (Note them here)

  Safe

  At Risk

  N/A

• Foreman's Name

• Work Performed / Location

• CWP/JHA Package for work being performed is on site and signed

  Yes

  No

  N/A

• PPE (Hard Hat, Safety Glasses, Type 3 Vest, etc)

  Safe

  At Risk

  N/A

• Housekeeping (Impalements protected, trash in containers, materials cleaned up and stacked to eliminate tripping hazards, portable toilets nearby and clean)

  Safe

  At Risk

  N/A

• Fall Protection (Anything over 6' - At heights or leading edges)

  Safe

  At Risk

  N/A

• Confined Space Entry (Gas Tester, Permit filled out, Employees trained, Blower in place, Form of rescue in place)

  Safe

  At Risk

  N/A

• Excavations (DigAlert current, Ladder in place and secure, Competent Person on site, Shored properly, Spoil pile 2' from edge)

  Safe

  At Risk

  N/A

• Ladders (3' above landing, Secured, Working form ladder at over 6'?' Using 3 point contact, Positioned at 4 to 1, Extension ladders separated)

  Safe

  At Risk

  N/A

• Electrical Cords (Cords not cut and covered with tape, Guards are in place)

  Safe

  At Risk

  N/A

• Traffic Control (Flaggers needed and/or qualified, Attenuator required, Cones/Arrow boards/Barricades/Signs and Banners properly placed)

  Safe

  At Risk

  N/A

• Fire Protection (Oxy/Act - stored properly, Flash arresters in place, Complying with project fire permits, Fire Ext charged and inspected)

  Safe

  At Risk

  N/A

• Hoisting / Lifting Equipment (Rigging inspected and not defective, Cranes / Boom trucks all documents and inspections, Operator certs current, Qualified rigger/signaler)

  Safe

  At Risk

  N/A

• Railroad (Has training, RR flagger on site, has protection limits written down, Stops work when horn is blown)

  Safe

  At Risk

  N/A

• Any additional observations (Note them here)

  Safe

  At Risk

  N/A