DPW Site Safety Observation

• Project/Work Assignment

• Crew #

• Location
  Address

• Supervisor

• Competent Person

• Prepared by

• Observation Date

  Date

JOB ADMINSTRATION

• Job briefing performed?

  Yes

  No

  N/A

• Competent person assigned

  Yes

  No

  N/A

• All workers properly trained in task?

  Yes

  No

  N/A

• Hazards recognized and appropriate mitigations taken?

  Yes

  No

  N/A

• All necessary permits completed and available?

  Yes

  No

  N/A

• Appropriate Safety Data Sheets (SDS) information accessible?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• All workers trained in the use and care of PPE?

  Yes

  No

  N/A

• Appropriate work clothes and footwear for the job being worn?

  Yes

  No

  N/A

• Worker PPE has been inspected?

  Yes

  No

  N/A

• PPE is maintained in an acceptable condition?

  Yes

  No

  N/A

• Hard hats being worn properly when required?

  Yes

  No

  N/A

• Safety glasses being worn properly when required?

  Yes

  No

  N/A

• High-visibility clothing being worn properly when required?

  Yes

  No

  N/A

• Gloves being worn when necessary?

  Yes

  No

  N/A

• Hearing protection being worn properly when required

  Yes

  No

  N/A

• Proper respiratory equipment being worn when required?

  Yes

  No

  N/A

• Additional protection being worn when required?

  Yes

  No

  N/A

• Specify:

SAFE WORK PRACTICES

• Properly lifting techniques being utilized?

  Yes

  No

  N/A

• Emergency All-Stop practice being utilized?

  Yes

  No

  N/A

• Changes in hazards or conditions being communicated?

  Yes

  No

  N/A

• Co-worker assistance being utilized?

  Yes

  No

  N/A

• Adequate lighting in use?

  Yes

  No

  N/A

FIRST AID & EMERGENCIES

• Properly trained/certified personnel on site?

  Yes

  No

  N/A

• Emergency phone numbers accessible?

  Yes

  No

  N/A

• First aid kit accessible?

  Yes

  No

  N/A

• First aid kit inspected?

  Yes

  No

  N/A

• Workers aware of general emergency procedures?

  Yes

  No

  N/A

• Workers aware of site specific emergency procedures?

  Yes

  No

  N/A

FIRE PREVENTION & PRECAUTIONS

• Proper flammable containers in use?

  Yes

  No

  N/A

• Fire extinguishing equipment accessible?

  Yes

  No

  N/A

• Fire extinguisher inspected and tagged?

  Yes

  No

  N/A

• Combustibles properly stored?

  Yes

  No

  N/A

HOUSEKEEPING

• Walkways, passageways, and access points are clear of hazards?

  Yes

  No

  N/A

• Work area is cleared of unnecessary debris?

  Yes

  No

  N/A

• All unnecessary equipment is clear of work area?

  Yes

  No

  N/A

• Materials are safely stacked and stored?

  Yes

  No

  N/A

• Vehicles, trailers, and equipment containers are clean and orderly?

  Yes

  No

  N/A

HEALTH & ENVIRONMENTAL HAZARDS

• Has the potential for a hazardous environment been identified?

  Yes

  No

  N/A

• Hazardous materials recognized and isolated?

  Yes

  No

  N/A

• Type of environmental hazards

• Precautions for heat stress being taken?

  Yes

  No

  N/A

• Precautions for cold exposure being taken?

  Yes

  No

  N/A

• Noise decibel reading

TOOL & EQUIPMENT (Hand & Power)

• Applies at this job site?

  Yes

  No

  N/A

• Workers properly trained in use?

  Yes

  No

  N/A

• Tool or equipment inspected prior to use?

  Yes

  No

  N/A

• Power cords in good condition with no defects?

  Yes

  No

  N/A

• All guards and safeties in place?

  Yes

  No

  N/A

• Maintenance performed prior to use?

  Yes

  No

  N/A

• Required PPE used during operation?

  Yes

  No

  N/A

• Tool maintained per Assured Equipment Grounding Program?

  Yes

  No

  N/A

VEHICLE & HEAVY EQUIPMENT

• Applies at this job site?

  Yes

  No

  N/A

• Vehicles and heavy equipment inspected prior to use?

  Yes

  No

  N/A

• Operated by trained/authorized personnel?

  Yes

  No

  N/A

• All lights working properly?

  Yes

  No

  N/A

• All warning devices working properly?

  Yes

  No

  N/A

• All operating systems working properly?

  Yes

  No

  N/A

• No leaks present?

  Yes

  No

  N/A

• Seat belts and/or restraining devices in use?

  Yes

  No

  N/A

• Trailered equipment secured for transport

  Yes

  No

  N/A

PUBLIC ACCESS/WALKWAY PROTECTION

• Applies at this job site?

  Yes

  No

  N/A

• Public access & walkways free of hazards?

  Yes

  No

  N/A

• Detour of public access & walkways identified and understandable?

  Yes

  No

  N/A

• Monitoring of public access being performed?

  Yes

  No

  N/A

ELECTRICAL HAZARDS & SAFETY

• Applies at this job site?

  Yes

  No

  N/A

• Extension cords inspected and in safe condition?

  Yes

  No

  N/A

• All electrical systems and equipment are properly protected?

  Yes

  No

  N/A

• Equipment is at least 10' away from overhead power lines?

  Yes

  No

  N/A

• All underground and overhead electrical sources identified?

  Yes

  No

  N/A

• Lockout/Tagout procedures being followed?

  Yes

  No

  N/A

SAFE LADDER USE

• Applies at this job site?

  Yes

  No

  N/A

• Ladders have been inspected prior to use?

  Yes

  No

  N/A

• Proper type and size are in use?

  Yes

  No

  N/A

• Ladder is placed on an acceptable surface?

  Yes

  No

  N/A

• Ladder is properly secured?

  Yes

  No

  N/A

• Worker(s) is using ladder in an appropriate and safe manner?

  Yes

  No

  N/A

• Worker(s) is using 3-points of contact?

  Yes

  No

  N/A

• Ladder(s) being used

  Extension

  Folding

• Ladder is set at a 75 degree angle or a 4 to 1 ratio?

  Yes

  No

  N/A

• Ladder is at least 2-3 rungs or 36" above landing?

  Yes

  No

  N/A

WORK ZONE SET-UP

• Applies at this job site?

  Yes

  No

  N/A

• Adequate warning signs in place?

  Yes

  No

  N/A

• Adequate cones or channeling devices in place?

  Yes

  No

  N/A

• Motorist protected from heavy equipment?

  Yes

  No

  N/A

• Traffic adequately controlled through work area?

  Yes

  No

  N/A

• Certified flagger(s) being utilized?

  Yes

  No

  N/A

• Flagger(s) utilizing proper PPE and equipment

  Yes

  No

  N/A

FALL PROTECTION

• Applies at this site?

  Yes

  No

  N/A

• Fall protection in place for work over 4'?

  Yes

  No

  N/A

• Drop precautions recognized?

  Yes

  No

  N/A

• Floor or ground openings properly marked and protected?

  Yes

  No

  N/A

• Guardrails in place and in compliance?

  Yes

  No

  N/A

• Fall arrest system in place and inspected?

  Yes

  No

  N/A

• Harness and equipment being worn properly?

  Yes

  No

  N/A

• Rescue plan in place?

  Yes

  No

  N/A

AERIAL LIFTS/MANLIFTS/SCAFFOLDING

• Applies at this job site?

  Yes

  No

  N/A

• Inspection completed?

  Yes

  No

  N/A

• Manufacturers operating manual present?

  Yes

  No

  N/A

• Trained/authorized operator?

  Yes

  No

  N/A

• Being used properly?

  Yes

  No

  N/A

• Outriggers in use?

  Yes

  No

  N/A

• Proper fall protection in use?

  Yes

  No

  N/A

TRENCHING & EXCAVATION SAFETY

• Applies at this site?

  Yes

  No

  N/A

• Permitting required?

• Underground utilities identified and marked?

  Yes

  No

  N/A

• Job site barricading and protection in place?

  Yes

  No

  N/A

• Soiled tested and area inspected?

  Yes

  No

  N/A

• Excavation inspected prior to entry?

  Yes

  No

  N/A

• Spill pile at least 2’ from edge?

  Yes

  No

  N/A

• Adequate and proper shoring in place where required?

  Yes

  No

  N/A

• Accessibility and placement of ladder(s) adequate?

  Yes

  No

  N/A

• Fall protection in use where required?

  Yes

  No

  N/A

CONFINED SPACES: Applies at this job site?

• Applies at this job site?

  Yes

  No

  N/A

• Entry permit required?

  Yes

  No

  N/A

• Air testing completed?

  Yes

  No

  N/A

• Ventilation in progress?

  Yes

  No

  N/A

• Rescue plan in place?

  Yes

  No

  N/A

• Overall Comments:

• Corrective Actions Required?

  Yes

  No

• Corrective Actions Taken:

• Completed By Signature

  Sign