FERMA - SSS - Safety

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Project Manager

  Pete Buss

  Ameet Patel

  Mike Kennedy

  Neil Ferrari

• Superintendent

  Select Travis Thompson Doug Rodoni Don Zschokke

  • Travis Thompson
  • Doug Rodoni
  • Don Zschokke

• Foreman

  Select Freddy P. Javier P. Raul P. Casey G. Hector D. Antonio C. Dagaberto U. Vicente D.

  • Freddy P.
  • Javier P.
  • Raul P.
  • Casey G.
  • Hector D.
  • Antonio C.
  • Dagaberto U.
  • Vicente D.

Site Topics

• Site Safety Binder

  Yes

  No

  N/A

• Tool Box Topics

  Yes

  No

  N/A

• MSDS Reviewed

  Yes

  No

  N/A

(HIPP) Heat Illness Prevention Program

• Prevention Program Reviewed

  Safe

  At Risk

  N/A

• Water Supply

  Safe

  At Risk

  N/A

• Shade Identified

  Safe

  At Risk

  N/A

(PPE) Personal Protective Equipment

• Foot Protection<br>

  Safe

  At Risk

  N/A

• Gloves & Clothing<br>

  Safe

  At Risk

  N/A

• Respiratory Protection<br>

  Safe

  At Risk

  N/A

• Hard Hat

  Safe

  At Risk

  N/A

• Hearing Protection<br>

  Safe

  At Risk

  N/A

• Eye & Face Protection<br>

  Safe

  At Risk

  N/A

Housekeeping

• <br>Piling & Stacking

  Safe

  At Risk

  N/A

• Debris Removal<br>

  Safe

  At Risk

  N/A

• Exits and Stairs Clear<br>

  Safe

  At Risk

  N/A

Site & Public Protection

Required Postings

• Traffic Signage

  Safe

  At Risk

  N/A

• Warning Signs

  Safe

  At Risk

  N/A

• Fed and State Postings

  Safe

  At Risk

  N/A

• Emergency Numbers

  Safe

  At Risk

  N/A

• Fences/ Barricades<br>

  Safe

  At Risk

  N/A

• Sanitation - Toilets/ Wash Sinks Garbage Cans <br>

  Safe

  At Risk

  N/A

• Excavation/Trenches<br>

  Safe

  At Risk

  N/A

• Lighting<br>

  Safe

  At Risk

  N/A

• Ventilation<br>

  Safe

  At Risk

  N/A

• Dust Control

  Safe

  At Risk

  N/A

• Rebar Protection<br>

  Safe

  At Risk

  N/A

Electrical

• Lighting

  Safe

  At Risk

  N/A

• Grounding

  Safe

  At Risk

  N/A

• Cords, Plugs, Receptacles

  Safe

  At Risk

  N/A

• Main Power, Temp Power, Generator

  Safe

  At Risk

  N/A

Ladders

• Ladder Condition

  Safe

  At Risk

  N/A

• Ladder Use

  Safe

  At Risk

  N/A

• Extension Ladder Secured Properly

  Safe

  At Risk

  N/A

First Aid

• Trained Person Identified

  Yes

  No

  N/A

• First Aid Kits

  Safe

  At Risk

  N/A

Fire Protection

• Extinguishers

  Safe

  At Risk

  N/A

• Flammable Storage

  Safe

  At Risk

  N/A

• Welding and Cutting Equipment

  Safe

  At Risk

  N/A

• Hot Work Permit

  Safe

  At Risk

  N/A

• Fire Watch

  Safe

  At Risk

  N/A

Tools

• Conditions

  Safe

  At Risk

  N/A

• Guarding

  Safe

  At Risk

  N/A

• Power Cords

  Safe

  At Risk

  N/A

• Labeling

  Safe

  At Risk

  N/A

• Proper Grounding

  Safe

  At Risk

  N/A

• Lock Out - Tag Out - Test Out

  Safe

  At Risk

  N/A

Edge and Hole Protection

• Hazard Zone Identified - Delineated

  Safe

  At Risk

  N/A

• Perimeter Railing - Toe Boards

  Safe

  At Risk

  N/A

• Floor and Wall Coverings

  Safe

  At Risk

  N/A

Scaffolding

• Inspection Tags

  Yes

  No

  N/A

• Tieback - Supports - Footings

  Safe

  At Risk

  N/A

• Locking Pins and Nuts

  Safe

  At Risk

  N/A

• Railing

  Safe

  At Risk

  N/A

• Planks - Platforms

  Safe

  At Risk

  N/A

Fall Protection

• Administrative Controls<br>

  Yes

  No

  N/A

• Engineering Controls

  Safe

  At Risk

  N/A

• Harness - Lanyard - SRL

  Safe

  At Risk

  N/A

• Anchorage

  Safe

  At Risk

  N/A

• Rescue Plan

  Safe

  At Risk

  N/A

Ergonomics

• Equipment Used

  Safe

  At Risk

  N/A

• Procedure Used

  Safe

  At Risk

  N/A

• Lifting Techniques

  Safe

  At Risk

  N/A

Site Equipment

• Pre-Use Inspections

  Safe

  At Risk

  N/A

• Operator Certificated

  Safe

  At Risk

  N/A

• Proper Use

  Safe

  At Risk

  N/A

Additional Notes/ Drawings

• Note/ Drawing

  Drawing

Acknowledgement

• Completed By

  Sign

• Safety Rating by Safety

• Foreman

  Sign

• Safety Rating by Foreman