Field Observation Report

• Document No.

• Client / Site

• Subcontractor Company

• Project Number(s):

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel Participating in Observations

General Jobsite

• First aid kit available and inspected weekly?

  Yes

  No

  N/A

• Enter date of last inspection:

  Date

• Enter name/initials of who inspected:

• Has project pre-start meeting been held with JIS?

  Yes

  No

  N/A

• Is the Project JSA at the jobsite?

  Yes

  No

  N/A

• Daily JSA (PTP) completed with signatures?

  Yes

  No

  N/A

• Work permit posted at jobsite with appropriate supporting paperwork?

  Yes

  No

  N/A

• Is work being performed that requires a work permit?

  Yes

  No

  N/A

• What is the name of the lead in charge of the work:

• How well do employees know evacuation procedures?

Housekeeping

• How well is the work area maintained clean and orderly?

• Surface encumbrances protected/marked?

  Safe

  At Risk

  N/A

• Are walkways designated and maintained?

  Safe

  At Risk

  N/A

• Adequate lighting?

  Safe

  At Risk

  N/A

Hazard Communication

• Chemicals are stored in approved containers and labeled?

  Safe

  At Risk

  N/A

• Can SDS information for products onsite be verified?

  Yes

  No

  N/A

• Name of product whose SDS was verified:

Personal Protective Equipment

• Are employees wearing appropriate PPE for task(s)?

  Safe

  At Risk

  N/A

• Has PPE been inspected pre-use?

  Yes

  No

  N/A

• What PPE was unfit for use:

PPE

• Description:

Hot Work/Fire Prevention

• Are hot work tasks occurring at site?

  Present

  Not Present

• Is proper work permit completed and posted at job site?

  Yes

  No

  N/A

• Is spark containment adequate for the work environment?

  Safe

  At Risk

  N/A

• Have flammable/combustible materials been moved within 35'?

  Safe

  At Risk

  N/A

• Are all manholes, drains, or other potential flammable sources covered (wetted fire blanket/sand)?

  Safe

  At Risk

  N/A

• Fuel/oxygen tanks are secured and properly stored when not in use?

  Safe

  At Risk

  N/A

• Equipment is maintained in good working condition (e.g. regulators, hoses, no radiator hose clamps...)

  Safe

  At Risk

  N/A

• Use of a 4-gas meter continuously at task?

  Safe

  At Risk

  N/A

• Check if calibration is current

• Last calibration date:

  Date

• Is a fire extinguisher present and inspection current?

  Safe

  At Risk

  N/A

• Last inspection date:

  Date

• Is there a designated fire watch that can adequately monitor the area?

  Yes

  No

  N/A

• Name of fire watch:

Fire watch:

• Name:

• Are industrial hygiene controls implemented when necessary?

  Safe

  At Risk

  N/A

• Description of exposure(s) present:

Hand, Power, and Powder-Actuated Tools

• Are hand, power, or powder-actuated tools in use at site?

  Present

  Not Present

• Are tools inspected pre-use?

  Safe

  At Risk

  N/A

• What tools are unfit for use:

Tool

• Tool:

• Are guards in place on all equipment and not modified?

  Safe

  At Risk

  N/A

• Have tools been stored properly when not in use?

  Yes

  No

  N/A

• Are defective/damaged tools tagged-out until repaired/replaced?

  Yes

  No

  N/A

Ladders

• Are ladders in use at site?

  Present

  Not Present

• Are ladders secured/stored properly when not in use?

  Yes

  No

  N/A

• Ladders in use extend 36" above landing, and are at the proper angle and secured?

  Safe

  At Risk

  N/A

• Correct ladders are being used for the work task?

  Yes

  No

  N/A

• What is the unsafe situation(s)?

• Fiber glass ladders used only?

  Yes

  No

  N/A

• Ladders are inspected pre-use?

  Safe

  At Risk

  N/A

• What ladder is unfit for use:

Ladder

• Description:

Electrical

• Equipment is properly bonded and grounded?

  Safe

  At Risk

  N/A

• Electrical cords, tools, and equipment are routinely inspected and documented?

  Yes

  No

  N/A

• What is the inspection color for equipment:

• What evidences that electrical cords, tools, and equipment are not inspected/documented?

• Are GFCIs used on all electrical cords?

  Safe

  At Risk

  N/A

• Lighting is intrinsically safe, as necessary, and covered with protective cages?

  Safe

  At Risk

  N/A

Live Electrical Work

• Is live electrical work occurring on site?

  Present

  Not Present

• LOTO is used before accessing any electrical system?

  Safe

  At Risk

  N/A

• Are LOTO procedures being followed (personal locks, Equipment Isolation Device list, LOTO system/lock boxes...)?

  Safe

  At Risk

  N/A

• How are LOTO procedures not being followed?

• Stop work!

• Who is participating in work without adequate LOTO:

Person

• Name:

• Can training for employees be verified?

  Yes

  No

  N/A

• Name of employee(s) whose training was verified and type of training (LOTO, live electrical, arc flash...):

Person

• Name:

• Is proper electrical PPE being worn (NFPA 70E)?

  Yes

  No

  N/A

Aerial Lifts

• Are aerial lift(s) in use at site?

  Present

  Not Present

• Is there evidence that a documented daily inspection has occurred?

  Yes

  No

  N/A

• Check if equipment is in use

• Equipment is not to be operated without an inspection conducted.

• Name of employee operating equipment that has not been inspected:

Person

• Name:

• Is equipment in proper working condition (e.g. alarms, lights, control labels, extinguishers, manual...)?

  Safe

  At Risk

  N/A

• Description of equipment that is unfit for use:

Equipment

• Equipment ID:

• Is fall protection being used by employees when operating aerial lift?

  Safe

  At Risk

  N/A

• Name of employee not using fall protection while operating aerial lift:

Person

• Name:

• Do employees keep feet on the floor of the man basket?

  Safe

  At Risk

  N/A

• Are spotters being used while equipment is in operation?

  Yes

  No

  N/A

• Why is a spotter not being used?

Mobile Equipment (PIV)

• Are PIV(s) being used at site?

  Present

  Not Present

• Are spotters being used while equipment is in operation?

  Yes

  No

  N/A

• Why is a spotter not being used?

• Is there evidence that a documented daily inspection has occurred?

  Yes

  No

  N/A

• Check if equipment is in use

• Equipment is not to be operated without an inspection conducted.

• Name of employee operating equipment that has not been inspected:

Person

• Name:

• Is equipment in proper working condition (e.g. alarms, lights, control labels, extinguishers, manual...)?

  Safe

  At Risk

  N/A

• Description of equipment that is unfit for use:

Equipment

• Equipment ID:

Cranes

• Are crane(s) in use at site?

  Present

  Not Present

• Is crane operator certified?

  Yes

  No

  N/A

• Operators Name and NCCCO #:

Operator

• Name:

• NCCCO #:

• Is the rigger qualified?

  Yes

  No

  N/A

• Is a designated signal man present during picks?

  Yes

  No

  N/A

• Is proper documentation in place (e.g. pre-lift evaluation plan)?

  Yes

  No

  N/A

• Have pre-use inspections been completed for crane and rigging?

  Yes

  No

  N/A

• When was last annual crane inspection?

  Date

• Are tag-lines and no-touch tools used in lieu of manual handling of a suspended load?

  Safe

  At Risk

  N/A

• Are employees kept from working under the suspended load (45 degree rule)?

  Safe

  At Risk

  N/A

• Is lifting area barricaded off, including the counterweight of the crane?

  Safe

  At Risk

  N/A

Fall Protection

• Is fall protection in use at site?

  Present

  Not Present

• Can fall protection training for employees be verified?

  Yes

  No

  N/A

• Name of employee whose training was verified:

Person

• Name:

• Are employees tied-off to adequate anchor points (5,000 lbs/person)?

  Safe

  At Risk

  N/A

• Are personnel below protected from falling hazards?

  Safe

  At Risk

  N/A

• Has fall protection been inspected pre-use?

  Safe

  At Risk

  N/A

• Is there evidence that fall protection has been in use during the shift?

  Yes

  No

  N/A

• How is the fall protection unfit for use:

• Who is using the Fall Protection:

Scaffolding

• Is scaffolding in use?

  Present

  Not Present

• Has scaffolding been inspected daily by a competent person?

  Yes

  No

  N/A

• Is scaffolding correctly tagged with hazards/controls identified?

  Safe

  At Risk

  N/A

• How is scaffold unfit for use:

• Is proper access provided with appropriate protection at the top of ladder?

  Safe

  At Risk

  N/A

Confined Space (PRCS)

• Is confined space work occurring at site?

  Present

  Not Present

• Confined space entry permit is complete and current with task?

  Yes

  No

  N/A

• Is a rescue plan current, communicated and in place at site?

  Yes

  No

  N/A

• Are confined spaces properly identified with signage?

  Yes

  No

  N/A

• Are all employees involved in work task trained?

  Yes

  No

  N/A

• Entry Supervisor

Person

• Entry Supervisor:

• Confined Space Attendant:

Person

• Confined Space Attendant:

• Confined Space Entrant:

Person

• Confined Space Entrant:

• Communication is effective between attendant and entrants?

  Yes

  No

  N/A

• Is space being continuously monitored for atmospheric contaminants and other hazards?

  Yes

  No

  N/A

• Are there any levels outside of normal parameters?

  Yes

  No

  N/A

• What level?

Contaniment

• Contaminant:

• Stop Work! Permit should be closed and employee training reviewed.

• Is proper PPE being worn inside the space (including a harness and lifeline when required)?

  Yes

  No

  N/A

Concrete Work

• Is concrete work occurring at site?

  Present

  Not Present

• Are employees taking precautions to protect against dust exposure?

  Safe

  At Risk

  N/A

• Description of exposure(s) present:

• Is exposed skin adequately protected?

  Safe

  At Risk

  N/A

• Is there a rinse/eyewash station designated (on permit and communicated)?

  Safe

  At Risk

  N/A

• Are equipment hazards guarded (e.g. rebar, masonry saw, bull floats, mixers...)?

  Safe

  At Risk

  N/A

• Description of hazard(s) present:

Excavations/Trenches

• Are excavations/trenches present (and part of task) at site?

  Present

  Not Present

• Has excavation permit been completed and is current?

  Yes

  No

  N/A

• Are excavations inspected daily (before work), and when conditions changed (e.g. weather...)?

  Safe

  At Risk

  N/A

• Competent person on hand?

  Yes

  No

  N/A

• Name of competent person:

• Excavations are shored/sloped from cave-ins (>5')?

  Safe

  At Risk

  N/A

• Stop Work! Employees must be protected!

• Excavations >4' treated as confined spaces (>5' is PRCS)?

  Safe

  At Risk

  N/A

• Stop Work! PRCS documentation and planning must be completed prior to task!

• Excavations >4' have ladders/egress at no more than 25' lateral travel (extend 36" above ground and are secured)?

  Safe

  At Risk

  N/A

• Materials/spoils are stored at least 2' from excavation?

  Safe

  At Risk

  N/A

• No compressed gas cylinders inside of excavations?

  Safe

  At Risk

  N/A

• All excavations are protected by a barricade (snow fence or hard barricade) at least 6' from the edge?

  Safe

  At Risk

  N/A

LOTO

• Is there a LOTO system in place for the assigned work?

  Present

  Not Present

• Authorized employees have identifiable locks?

  Yes

  No

  N/A

• Has isolation points been verified and system tried-out before commencing work task?

  Yes

  No

  N/A

• Is a system in place for approved method to remove personal locks that are left?

  Yes

  No

  N/A

• Do LOTO systems have specific equipment procedures (EID lists)?

  Safe

  At Risk

  N/A

Hazardous Materials

• Are there hazardous materials/processes at the site (e.g. lead, asbestos, radiation, benzene...)?

  Present

  Not Present

• Is a Hazardous Waste Plan complete and in place (when necessary)?

  Yes

  No

  N/A

• SDS's have been obtained for materials prior to work task?

  Yes

  No

  N/A

• Are removed materials being disposed of in accordance to environmental procedures/waste plan?

  Yes

  No

  N/A

• Have engineering controls and proper PPE been utilized?

  Safe

  At Risk

  N/A

• Verified that materials for demolition, cutting, torching, etc are free from hazard (industrial hygiene)?

  Safe

  At Risk

  N/A

• Description of exposure(s) present:

Signature

• Printed Name of Report Author:

• Report Author Signature:

  Sign