Field Safety Report

• Job Name

• Conducted on

  Date

• On-Site Superintendent(s)

• Prepared by

MEDICAL AND FIRST AID

• Are First-Aid Kits accessible and identified?

  Safe

  At Risk

  N/A

• Are Bloodborne Pathogen kits available?

  Safe

  At Risk

  N/A

• Are daily logs for First-Aid present and up to date?

  Safe

  At Risk

  N/A

• Are First-Aid kits inspected weekly?

  Safe

  At Risk

  N/A

HAZARD COMMUNICATION

• Are SDS books on-site and available?

  Safe

  At Risk

  N/A

• Do all employees know where the SDS books are located?

  Safe

  At Risk

  N/A

SITE SAFETY PLAN

• Is a site map available?

  Safe

  At Risk

  N/A

• Site plan is posted?

  Safe

  At Risk

  N/A

• Are emergency phone numbers posted?

  Safe

  At Risk

  N/A

FEDERAL POSTERS

• Are posters located in a conspicuous location?

  Safe

  At Risk

  N/A

• Minimum wage

  Safe

  At Risk

  N/A

• OSHA Health and Safety

  Safe

  At Risk

  N/A

• Equal Employment Opportunity

  Safe

  At Risk

  N/A

• OSHA 300 Summary ( February 1st - April 30th only)

  Safe

  At Risk

  N/A

EMERGENCY PLAN

• Have muster points be established?

  Safe

  At Risk

  N/A

• Do all employees know the location of muster points?

  Safe

  At Risk

  N/A

• Has an emergency signal been established?

  Safe

  At Risk

  N/A

• Are proper exit signs and routes available and posted?

  Safe

  At Risk

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Have levels of personal protective equipment been established?

  Safe

  At Risk

  N/A

• Do all employees know their level of protection?

  Safe

  At Risk

  N/A

• Are there sufficient quantities of PPE on-site?

  Safe

  At Risk

  N/A

TASK HAZARD ANALYSIS

• Has a THA be filled out?

  Safe

  At Risk

  N/A

• Has the THA been filled out properly?

  Safe

  At Risk

  N/A

• Has a THA been filled out with thought in each step of the task?

  Safe

  At Risk

  N/A

• Does the THA cover all task to be performed?

  Safe

  At Risk

  N/A

• Has the THA been reviewed and signed by each employee?

  Safe

  At Risk

  N/A

• Is the THA reviewed after lunch and necessary changes made?

  Safe

  At Risk

  N/A

FIRE PREVENTION

• Smoking prohibited in restricted areas?

  Safe

  At Risk

  N/A

• Flammable storage containers available?

  Safe

  At Risk

  N/A

• Fire extinguisher located near flammable storage?

  Safe

  At Risk

  N/A

• Is flammable storage properly marked?

  Safe

  At Risk

  N/A

FIRE PROTECTION

• Are sufficient fire extinguishers available?

  Safe

  At Risk

  N/A

• Do all employees know the location of fire extinguishers?

  Safe

  At Risk

  N/A

• Are fire extinguishers inspected and in proper working order?

  Safe

  At Risk

  N/A

• Are flammable and combustable materials segregated from ignition sources?

  Safe

  At Risk

  N/A

WELDING AND CUTTING

• Are fire extinguishers present at welding and cutting operations?

  Safe

  At Risk

  N/A

• Has a hot work permit been obtained?

  Safe

  At Risk

  N/A

• Are proper helmets, glasses, and gloves being used for welding and cutting?

  Safe

  At Risk

  N/A

• Are welding machines properly grounded?

  Safe

  At Risk

  N/A

• Are only trained employees permitted to operate welding and cutting equipment?

  Safe

  At Risk

  N/A

HAND AND POWER TOOLS

• Are tools inspected before each use?

  Safe

  At Risk

  N/A

• Are tools being used properly?

  Safe

  At Risk

  N/A

• Are all required guards and covers in place?

  Safe

  At Risk

  N/A

• Is proper PPE being used for the tool?

  Safe

  At Risk

  N/A

MATERIALS HANDLING

• Are materials stacked and stored as to prevent sliding or collapsing?

  Safe

  At Risk

  N/A

• Are all containers labeled as to their contents?

  Safe

  At Risk

  N/A

• Are all chemicals, flammables, and combustibles stored in approved containers?

  Safe

  At Risk

  N/A

• Are all flammables and combustibles stored in non-smoking areas?

  Safe

  At Risk

  N/A

• Are mechanical means utilized to move material when necessary?<br>

  Safe

  At Risk

  N/A

• Are tripping and puncture hazards identified and labeled?

  Safe

  At Risk

  N/A

ELECTRICAL

• Are warning signs exhibited on high voltage equipment?

  Safe

  At Risk

  N/A

• Is electrical equipment and wiring properly guarded?

  Safe

  At Risk

  N/A

• Are extension cords and cables guarded and maintained in good condition?

  Safe

  At Risk

  N/A

• Are extension cords and temporary power cords kept out of wet areas?

  Safe

  At Risk

  N/A

• Are cords protected from traffic?

  Safe

  At Risk

  N/A

• Are proper lockout/tagout procedures in place?

  Safe

  At Risk

  N/A

• Are GFCI's being used properly?

  Safe

  At Risk

  N/A

• Are energized electrical parts protected?

  Safe

  At Risk

  N/A

WALKING AND WORKING SURFACES

• Are access-ways, stairs, ramps, and ladders clean of ice, mud, snow, or debris?

  Safe

  At Risk

  N/A

• Are stairways and floor openings properly guarded?

  Safe

  At Risk

  N/A

• Do all guardrails meet OSHA standards?

  Safe

  At Risk

  N/A

• Are ladders inspected and properly secured?

  Safe

  At Risk

  N/A

• Is housekeeping in good order and up to site standards?

  Safe

  At Risk

  N/A

SCAFFOLDING

• Is scaffolding placed on a flat, firm surface?

  Safe

  At Risk

  N/A

• Are scaffold planks free of mud, ice, grease, etc?

  Safe

  At Risk

  N/A

• Is scaffolding inspected before each use (brandt competent person)?

  Safe

  At Risk

  N/A

• Does scaffold planking overlap a minimum of 12 inches?

  Safe

  At Risk

  N/A

• Are all pins in place and wheels locked?

  Safe

  At Risk

  N/A

EXCAVATIONS

• Has soil been properly classified?

  Safe

  At Risk

  N/A

• Are ladders used in trenches over 4 feet deep?

  Safe

  At Risk

  N/A

• Are trenches/excavations deeper than 5 feet properly sloped, benched, or shored?

  Safe

  At Risk

  N/A

• Are spoil piles placed, at a minimum, 24 inches from the trench/excavation?

  Safe

  At Risk

  N/A

• Has the operator received competent person excavation training?

  Safe

  At Risk

  N/A

• Are guardrails or fences placed around trenches/excavations near pedestrian or vehicle thoroughfares?

  Safe

  At Risk

  N/A

HEAVY EQUIPMENT

• Is equipment being operated only by trained operators?

  Safe

  At Risk

  N/A

• Has a daily inspection been performed?

  Safe

  At Risk

  N/A

• Are back-up alarms installed and working properly?

  Safe

  At Risk

  N/A

• Is equipment being operated in a safe manner?

  Safe

  At Risk

  N/A

• Is equipment shut down before fueling or maintenance?

  Safe

  At Risk

  N/A

CONFINED SPACE ENTRY

• Has the space been properly classified?

  Safe

  At Risk

  N/A

• Are only trained personnel working as a supervisor, entrant, or attendent?

  Safe

  At Risk

  N/A

• Has all equipment been inspected prior to use?

  Safe

  At Risk

  N/A

• If permit required, is a safety representative on-site?

  Safe

  At Risk

  N/A

• Have all air monitors been calibrated and have a certificate of calibration?

  Safe

  At Risk

  N/A

• Are spaces ventilated and checked for atmospheric hazards prior to entry?

  Safe

  At Risk

  N/A

• If permit required, is the permit filled out properly and authorized?

  Safe

  At Risk

  N/A

RIGGING AND FLAGGING

• Have all employees involved been trained and have a Rigging and Flagging certification card?

  Safe

  At Risk

  N/A

• Has a lift plan been prepared, including THA and BIPP?

  Safe

  At Risk

  N/A

• Has the lift plan been reviewed with all involved employees?

  Safe

  At Risk

  N/A

• Have yearly/daily crane inspections and operators certification been verified with copies made and retained?

  Safe

  At Risk

  N/A

• Has all rigging material been inspected prior to use?

  Safe

  At Risk

  N/A

• Are slings padded or protected from sharp edges?

  Safe

  At Risk

  N/A

• Do employees keep clear of suspended loads?

  Safe

  At Risk

  N/A

• Is a tag line used on each load?

  Safe

  At Risk

  N/A

COMPRESSED GAS CYLINDERS

• Are cylinders stored in well-ventilated areas?

  Safe

  At Risk

  N/A

• Are no smoking signs posted in the cylinder storage areas?

  Safe

  At Risk

  N/A

• Are all cylinders stored and secured in an upright position?

  Safe

  At Risk

  N/A

• Are cylinders protected from damage?

  Safe

  At Risk

  N/A

• Are all cylinder caps in place when stored?

  Safe

  At Risk

  N/A

• Are regulators removed and replaced with the cap if not used in a 24 hour period?

  Safe

  At Risk

  N/A

• Are fuel gas and o2 cylinders stored a minimum of 20 feet apart or by other approved methods?

  Safe

  At Risk

  N/A

EQUIPMENT INSPECTION

• Has all equipment( scissor lift, boom lift, fork lift) been inspected prior to use?

  Safe

  At Risk

  N/A

• Is equipment clean, and in good working order?

  Safe

  At Risk

  N/A

• Has the operator been trained and has a current certification card?

  Safe

  At Risk

  N/A

ADDITIONAL INFORMATION

• What is the current phase of the job?

  Select Underground Slab Rough-In Wall/Overhead Rough-In Finish Out

  • Underground
  • Slab Rough-In
  • Wall/Overhead Rough-In
  • Finish Out

• Employees are working how many hours per week?

  Select 40 or less 40 to 50 50 to 60 more than 60

  • 40 or less
  • 40 to 50
  • 50 to 60
  • more than 60

• How many Brandt employees are on this job?

  Select 1-20 21-40 41-60 61-80 81-100 more than 100

  • 1-20
  • 21-40
  • 41-60
  • 61-80
  • 81-100
  • more than 100

• How many sub contract employees are on this job?

  Select 1-5 6-10 11-15 16-20 21-25 more than 25

  • 1-5
  • 6-10
  • 11-15
  • 16-20
  • 21-25
  • more than 25

• Superintendent Signiture

  Sign