Information
-
Project/Job #
-
Project/Job
-
Conducted on
-
Prepared by
-
Location
-
Personnel
BEHAVIOR
-
A. TSSP reviewed and signed?
-
Add media
-
undefined
-
B. TSSP for each task?
-
C. Mentors assigned?
-
D. Near Miss Reporting
-
E. Hazard Recognition Reporting
-
F. Other
WORK AREAS
-
A. General Housekeeping
-
B. Walking - Working Surfaces
-
C. Unprotected Sides or Holes
-
D. Impalement Hazards
-
E.. Sanitary Facilities
-
F.. Water -- Trash Receptacles
-
G. Material Storage/Lay Down
-
H. Convex, Box 4 U, Gang Box
JOB SITE POSTERS
-
A. All OSHA Required Posters
-
B. Emergency Evacuations
-
C. Emergency Contacts List
HEALTH/FIRST AID
-
A. CPR/First AidTraining
-
B. First Aid Kit (No Expired Items)
-
C. Eye Wash Facilities in Field
-
D. Access to Eye Wash
-
E. Other
PERSONAL PROTECTIVE EQUIPMENT
-
A. Hard Hats
-
B. Safety Glasses with Side Shields
-
C. Face Shield / Goggles (If Required)
-
D. Respiratory Protection (If Required)
-
E. Hearing Protection (If required)
-
F. Clothing (FRC etc. if required)
-
G. Gloves
-
H. Foot Protection
FALL PROTECTION
-
A. Trained Personnel (Competent Person)
-
B. Worn Properly
-
C. Suitable Anchorage Points
-
D. Inspected/Color Coded
-
E. Stored Properly
-
F. Emergency Rescue Plan
LADDERS
-
A. Base/Footing/Set Up
-
B. Inspections/Color Coded
-
C. Proper Type for Task
TOOLS AND EQUIPMENT
-
A. In Good Condition
-
B. Inspected/Color Coded
-
C. Whip-Checks
-
D. Other:
EXCAVATIONS
-
A. Trained Personnel (Competent Person)
-
B. Access/Egress
-
C. Soil Condition
-
D. Water Accumulating
-
E. Shoring/Shielding/Sloping
-
F. Barricades
-
G. Spoil Pile
-
H. Air Monitoriing
-
I. Emergency Rescue Plan
CONFINED SPACE
-
A. Trained Personnel (Competent Person)
-
B. Attendant Trained
-
C. Entrants Trained
-
D. Attendant Wearing
-
E. Attendant Sign In Sheet
-
F. Permit Required
-
G. Permit Followed
-
H. Air Monitoring
-
I. Emergency Rescue Plan
ELECTRICAL
-
A. G.F.C.I.'s
-
B. Extension Cords
-
C. Power Tools
-
D. Lock Out/Tag Out
-
E. Assured Ground Inspected
FIRE SAFETY
-
A. Hot Work Permit (if required)
-
B. Fire Watch Assigned (Competent Person)
-
C. Fire Extinguisher/Inspected
-
D. Combustibles removed/isolated
-
E. Hot Work Barricade (if required)
-
F. Gas Can(s)
RIGGING AND HOISTING
-
A. Capacity Tags
-
B. Hooks and Latches
-
C. Chain falls/Come-a-longs
-
D. Tag Lines
-
E. Inspected/Color Coded
-
F. Designated Qualified Rigger
-
G. Damage
SCAFFOLD
-
A. Trained Personnel (Competent Person)
-
B. Hand and Mid-rails, Toeboards
-
C. Platform Decked/Secured
-
D. Level Footing/Set up
-
E. Access/Egress
-
F. Away from Powerlines
-
G. Barricades
-
H. Inspection/Tagged Correctly
CRANE EQUIPMENT
-
A. Crane Inspection
-
B. Operator Manual
-
C. Crane Setup
-
D. Crane Swing Radius
-
E. Flagman with Vest
-
F. Operator Qualified and Certified
-
G. Designated Qualified Signaller
-
H. Fall Zone Procedures
-
I. Lift Plan (if required)
EQUIPMENT
-
A. Equipment Inspections
-
B. Operator Qualified and Certified
-
C. Operator Manual
-
D. Flagman with Vest
-
E. Proper setup and use
HAZCOM
-
A. Training - Right to Know
-
B. MSDS on Site
-
C. MSDS for all Chemicals on Site
-
D. Proper Storage of Chemicals
-
E. Proper PPE for Handling Chemicals
OTHER
-
A.
-
B.
-
C.
-
D.
Comments/Recommendations
-
Enter any corrective actions that will be undertaken
Sign Off
-
Safety Representative
-
Production Leader
-
Construction Supervisor
-
Field Hourly Rep / Others
-
Field Hourly Rep / Others
-
Field Hourly Rep / Others
