Information
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Conducted on
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Location
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CLIENT
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SUPERVISOR/FOREMAN
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HEALTH & SAFETY MANAGER
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JOB NUMBER
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JOB DESCRIPTION
HAZCOM (1910.1200)
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MSDS available on site?
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Daily Safety meeting held & attended by crew?
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Hazardous work permit completed and signed?
PERSONAL PROTECTIVE EQUIPMENT (1910.132)
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PPE appropriate for task?
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PPE being properly worn by crew ?
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Respiratory Protection being utilized ?
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Action Levels being adhered to ?
AIR MONITORING
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Appropriate air monitoring being conducted?
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Air monitoring instruments properly calibrated?
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Readings properly documented?
LOCKOUT / TAGOUT (1910.147)
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Have all types of energy been de-energized?
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Is a LO/TO Permit completed and available?
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Do all affected employees have locks applied?
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Are all other LO/TO Procedures being followed?
HOT WORK
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Is the Hot Work permit properly completed?
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Are available fire hoses, sprinklers or extinguishers in good repair?
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Hot work equipment (torches, welders, grinders) in good repair?
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Have containers, tanks or vessels been inerted to less than 8% oxygen?
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Have explosive atmospheres been eliminated (35 feet)?
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Have all wall and floor openings been covered (35 feet)?
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Are welding blankets being utilized where necessary?
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Has paint or coatings been removed from the area where the hot work will be conducted?
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Have all combustible & flammable materials/liquids been removed from the area (35 feet)?
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Has a fire watch been maintained for 30 minutes after completion of the hot work?
EXCAVATION/TRENCHING (1926.651-652)
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Is there a competent person on site?
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Have all utilities been identified or marked?
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Is there a ladder available in the excavation for every 25 feet of travel distance?
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For excavations over 4 feet, are sloping or shoring options being followed?
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Are excavation spoils located at least 2 feet from the edge of the excavation?
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Is standing water in the excavation being controlled?
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If no personnel entry is required has a "no-mans-land" been established 3/4 of the excavation depth away from the edge?
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Has the excavation been evaluated for confined space hazards?
FIRE SAFETY
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Are a sufficient number of fire extinguishers present?
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Are all extinguishers inspected with tags attached?
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For flammable/combustible transfers, has bonding and grounding been performed?
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Has bonding and grounding been checked for continuity?
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Have all ignition sources been eliminated?
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Is LEL area monitoring been conducted?
ELECTRICAL SAFETY
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Is equipment appropriate for the location (e.g. U/L listed Class 1 Division 1 for flammable locations?
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Is an operable Ground Fault Circuit Interrupter (GFCI) used on all equipment? (Where appropriate)
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Are equipment leads and extension cords in good repair?
SCAFFOLD & ELEVATED LIFT SAFETY (1910.128)
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Competent Person on site?
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Daily inspection documented?
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All personnel "User" trained?
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Are all components in good working condition?
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Scaffolding erected according to guidelines?
WORKING ON OR NEAR WATER
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Has the boat operator been certified by CHES?
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Has a boating safety checklist been completed?
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Are appropriate PFD's being used?
VACTOR SAFETY
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Electric vacuum relief or in-line tee being utilized?
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Hands & feet kept a minimum 2' from the end of the hose?
HIGH PRESSURE WATER JETTING
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Has the HPWJ checklist been completed & signed?
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Hoses pressure tested & tagged?
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Work area barricaded & HPWJ signs posted?
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Are whip checks utilized?
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Dump control valves used & functioning properly?
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Lance protector used?
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Stinger used?
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Anti-withdrawal devices used & appropriate size?
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Metatarsal guard/shin guards used?
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Medical cards carried by all personnel?
EMERGENCY PREPAREDNESS
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Appropriate size first-aid kits on site, available and stocked?
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Minimum of two First-aid/CPR trained personnel on site? (where appropriate)
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Safety shower, or hose and eye wash in immediate vicinity when working with acids or caustics?
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Emergency numbers obtained, posted and means to contact emergency services posted?
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Location of nearest hospital documented and known by crew?
FALL PROTECTION (GREATER THAN 6 FEET)
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Are harnesses and appropriate lanyards being worn?
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Are anchor points of sufficient strength (i.e.. 5000 capacity)
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If no harness/lifelines are utilized, has a warning line been placed at least 6 feet from the edge?
MISCELLANEOUS SAFETY ITEMS
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Have appropriate smoking and eating areas been designated?
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Is the work zone properly barricaded or secured?
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Are appropriate work zones (hot deacon support) established and sufficient?
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Is the system of communication utilized by the crew sufficient?
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Is the lighting utilized on the site sufficient to safely illuminate the work zone?
GENERAL SITE CONDITIONS OR COMMENTS
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Site Conditions?
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REVIEWED H&S MANAGER:
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SUPERVISOR / FOREMAN
