Field SSA

• Job # / Name

• Assessment Date

  Date

• Assessor

• Field Location

• Foreman

• Crew Members

• Superintendent

Administrative Safety

• Has the Morning Safety Huddle been completed?

  Yes

  No

  N/A

• What hazards and/or safety message was shared with the crew?

• Did the crew complete a stretch & flex exercise?

  Yes

  No

  N/A

• Did the crew stretch prior to starting work?

  Yes

  No

  N/A

• What actions were taken?

• What actions were taken?

• Has the Weekly Toolbox Talk been completed?

  Yes

  No

  N/A

• What was the topic?

• Do job-site conditions meet "Milestone 5" expectations?

  Yes

  No

  N/A

• What are the current weather conditions?

• Further Comments?

COVID-19

• Estimate how many trades are onsite currently.

• Are social distancing practices followed?

  Yes

  No

  N/A

• What actions were taken to address with crew and/or GC?

• Are restroom facilities clean and hand washing systems available?

  Yes

  No

  N/A

• What actions were taken?

  Yes

  No

  N/A

• Further Comments?

Housekeeping

• Is there clear safe access to work areas?

  Yes

  No

  N/A

• What actions were taken?

• Are all loose materials on the job-site secure from wind?

  Yes

  No

  N/A

• What actions were taken?

• Further Comments?

Personal Protective Equipment (PPE)

• Are all employees wearing required PPE? (hard hat, safety glasses, hi-vis, steel toed boots)

  Yes

  No

  N/A

• What PPE is not being worn properly and what actions were taken to address?

• Are grinding activities in progress?

  Yes

  No

  N/A

• Are employees wearing proper face protection (i.e. a Full Face Respirator or Half Face with a Face Shield?)

  Yes

  No

  N/A

• What actions were taken to address non-compliance?

• Are sawing activities in progress?

  Yes

  No

  N/A

• Are dust control measures in place?

  Yes

  No

  N/A

• What actions were taken to address non-compliance?

• Further Comments?

First Aid/Fire Prevention

• Are the First Aid Kits available and contents up to date?

  Yes

  No

  N/A

• What actions were taken

• Are fire extinguishers accessible?

  Yes

  No

  N/A

• What was the date of the last inspection?

• Are employees aware of emergency procedures and evacuation assembly points?

  Yes

  No

  N/A

• What actions were taken to educate employees of emergency procedures and/or evacuation assembly points?

• Further Comments?

Mobile Equipment

• What mobile equipment is currently in use onsite?

• Have daily pre-use inspections been completed for all equipment in use?

  Yes

  No

  N/A

• What actions were taken to educate on pre-use inspection process?

• Can employees operating equipment verify that they hold valid training for equipment operated?

  Yes

  No

  N/A

• Are employees operating equipment in a safe manner (avoiding pinch points, not walking under suspended loads, line of fire, objects are moved properly, load is appropriate for piece of equipment, etc)

  Yes

  No

  N/A

• What actions were taken?

• Have lifting devices been inspection prior to use?

  Yes

  No

  N/A

• What actions were taken?

• What actions were taken?

• Is panel erection in progress?

  Yes

  No

  N/A

• Is the swing radius on the crane identified?

  Yes

  No

  N/A

• What actions were taken?

• Are Aerial Lifts in use?

  Yes

  No

  N/A

• Does operator have on required harness?

  Yes

  No

  N/A

• Has harness been visually inspection prior to use?

  Yes

  No

  N/A

• What actions were taken?

• What actions were taken?

• Yes

  No

  N/A

• Are operators tied off?

  Yes

  No

  N/A

• What actions were taken?

• Further Comments?

Rigging

• Is rigging in use in proper operating condition?

  Yes

  No

  N/A

• Has a visual pre-use inspection been completed?

  Yes

  No

  N/A

• What actions were taken?

• Is an adquate stock of replacement latches available in the Field Truck?

  Yes

  No

  N/A

• What actions were taken?

• Are braces visually inspected prior to use?

  Yes

  No

  N/A

• Does the condition match the results of the visual inspection?

  Yes

  No

  N/A

• Are braces installed safely and according to internal procedures?

  Yes

  No

  N/A

• What actions were taken?

Excavations/ Trenches

• Are foots in compliance with the SAP?

  Yes

  No

  N/A

• What actions were taken to address with the GC?

• Do employees have adequate egress to footing?

  Yes

  No

  N/A

• What actions were taken to address?

• Further Comments?

Welding/Hot Work

• Are welding tasks in progress?

  Yes

  No

  N/A

• Are hot work permits in place?

  Yes

  No

  N/A

• What actions were taken to address?

• Are fire extinguishers accessible in working area?

  Yes

  No

  N/A

• What actions were taken?

• Is the correct PPE being used?

  Yes

  No

  N/A

• What actions were taken?

• Is there adequate ventilation?

  Yes

  No

  N/A

• What actions were taken?

• Further Comments?

Chemicals & Fuels

• Are chemicals stored correctly and labelled?

  Yes

  No

  N/A

• What actions were taken?

• Are Safety Data Sheets (SDS) available for the chemicals on site?

  Yes

  No

  N/A

• Are fuels labeled and stored properly in Field Truck?

  Yes

  No

  N/A

• What chemical was not labeled properly?

• What actions were taken?

• Further Comments?

Hand/Power Tools

• Are tools stored properly in trucks when not in use (ex. batteries removed from cordless tools)

  Yes

  No

  N/A

• What tools were not stored properly?

• What actions were taken?

• Are safe practices followed for tools in use?

  Yes

  No

  N/A

• What tools were not used safely?

• What actions were taken to address at-risk behavior?

• Are GFCI's in use?

  Yes

  No

  N/A

• What actions were taken?

• Are all guards in place and in proper working order?

  Yes

  No

  N/A

• What actions were taken to correct missing/inadequate guarding?

• Are blades in appropriate condition?

  Yes

  No

  N/A

• What actions were taken?

• Further Comments?

Ladders

• Can an aerial lift be used in place of a ladder for work in progress?

  Yes

  No

  N/A

• Why did the employee choose to use a ladder instead of a lift?

• Are ladders in good condition, free from damage and signs of wear and tear?

  Yes

  No

  N/A

• What actions were taken to address damage or wear?

• Is the correct ladder type and size being used?

  Yes

  No

  N/A

• What actions were taken?

• Further Comments?

General Jobsite Photos

• Overall Site Rating

  Superior

  Average

  Poor

  N/A

• Add any supporting photos otherwise not included.

  Media

• Unsafe Behaviors or Conditions

• Rate the Unsafe Behavior or Condition

  Low Risk

  Medium Risk

  High Risk

• Unsafe Behaviors or Condition

• Rate the Unsafe Behavior or Condition

  Low Risk

  Medium Risk

  High Risk

• Unsafe Behavior or Condition

• Rate the Unsafe Behavior or Condition

  Low Risk

  Medium Risk

  High Risk

• Safe Behavior, Condition or Recognition

• Rate the Safe Behavior, Condition or Recognition

  Low Impact

  Medium Impact

  High Impact

• Safe Behavior, Condition or Recognition

• Rate the Safe Behavior, Condition or Recognition

  Low Impact

  Medium Impact

  High Impact

• Safe Behavior, Condition or Recognition

• Rate the Safe Behavior, Condition or Recognition

  Low Impact

  Medium Impact

  High Impact

• Safe Behavior, Condition or Recognition

• Rate the Safe Behavior, Condition or Recognition

  Low Impact

  Medium Impact

  High Impact

• List any additional comments