F.O.G. Report for Skanska Ronler Acres - duplicate

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Job information:

• Site Description, Location and Project:

• Work Week & Year:

• CC Name:

• # of Crew Performing Elevated Work:

• Days Elevated Work to Occur:

• Monday

  Yes

  No

• Tuesday

  Yes

  No

• Wednesday

  Yes

  No

• Thursday

  Yes

  No

• Friday

  Yes

  No

• Saturday

  Yes

  No

• Sunday

  Yes

  No

Instructions

• 1. Inspect the site and submit this form each week by Wednesday noon to Apollo Admin.<br><br><br><br>

  Yes

  No

• 2. Complete all sections on this form.

  Yes

  No

• 3. F.O.G. Plan must be in Foreman’s possession.

  Yes

  No

• 4. Any condition with a fall hazard with “Feet Off Ground” requires a Work Plan. If Feet are not required to leave ground this plan is not required.

  Yes

  No

SECTION 1: PROJECT SPECIFIC FALL HAZARDS

• <br>Ladders<br>

  Yes

  No

• <br>Deck/Walking Working Surface Leading Edge<br>

  Yes

  No

• <br>Scaffold and/or Staging: Falls From

  Yes

  No

• <br>Catwalk/Scaffold: <br> <br><br>

  Yes

  No

• Falls From Elevation

  Yes

  No

• Working from MEWP

  Yes

  No

• Roof or Floor Penetrations/Openings (2” or bigger must be protected over 12” requires Safety to review)

  Yes

  No

• Open steel Beam/Truss/Framework:

  Yes

  No

• Working Outside of Guardrail Systems (MEWP and Scaffold)

  Yes

  No

• Shaft Openings

  Yes

  No

• <br>Tank/Vessel/Equipment: Falls Into

  Yes

  No

SECTION 2: FALL PROTECTION METHODS OR SYSTEMS TO BE USED

• Parapet Wall Height of 39” or Greater

  Yes

  No

• Non-Engineered Scaffold (SINGLE PLANK)

  Yes

  No

• Engineered Scaffold

  Yes

  No

• Guardrail System

  Yes

  No

• Hole Covers: Secured and Labeled<br><br>

  Yes

  No

• Fall protection Harness (If this is checked, Identify anchor point)

  Yes

  No

• Self Retracting Lifeline (anchor point)

  Yes

  No

• Embedded strut (anchor point)

  Yes

  No

• Rope Grab (anchor point)

  Yes

  No

• Horizontal life line (anchor point)

  Yes

  No

SECTION 3: PERSONNEL ACCESS

• Ladder: A-Frame

  Yes

  No

• Ladder: Extension

  Yes

  No

• Personnel Lift

  Yes

  No

• Catwalk<br> <br><br> <br><br> <br><br> <br> <br>

  Yes

  No

• Stair Tower /Scaffold Ladder System

  Yes

  No

SECTION 4: DESCRIBE OVERHEAD PROTECTION FOR WORKERS WHO MAY PASS UNDER OVERHEAD WORK

• <br>Install Caution Tape with Signage when needed

  Yes

  No

• Install Danger Tape with Signage when needed

  Yes

  No

• Block Access/Egress Points Into Work Zone

  Yes

  No

• Provide Spotter/Flagger in Work Zone IF NEEDED<br> <br><br> <br><br>

  Yes

  No

Section 5: RESCUE PLAN OR SYSTEM

• Use Life Lines/Retrieval Devices (tri pods, ect....)

  Yes

  No

• <br>Utilize Scaffolds or SINGLE PLANK

  Yes

  No

• Utilize Ladder

  Yes

  No

• Utilize Lift

  Yes

  No

• Initiate Emergency Response:503.613.4444 or ext 4.4444<br> <br><br> <br><br>

  Yes

  No

• Other:

  Yes

  No

Sign Off

• G/F – Foreman signature:

  Sign

• CC's Name:

  Sign