Information
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Site conducted
Project Information
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Template Title
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Location
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Conducted on
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Inspection reviewed with?
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Prepared by:
Soft Tissue Operations Mitigation Program
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Material handling plan in place. No lifting over 50 Lbs.
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Material Moving Equipment on site and in use (i.e. carts, dolleys,hoist, wire carts, fork lifts, etc.)
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Proper lifting procedures addressed on site specific plan and enacted on the field?
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Team members trained on STOMP procedures
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Repetitive motion tasks addressed and plan in place to prevent injuries?
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Daily Safety Huddle being done
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what was today's topic
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was there a JHA Performed.
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Are coordinators performing Observations and coaching?
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Supervisor Audits and Observations being performed
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Supervisor set proper example to address STOMP issues – mechanical aids – Observations.
Safety Mentoring and Coaching
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Coaching mentoring Opportunity
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Description
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Select control needed
- PPE
- Administrative
- Engineering
- Substitution
- Elimination
- Other
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Describe hazard and elimination plan in detail
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Details of control measure
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Were there at risk behaviors involved?
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What type of feed back was given?
- Time out for safety
- Safety Leadership
- Effective feedback
- Other specific feedback
- Communication
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To whom? describe it in detail
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Comments
Personal Protective Equipment
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Hard hats, safety glasses in use by all personnel
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Gloves (sharp edges, using knives, handling materials)
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Proper foot gear and protective clothing. Traffic vest if necessary
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comments
Administration
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Is site specific Plan in place?
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Employees on site signed
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JHA updated by supervisor according to changing scope of work?
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Emergency program in place
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trained personnel
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Emergency Phone Number posted
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State / Fed. Posters (English-Spanish) Posted?
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Safety manual available?
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Hazard communication program available?
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Is there cold water provided
Hazard Communication (HazCom)
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Employees trained on Hazard communication Risks ?
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Proper labels on containers?
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(SDS) Safety data Sheets manual current?
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Emergency Action Plan available?
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First-Aid Kit Available?
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First-Aid/CPR trained personal onsite
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(BBP) Bloodborne Pathogens control plan available?
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Is training upto date?
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Is there a Silica Exposure Control Plan In Place?
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Is the competent person performing inspections and implementing the ECP?
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Can the competent person identify existing and foreseeable silica hazards
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Are exposed employees trained on silica exposure control?
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Do employees have access to SDS sheet on silica exposure in the workplace
Medical/Emergency
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Incident investigation proecedure in place and forms available
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Employees understand Incident<br>Reporting procedure
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Map to medical facility posted
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Have there been any incidents onsite
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Employees trained to prevent similar incidents
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Is employee back to work
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Why
Electrical (General)
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Are electrical rooms actionable with company policies?
Electrical Rooms
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Adequate lighting
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Signage present
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Electrical room protected
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Electrical panels protected and locked
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Energized parts protected
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Extension cords in compliance per company policy
Extension Cords
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Outer insulation damage on cords
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Approved three wire extension cords
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Ground prongs on cords
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Cords protected from traffic
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Temporary Panels actionable in accordance with SOP?
Temporary Panels
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GFCI's used and functioning
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Signage present
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Proper use of temporary power<br>boxes
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Safety plates on outlets and J boxes
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J box knockouts utilized and covered
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Hardware splices in J boxes
LOCK OUT/ TAG OUT (LOTO)
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Are LOTO procedures actionable?
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Are employees trained on the procedure?
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Do they need to be Trained?
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Plan of Action and responsible person.
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LOTO log posted according to company policy
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Do they Have the necessary equipment for LOTO procedures including kit, tags, permanent locks
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Company procedure being followed and enforced?
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what is the deficiency and how will it be corrected?
Hot Electrical Work
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Is hot electrical work actionable?
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JSA completed
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All affected employees briefed
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Proper level of PPE being used
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Insulated gloves tested and up to<br>date
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Electrical PPE inspected
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LOTO procedures being used
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Boundaries established and barriers set
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Back up person trained in emergency<br>procedure
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JSA steps and procedure being<br>observed
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Energized parts protected
Ladders & Stairs
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Are we using ladders?
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Safe procedures being followed
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Ladders inspected
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Are ladder being used for its intended purpose?
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Safe work distance kept from hazards
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Employees not using top two rungs
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Extension ladders only used to gain access? extended 3 feet above landing or secured at top.
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Step ladders in the open position
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Rope for hoisting present with<br>extension ladders
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Landings and treads filled on stairs
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Handrails on stairs?
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Stairs illuminated
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Ladder inspection
Ladder Inspection
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Side rails in good condition?
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Steps or rungs not loose or damaged?
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Spreader braces not damaged and open fully
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Rivets, screws or bolts not missing or damaged
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free from oil grease or slippery materials
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is ladder stable?
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Non slip feet in good condition?
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is ladder wobbly or loose?
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hinges spreaders not loose or damaged
Fall Protection (29CFR 1926.500's)
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Are there fall hazards present?
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Fall protection plan (site specific) in place and employees know the requirements?
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Are guardrails installed where JBI employees are working?
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Floor wall and window openings protected
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Fall protection being used at 6 feet or higher
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Proper anchorage points used
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Harness being worn properly
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Employees trained
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Safety harness, lanyards, and<br>retractable inspected?
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Overhead protection from falling<br>objects in place ?
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HLL and vertical life lines inspected<br>and used properly
Scissor & Aerial Lifts
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Are aerial lifts being used?
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Operators trained
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Equipment/workplace inspections<br>completed and documented
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Operators following safety<br>procedures
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Harness and lanyard used in aerial lifts
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Safe work distance kept from<br>elevation changes
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Gate or chain secured
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Nothing used to increase height
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Load ratings observed
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Is aerial platform operated on a flat level surface?
Motorized Equipment (Sky Jack, Backhoe etc.)
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Is there earthmoving or telescopic handler equipment being used?
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What kind of equipment?
- Scissor Lifts
- Boom Lifts
- Back Hoe
- Mini Excavator
- Telescopic Handler
- Fork lift
- Trencher
- Skid Steer
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Operator trained on that particular<br>equipment?
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Name the employees that require training and equipment.
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what equipment is he operating?
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When do we need to conduct training?
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Seat belt utilized
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Back up alarm functioning
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Horn functioning
Hand & Power Tools
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Is there a risk associated with hand and power tools?
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Employees trained
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Additional PPE provided or available
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Safe practices being observed
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Tool in good condition
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Proper tool for the job
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Information label on tool
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Manufacturer instructions being<br>observed
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Cord in good condition
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Guards in place
Excavations
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Are there any risk associated with excavations?
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Competent person present
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Utilities located and marked
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Walls sloped or shored to prevent cave in prior to employees getting inside?
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Employees trained
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Daily Inspections documented
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Proper access if is more than 4' deep
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Access and exits within 25 feet
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Fissures, cracks or shrinkage evident
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Surface conditions acceptable
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Perimeter protected/barricaded
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Traffic exposure controlled
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Top of shoring18 inches above ground
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More than 6 inches between box &<br>excavation wall
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Spoil 2 feet back from edge
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Excavations more than 20 feet deep<br>engineered
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Water entering excavation
Housekeeping
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Are there slips, trips, hazards risk?
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Slip, trip, fall hazards protected and<br>clearly visible
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Slip, trip, fall hazards eliminated
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Stairs clear of tripping hazards
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Work platforms clean
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Walkways clear
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Clear access to building or site
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Materials properly stored
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Trash in protected container
Site & Public Protection
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is public protection signage actionable
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Perimeter fence or barricades<br>installed
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Adequate lighting provided
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Security system in place
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Hand sanitizer available
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Superintendent Signature
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Comments
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Add media
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Safety Signature
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Address behavioral issues positive and negative – Other general comments – PPE worn – Supervisor set proper example – accidents / near misses reported