GH Phipps Safety Form

• Conducted on

  Date

• Job Name

• Job Number

• GHP Inspector's Name

• Additional Inspectors

GENERAL SAFETY

• Work areas and the site neat and orderly, with tripping hazards removed?

  Yes

  No

  N/A

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  Date

• Trash and debris being placed in proper receptacles?

  Yes

  No

  N/A

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  Date

• Proper employment and OSHA signage on display?

  Yes

  No

  N/A

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  Date

• JHAs being performed daily for each task?

  Yes

  No

  N/A

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  Date

• Storm-water Management Inspections being completed on time and findings corrected in 72 hours?

  Yes

  No

  N/A

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  Date

• Task-specific signage being used (e.g. Lasers, Powder Actuated Fasteners, Overhead Work, Egress Path, etc.)?

  Yes

  No

  N/A

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  Date

• First-aid, blood-borne pathogen, eye-wash, & spill kit stocked and available? Water infiltration protection (wip) kit available (where applicable)?

  Yes

  No

  N/A

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  Date

• Are: 1.) GH Phipps Tool Box/Training Meeting Records, 2.) GH Phipps SDS forms & Policies, 3.) Subcontractor SDS forms & Policies, and 4.) GH Phipps & Subcontractor Haz-Com forms, updated/available/verified for all activities onsite?

  Yes

  No

  N/A

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  Date

• Fire extinguishers inspected monthly? Designated fire extinguisher(s) located <50’ from flammable/pressurized material storage?

  Yes

  No

  N/A

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  Date

• Liquids, flammables, and pollutants stored properly in secondary containment/covered? Are “NO SMOKING” signs posted?

  Yes

  No

  N/A

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  Date

• Impalement hazards (rebar, conduit, pipe, etc) properly protected?

  Yes

  No

  N/A

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  Date

• Temporary toilet facilities adequate, maintained, secured, and located on impervious surface/catch tray?

  Yes

  No

  N/A

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  Date

• PPE: Hardhats, boots, pants, 4” sleeves, hi-visibility vests, eye protection (Z.87 with side shields), hearing protection, and gloves in use by all employees? Face shields being used for overhead work? Kevlar sleeves/gloves for sharps/demo work?

  Yes

  No

  N/A

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  Date

• Overhead hazards protected?

  Yes

  No

  N/A

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  Date

• Are environmental hazards managed (sun/hot/cold/wet/wind/ice/insects/vermin/asbestos/mercury/silica)?

  Yes

  No

  N/A

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  Date

Slips / Trips / Falls

• Holes larger than 2” in diameter covered, marked, and secured?

  Yes

  No

  N/A

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  Date

• Floor openings > 2’ in diameter and wall openings > 19” properly protected (e.g. guardrails, handrails, barricades, and toe boards)?

  Yes

  No

  N/A

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  Date

• Access/egress and main travel ways free from cords, hoses, mud, ice, and other trip hazards with 3’ clear?

  Yes

  No

  N/A

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  Date

• Six (6) foot + fall exposures properly tied-off or protected (e.g. guardrails, handrails, barricades, and toe boards)?

  Yes

  No

  N/A

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  Date

• Barricades, fencing, caution/danger tape, etc, being used properly and maintained?

  Yes

  No

  N/A

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  Date

• Vertical elevation breaks greater than 19”? Are there steps?

  Yes

  No

  N/A

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  Date

• Proper fall arrest/protection (lanyards/retractables) in use, including in boom lifts? Inspected as required by manufacturer?

  Yes

  No

  N/A

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  Date

• Roof flagging 15’ back from leading edge for general activities and 6’ back from roof work maintained?

  Yes

  No

  N/A

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  Date

Ladders

• Extension ladders extended 3’ above upper landing(s)? Are they securely fastened with a cattle guard at the upper landing(s)?

  Yes

  No

  N/A

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  Date

• Ladders positioned at 4:1 (rise/run)?

  Yes

  No

  N/A

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  Date

• Only type 1, 1A, and 1AA ladders in use with all labels legible, and without any damaged/missing parts?

  Yes

  No

  N/A

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  Date

• Stepladders being used in proper position and employees are not on the top 2 rungs?

  Yes

  No

  N/A

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  Date

Tools

• Tools in proper working condition, including guards and mag switches (where required)?

  Yes

  No

  N/A

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  Date

• GFCIs in use for ALL power equipment?

  Yes

  No

  N/A

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  Date

• Damaged tools and equipment tagged out?

  Yes

  No

  N/A

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  Date

• Employees trained to operate power tools and carrying certification to operate powder-actuated tools?

  Yes

  No

  N/A

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  Date

Equipment

• Has equipment been inspected? Backup alarm functioning properly? Seatbelts in use?

  Yes

  No

  N/A

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  Date

• Operators certified (forklift and crane) and trained (scissors and boom lifts)?

  Yes

  No

  N/A

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  Date

• Swing radiuses barricaded?

  Yes

  No

  N/A

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  Date

• Equipment is not left running with an operator more than 25’ away or idling in enclosed spaces? Are CO monitors in place?

  Yes

  No

  N/A

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  Date

Material Handling & Rigging

• Employees using proper lifting techniques?

  Yes

  No

  N/A

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  Date

• Chains, straps, and chokers in good condition with legible capacity ratings?

  Yes

  No

  N/A

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  Date

• Lifting hooks have safety latch in place?

  Yes

  No

  N/A

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  Date

• Tag-lines being used properly (correct length)?

  Yes

  No

  N/A

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  Date

• Hoisting equipment being used and stored correctly?

  Yes

  No

  N/A

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  Date

Trenching & Excavating

• Excavations greater than 5’ deep properly sloped/benched and shored?

  Yes

  No

  N/A

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  Date

• Excavation contractor’s competent person signed-off on excavation before employees entering?

  Yes

  No

  N/A

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  Date

• Crew aware of potential existing and overhead utilities?

  Yes

  No

  N/A

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  Date

• Spoils kept at 2’ away from excavation/trench edge?

  Yes

  No

  N/A

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  Date

• Open excavations barricaded at perimeter?

  Yes

  No

  N/A

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  Date

• Adequate egress/exits from trench; not more than 50’ apart?

  Yes

  No

  N/A

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  Date

• Utility locates have been completed and underground utilities marked?

  Yes

  No

  N/A

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  Date

Scaffolding

• Mud-sills properly installed? Is scaffolding tied to structure adequately?

  Yes

  No

  N/A

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  Date

• Is access/egress adequate?

  Yes

  No

  N/A

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  Date

• Planking properly installed? Top-rail/mid-rail/toe boards in place?

  Yes

  No

  N/A

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  Date

• Has a competent person signed off before employees are granted access? Is it tagged?

  Yes

  No

  N/A

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  Date

• Mobile scaffolds (e.g. baker scaffolds) properly erected with outriggers/base plates/casters locked/hand-rails above 6’?

  Yes

  No

  N/A

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  Date

Electrical

• Extension cords inspected and in good condition with grounding prong?

  Yes

  No

  N/A

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  Date

• Temporary lighting adequate and are protective cages in place?

  Yes

  No

  N/A

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  Date

• Is GHP assured grounding colors are up-to-date for tools and cords?

  Yes

  No

  N/A

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  Date

• Verify no open circuits, panels, cover plates, etc.? Panels and gear have a minimum 36” clearance?

  Yes

  No

  N/A

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  Date

• Minimum 10’ clearance between equipment and any power lines (scaffolding, cranes, excavators, forklifts, & equipment)?

  Yes

  No

  N/A

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  Date

Welding/Cutting

• Are hot works permits in place before hot work occurs?

  Yes

  No

  N/A

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  Date

• Is fire watch occurring 30 minutes after hot work?

  Yes

  No

  N/A

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  Date

• Is a fire extinguisher immediately available and ready (within 25’)?

  Yes

  No

  N/A

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  Date

• Proper PPE including hardhat-mounted hood, welding screens, fire blankets, and air monitoring in use?

  Yes

  No

  N/A

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  Date

Confined Space

• Safety Department contacted to walk potential confined spaces?

  Yes

  No

  N/A

• Select date

  Date

• Evaluation procedures followed and permit in place?

  Yes

  No

  N/A

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  Date

• Calibrated air monitors (Phipps and Subcontractor’s) in use?

  Yes

  No

  N/A

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  Date

• Signage in place and access restricted?

  Yes

  No

  N/A

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  Date

Open Observations

GHP Inspector’s Signature

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  Sign