HAMMER, INC. WORK IN PROGRESS SAFETY AND HEALTH ASSEMENT

• Conducted on

  Date

• Location

• Project Name

• Supervisor

• Work Order (if yes document # in notes)

  Yes

  No

  N/A

• Instructions: Select the rating, using the below schedule, that describes the job performance in each category. (Use N/A if not applicable)

Safe Work Permit/JSA

• Permit Issued

  Yes

  No

  N/A

• JSA Completed

  Yes

  No

  N/A

• Hazard prevention controls on place

  Yes

  No

  N/A

• Workers assigned to job on permit

  Yes

  No

  N/A

• Additional permits issued based on work (hot work, confined space, etc.)

  Yes

  No

  N/A

Personal Protection Equipment

• Eye Protection

  Safe

  At Risk

  N/A

• Hearing Protection

  Safe

  At Risk

  N/A

• Head/ Face Protection

  Safe

  At Risk

  N/A

• Respiratory Protection

  Safe

  At Risk

  N/A

• Hi Vis Clothing

  Safe

  At Risk

  N/A

Housekeeping

• Trip Hazards

  Exceeds Expectation

  Meets Expectation

  Below Expectation

  N/A

• Combustibles Properly Stored

  Exceeds Expectation

  Meets Expectation

  Below Expectation

  N/A

• Trash Properly Disposed off

  Exceeds Expectation

  Meets Expectation

  Below Expectation

  N/A

• Materials Properly Stacked/Stored

  Exceeds Expectation

  Meets Expectation

  Below Expectation

  N/A

Slips, Trips, and Fall Prevention

• Personal Fall arrest system required? (harness / SRL)

  Yes

  No

• Inspected and good working condition

  Yes

  No

  N/A

• Ladder / Scaffolds

  Yes

  No

  N/A

• Inspection tag completed for current shift

  Yes

  No

  N/A

• Is there risk of objects falling off scaffold and striking someone below? (toe boards in place, netting, barricades, etc.)

  Safe

  At Risk

  N/A

Mobile Equipment Interaction Prevention

• Is there mobile equipment and pedestrian interaction on the job site?

  Yes

  No

• Inspection completed

  Yes

  No

  N/A

• Signage / barricades in place

  Yes

  No

  N/A

• Hi-Viz Clothing required

  Safe

  At Risk

  N/A

Fire/Explosion Prevention

• Is there any hot work on this job?

  Yes

  No

• Hot Work Permit Completed

  Yes

  No

  N/A

• Fire Watch identified, trained, and present

  Yes

  No

  N/A

• Fire Extinguisher present and inspected within the last year

  Yes

  No

  N/A

• All Combustibles Outside 35 feet from hot work

  Yes

  No

  N/A

• Gas Cylinders properly secured

  Yes

  No

  N/A

Preventing contact with unguarded/uncontrolled energy

• Is LOTO required for this job?

  Yes

  No

• All energy sources identified and isolated

  Yes

  No

  N/A

• LOTO procedures followed

  Yes

  No

  N/A

• All personnel properly locked out

  Yes

  No

  N/A

Preventing chemical exposure

• Is there a chance of harmful chemical exposure

  Yes

  No

• Line Break Permit Completed

  Yes

  No

  N/A

• Positive verification of zero energy

  Yes

  No

  N/A

• Proper PPE

  Yes

  No

  N/A

Confined Space Entry

• Is confined space entry required for this job?

  Yes

  No

• CSE attendant present and trained

  Yes

  No

  N/A

• Is there a constant communication method in place? (Document the method in notes)

  Yes

  No

  N/A

• Continuous atmospheric monitoring required?

  Yes

  No

  N/A

• Monitor bumped and calibrated

  Yes

  No

  N/A

Additional Hazards / Comments

• Did you encounter any additional hazards not listed during your inspection?

  Yes

  No

• Please provide details of the hazards

• Any additional comments required for this inspection?

  Yes

  No

• Add comments below.

• Name of Person conducting Audit

  Sign