Hazard Assessment Checklist for Construction Industry

• Subcontractor Company Name

• Location
  Address

• Project Title

• Subcontractor Superintendent

• Conducted on

  Date

• Prepared by

• Description of the activity or work to be performed (Work scope)

Personal Protective Equipment

• Select available and appropriate PPE to protect employees against hazards

  Select Full face shields Safety goggles Safety boots Work gloves Ear plugs Or ear muffs Respirators High visibility vests Fall Protection devices (harness and lanyards) Hard hats Others

  • Full face shields
  • Safety goggles
  • Safety boots
  • Work gloves
  • Ear plugs Or ear muffs
  • Respirators
  • High visibility vests
  • Fall Protection devices (harness and lanyards)
  • Hard hats
  • Others

• Enter other PPE used

Hand and Power Tools

• Will the work involve the use of electrically powered tools?

  Yes

  No

  N/A

• Will the work involve the use of pneumatically powered tools?

  Yes

  No

  N/A

• Will the work performed on this project involve the use of powder-actuated tools?

  Yes

  No

  N/A

Ground & Surface Penetrations

• Will the work scope require you to cut into, chip into, drill into, or make any other penetrations into walls, ceilings or floors?

  Yes

  No

  N/A

• Will the work scope require you to excavate, trench, dig, or otherwise penetrate into the ground (including use of stakes or poles)?

  Yes

  No

  N/A

• Will the work scope require you to penetrate into any concrete surface at any depth?

  Yes

  No

  N/A

• Have building surfaces or structures to be penetrated been evaluated for lead and asbestos?

  Yes

  No

  N/A

Excavation and Trenching

• Will this work scope involve any excavation up to 5 feet deep?

  Yes

  No

  N/A

• Will this work scope involve any excavation deeper than 5 feet?

  Yes

  No

  N/A

• Will this work scope involve sanitary sewer line repair or replacement?

  Yes

  No

  N/A

• Will this work scope involve storm sewer line repair or replacement?

  Yes

  No

  N/A

Demolition

• The subcontractor has signed off on the Isolation Plan: Electrical, Gas, Water, Steam, or other Utilities?

  Yes

  No

  N/A

• Subcontractor will submit the following items for Demolition Plan: - An Isolation Plan along with an SOP for startup.

  Yes

  No

  N/A

Traffic & Pedestrian Control

• Will this work scope require any traffic or pedestrian disruptions?

  Yes

  No

  N/A

• Blocking or partially blocking any roadway, walkway or driveway?

  Yes

  No

  N/A

Hazardous Energy Control (LOTO)

• Will you be doing any electrical work?

  Yes

  No

  N/A

• Electrical work includes:

• Working within 42 inches of an energized electrical part (for example; working inside a VFD with an unshielded line side or working within 42 inches of an energized crane bus bar)

  Yes

  No

  N/A

• Testing for zero energy

  Yes

  No

  N/A

• Troubleshooting and inspecting

  Yes

  No

  N/A

• Making changes to the facility electrical system (for example; replacing breakers or wiring)

  Yes

  No

  N/A

• Will your work involve working on non-electrical systems that contain hazardous energy?

  Yes

  No

  N/A

• Select non-electrical systems

  Select Mechanical Hydraulic Pneumatic Water Chemical Steam Thermal

  • Mechanical
  • Hydraulic
  • Pneumatic
  • Water
  • Chemical
  • Steam
  • Thermal

• Will your work include service, maintenance, or modification of equipment in which the unexpected energization or start-up of the equipment, or the release of stored energy, could cause injury to people or damage to equipment?

  Yes

  No

  N/A

• Will your work require you to overlock onto an existing LBNL LOTO lock to protect from hazardous energy?

  Yes

  No

  N/A

• Are you removing or opening any electrical equipment covers of electrical equipment? For example boxes, panels, disconnect switches, etc.

  Yes

  No

  N/A

• Are you doing any demolition work that will require the removal of electrical equipment, walls, partitions, building structures, piping systems, ducts, etc.?

  Yes

  No

  N/A

• Are you working on the travel path of a crane, hoists, or other equipment that present crush or pinch hazards?

  Yes

  No

  N/A

• Will your work require installing, repairing or modifying rotating equipment?

  Yes

  No

  N/A

• Will your work require the potential exposure to more than 250 volts?

  Yes

  No

  N/A

Elevated Surfaces, Cranes & Heavy Equipment

• Elevated Work Platforms

  Select Aerial Lift Articulating Boom Lift Scissor Lift Man-Lift Other

  • Aerial Lift
  • Articulating Boom Lift
  • Scissor Lift
  • Man-Lift
  • Other

• Enter other elevated work platforms used

• Scaffolding

  Select Tubular & Coupler Scaffolding Rolling Scaffold Mobile Scaffold Mason/Bricklayers Scaffold Other

  • Tubular & Coupler Scaffolding
  • Rolling Scaffold
  • Mobile Scaffold
  • Mason/Bricklayers Scaffold
  • Other

• Other scaffold used

• Ladders

  Select Portable ladder Self-supporting ladder Non-self supporting ladder Other

  • Portable ladder
  • Self-supporting ladder
  • Non-self supporting ladder
  • Other

• Other type of ladder used

• Cranes

  Select Backhoe Front End Loader Excavator Crane Under 3 Tons Crane Over 3 Tons Forklift Other

  • Backhoe
  • Front End Loader
  • Excavator
  • Crane Under 3 Tons
  • Crane Over 3 Tons
  • Forklift
  • Other

• Other type of crane used

Fire Protection & Prevention

• Will work include the use of open flames such as torches, welders, grinders, tar pots or any other tool or process/procedure that could cause sparks or open flames?

  Yes

  No

  N/A

• Will work be performed near combustible storage containers?

  Yes

  No

  N/A

• Will there be on-site refueling of equipment?

  Yes

  No

  N/A

• Has a Fire Watch been training in the use of fire extinguisher and emergency procedures for the work being performed?

  Yes

  No

  N/A

Steel Erection and Assembly

• Is steel erection part of this work scope?

  Yes

  No

  N/A

Roofing

• Will roof installation or roof repairs be performed?

  Yes

  No

  N/A

• Will you be on any roof performing work in your specific trade?

  Yes

  No

  N/A

• Will employees remain 15 feet back from the roof or other leading edges greater than 6 feet in height?

  Yes

  No

  N/A

• Will a warning line system (non-conforming guardrail) be used to delineate the 15-foot boundary?

  Yes

  No

  N/A

• Will work take place beyond the warning line?

  Yes

  No

  N/A

Hazardous Substances and Materials

• Will the work involve the use of any chemicals, such as paints, solvents, adhesives, epoxy coatings, fuels or other hazardous materials?

  Yes

  No

  N/A

• Will employees be potentially exposed to airborne concentrations of hazardous gas, fume, dust or mist?

  Yes

  No

  N/A

Permit-Required Confined Space Entry

• Will the scope of your work require you to be working in a confined space where physical or atmospheric hazards (i.e. Flammable or toxic) may be present?

  Yes

  No

  N/A

Welding/Hot Cutting

• Will the work involve welding/cutting steel at painted surfaces?

  Yes

  No

  N/A

• Will the work involve welding/cutting stainless steel?

  Yes

  No

  N/A

Lead Paint

• Will the work involve sanding, grinding, scraping, brazing, cutting, welding, removing or otherwise disturbing painted surfaces in such a way that lead particles may become airborne?

  Yes

  No

  N/A

Asbestos

• Will the work involve sanding, grinding, scraping, brazing, cutting, welding, removing or otherwise disturbing painted surfaces in such a way that lead particles may become airborne?

  Yes

  No

  N/A

Application of Paint and other Coatings

• Does the scope of your work include sanding, scraping, grinding, washing or other prep activity?

  Yes

  No

  N/A

Silica Dust

• Will work involve jack-hammering, rotohammering, drilling, grinding or other disturbance of concrete or use of products that contain crystalline silica that might create silica dust?

  Yes

  No

  N/A

• Will work involve wet slab or wall concrete cutting, drilling, and coring or cutting/sanding drywall or joint compound?

  Yes

  No

  N/A

Radiation and Laser Safety

• Will radioactive material/sources be used?

  Yes

  No

  N/A

• Will you be working on a class 3B or Class 4 laser?

  Yes

  No

  N/A

• Will you be working on a microwave source greater than 5mW/cm2?

  Yes

  No

  N/A

Observations

• Describe other observations here

Completion

• Full Name and Signature of the Inspector

  Sign