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 Hardhat Safety Glasses Class 3 Safety Vest Full face shields Safety goggles Safety boots Work gloves Anti-Vibration Gloves Ear plugs / Ear muffs Respirators Dust Masks Fall Protection devices (harness and SRL's) Others

  • Hardhat
  • Safety Glasses
  • Class 3 Safety Vest
  • Full face shields
  • Safety goggles
  • Safety boots
  • Work gloves
  • Anti-Vibration Gloves
  • Ear plugs / Ear muffs
  • Respirators
  • Dust Masks
  • Fall Protection devices (harness and SRL's)
  • Others

• Enter other PPE used

Hand and Power Tools

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

  Yes

  No

  N/A

• If yes, make sure tools and cords are inspected and guards are in place

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

  Yes

  No

  N/A

• If yes, make sure tools and cords are inspected and whip checks are in place

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

  Yes

  No

  N/A

• If yes, has the employee been trained and certified to operate the tool

Ground & Surface Penetrations

• Will the scope of work require you to cut, grind, drill into, or make any other penetrations into concrete or asphalt?

  Yes

  No

  N/A

• If yes, has ensure that proper control measures for silica are implemented i.e. water, vacuum system, respiratory

• Will the work scope require you to excavate, trench, dig, or otherwise penetrate into the ground?

  Yes

  No

  N/A

• If yes, have utilities been located and marked, protective measures in place i.e. shoring, sloping, shielding

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

  Yes

  No

  N/A

• Note: Please contact and inform the safety department if results are positive for lead or asbestos

Excavation and Trenching

• Will the scope of work involve trench work 4 feet or deeper?

  Yes

  No

  N/A

• If yes, please follow Wildcats trenching and excavation policy and/or contact the safety department if you require additional information

• Will this work scope involve any excavation deeper than 20 feet?

  Yes

  No

  N/A

• If yes, is the trench box rated for the depth and soil type

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

  Yes

  No

  N/A

• If yes, please use Tyvek and nitrile gloves to protect employees from exposure to biological hazards

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

  Yes

  No

  N/A

• Will there be the need for specialized equipment?

  Yes

  No

  N/A

• If yes, please contact the safety department in advance

• Please list specialized equipment needed:

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

• Will the scope of work require the use of traffic control i.e. flaggers, barricades, MHT, etc.

  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 Bull Dozer

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

• 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

• If yes, a hot work permit is required as well as a fire watch

• Will work be performed near combustible storage containers?

  Yes

  No

  N/A

• Will there be on-site refueling of equipment?

  Yes

  No

  N/A

• If yes, make sure spill kits are available and safety department is notified when spills occur

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

  Yes

  No

  N/A

• Has a muster area been identified if an emergency occurs?

  Yes

  No

  N/A

Steel Erection and Assembly

• Is steel erection part of this work scope?

  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

• If yes, please contact the safety department so a hazard assessment can be conducted

• Do all employees know where to find the SDS (Safety Data Sheets) .

  Yes

  No

  N/A

• If chemicals are brought onsite please make sure that the safety department has a copy of the SDS

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

• If yes, please contact the safety department and follow Wildcats safety policy regarding confined space procedures

Welding/Hot Cutting

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

  Yes

  No

  N/A

• If yes, please contact the safety department to make sure that the surface has been tested for lead based paint

• Will the work involve welding/cutting stainless steel?

  Yes

  No

  N/A

• If yes, please contact the safety department for further instructions

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

• If yes, please contact the safety department for further instructions

Asbestos

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

  Yes

  No

  N/A

• If yes, please contact the safety department for further instructions

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

• If yes, make sure Wildcat Safety Policy is followed for working with silica

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