Information

  • Conducted on

  • Prepared by

  • Location:
  • Crew/Foreman:

  • 1) Crush Points - Are crush points identified on JHA and communicated to everyone? Is there a spotter where one is needed? Are people working in crush points?

  • 2) Working at Heights - Is fall protection being used correctly? Are we preventing dropped objects? Does our work area have a controlled access zone. Guardrails and toe-boards where needed? Do we have a rescue plan? Has fall protection been inspected?

  • 3) TSCD Recognition - Scaffold, stair tower, shoring, engineered fall protection. Are our temporary structures in the area identified, documented and inspected daily?

  • 4) Heat - Do the crew members have access to cold water, ice, shade and a place to rest? Does everyone on the crew know how much water they should be drinking?

  • 5) Crane Safety - Do we have a pick plan for every lift? Are we recognizing and following the critical liftplan? Is there a trained rigger and spotter that are identified? Are we using tag lines on all loads? Do we have good communication between the operator and the crew on the ground?

  • 6) Equipment Operation - Is the operator designated for that piece of equipment? Does the operator have a spotter if necessary? Is this the right equipment for the job?

  • 7) Hazard Identification - Is there a JHA with the operation? Is the JHA completed with good hazard prevention? With pictures? Is the crew review current? Has everyone signed off? Are we using mini JHA for everything?

  • 8) Housekeeping/Access - Is the work area littered with scrap or trash? Is the entire work area clean? Housekeeping and access planned and well managed? Access graded, level and free of rebar, lumber and other materials?

  • 9) Meetings - Toolbox, Play of the Day, PSM Does the paperwork have detailed information and reviewed with the whole crew? Are we following our plan? Did the crew ask you to sign off on the JHA?

  • 10) 5 Minute Operation Observation - Did you observe any unsafe acts or conditions? Are we rushing our tasks? Does our crew have good communication? Are we looking out for one another?

  • Safe Comments

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  • For all at risk comments please indicate the number (1,2, etc.) and sign off below.

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