HJ Foundation (Job-Site Safety Survey)

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Daily Paperwork & General Safety

• Daily JHA/Toolbox Talk completed

  Yes

  No

  N/A

• Daily Crane & Equipment Inspection completed

  Yes

  No

  N/A

• Safety Manual & MSDS on site

  Yes

  No

  N/A

• Job specific paperwork available (AHA and/or SSJHA)

  Yes

  No

  N/A

• Federal, Ethics and EEO Statement Posted

  Yes

  No

  N/A

• No Cuts Locate number(s) available

  Yes

  No

  N/A

• Emergency numbers and facilities identified

  Yes

  No

  N/A

• Proper First Aid Kit on site

  Yes

  No

  N/A

• Fresh drinking water available on site

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• Employee(s) dressed properly for work (shirts w/ 4" sleeves, long pants and sturdy work boots (safety-toe if reuired)

  Yes

  No

  N/A

• Hardhats

  Yes

  No

  N/A

• Safety Glasses

  Yes

  No

  N/A

• Gloves (if required)

  Yes

  No

  N/A

• High Visibility Clothing and/or Reflective Vest

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Type:

  Muffs

  Plugs

  Mutliple

• Face Sheild

  Yes

  No

  N/A

• Activity:

  Chipping

  Grinding

  Saw Cutting

  Multiple

• Buoyant Work Vest (if near water i.e. tremie work)

  Yes

  No

  N/A

• Respiratory Protection (if required, fit test needed)

  Yes

  No

  N/A

• Type:

  Disposable N95

  Half Face w/ cartridges

  Multiple

• All suppliers and sub contractors involved with HJ Foundation are in compliance w/ PPE requirements

  Yes

  No

  N/A

Fall Protection

• Competent Person(s)

  Yes

  No

  N/A

• Hazard(s)

  Yes

  No

  N/A

• Proper System/Equipment used

  Yes

  No

  N/A

• Type:

  Guardrail

  Personal Fall Arrest System

  Hole Covers

  Multiple

• Full Body Harness and lanyards in good working condition

  Yes

  No

  N/A

• (SRL) Self Retracting Lifeline tested

  Yes

  No

  N/A

• Proper Anchorage/Tie-Off

  Yes

  No

  N/A

• Rebar Caps in use

  Yes

  No

  N/A

Crane(s)

• Certified Operator(s)

  Yes

  No

  N/A

• Set up:

  CFA

  Assist

  Sheet Piling

  Multiple

• Inspection Certificate up to date

  Yes

  No

  N/A

• Expires:

• Operator's Manual in crane

  Yes

  No

  N/A

• Lift Plan and Weight Sheet in crane

  Yes

  No

  N/A

• Anti 2-Block(s) Operational

  Yes

  No

  N/A

• Line(s) installed on

  1st

  2nd

  3rd

  Multiple

• E-Stop(s) Operational

  Yes

  No

  N/A

• Swing Radius

  Yes

  No

  N/A

• Swing Alarm Operational

  Yes

  No

  N/A

• Back Up Alarm Operational

  Yes

  No

  N/A

• Boom Angle Indicator Operational

  Yes

  No

  N/A

• Type:

  Computer

  Manual

  Multiple

• Fire Extinguisher (5lb ABC)

  Yes

  No

  N/A

• Warning and/or Operational Decals

  Yes

  No

  N/A

• Steps and/or Ladder

  Yes

  No

  N/A

• Mirrors & Windows in good condition

  Yes

  No

  N/A

• Mechanical deficiencies reported

  Yes

  No

  N/A

• Catwalks (clear of debris)

  Yes

  No

  N/A

Drill Rig//Low Headroom Rig

• Qualified Operator(s)

  Yes

  No

  N/A

• Operator's Manual in drill rig

  Yes

  No

  N/A

• Anti 2-Block Operational

  Yes

  No

  N/A

• E-Stop(s) Operational

  Yes

  No

  N/A

• Swing Alarm Operational

  Yes

  No

  N/A

• Back Up Alarm Operational

  Yes

  No

  N/A

• Fire Extinguisher (5lb ABC)

  Yes

  No

  N/A

• Warning and/or Operational Decals

  Yes

  No

  N/A

• Steps and/or Ladder

  Yes

  No

  N/A

• Mirrors & Windows in good condition

  Yes

  No

  N/A

• Mechanical deficiencies reported

  Yes

  No

  N/A

• Catwalks (clear of debris)

  Yes

  No

  N/A

Rigging

• Certified Rigger(s)/Signal Person(s)

  Yes

  No

  N/A

• Nylon Straps

  Safe

  At Risk

  N/A

• Wire Rope Slings

  Safe

  At Risk

  N/A

• Chains

  Safe

  At Risk

  N/A

• Spreaders

  Yes

  No

  N/A

• Type:

  Chain

  Wire Rope

  Multiple

• Blocks, Hooks & Latches

  Safe

  At Risk

  N/A

• Shackles

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Material Handling

• Proper Lifting

  Safe

  At Risk

  N/A

• Hands free of Pinch Points

  Safe

  At Risk

  N/A

• Mechanical Assist or 2-Man Lift when too heavy

  Safe

  At Risk

  N/A

Heavy Equipment

• Qualified Operator(s)

  Yes

  No

  N/A

• Machine Type:

  Select Backhoe Bobcat End-Loader Excavator Forklift Multiple

  • Backhoe
  • Bobcat
  • End-Loader
  • Excavator
  • Forklift
  • Multiple

• Operator's Manual in machine

  Yes

  No

  N/A

• E-Stop(s) Operational

  Yes

  No

  N/A

• Swing Alarm Operational

  Yes

  No

  N/A

• Back-Up Alarm Operational

  Yes

  No

  N/A

• Mirrors and Windows in good condition

  Yes

  No

  N/A

• Tracks Clean

  Yes

  No

  N/A

• Mechanical deficiencies reported

  Yes

  No

  N/A

Grout Pump (Operator & Surrounding Area)

• Operator wearing Hearing Protection

  Yes

  No

  N/A

• Operator Position (Caught-In-Between, etc)

  Safe

  At Risk

  N/A

• E-Stop(s) Operational

  Yes

  No

  N/A

• Clamps properly secured

  Yes

  No

  N/A

• 1st Grout Hose properly secured

  Yes

  No

  N/A

• Gray Cover on 1st Grout Hose

  Yes

  No

  N/A

• Machine kept clean

  Yes

  No

  N/A

• Mechanical deficiencies reported

  Yes

  No

  N/A

Confined Spaces/Excavations

• Competent Person(s)

  Yes

  No

  N/A

• Permit Required

  Yes

  No

  N/A

• Air Monitoring completed

  Yes

  No

  N/A

• Decibel Monitoring completed

  Yes

  No

  N/A

• Access/Egress

  Safe

  At Risk

  N/A

• Type:

  Ladder

  Ramp

  Other

  Multiple

• Proper Excavation Protection

  Yes

  No

  N/A

• Type:

  Benching

  Shoring

  Sloping

  Multiple

• Soil Type (if known)

  Solid Rock

  Stable Rock

  A

  B

  C

Cutting & Welding

• Hot Work Permit Pulled

  Yes

  No

  N/A

• Fire Watch

  Yes

  No

  N/A

• Area clear of combustibles

  Yes

  No

  N/A

• Compressed Gas Cylinders properly stored

  Yes

  No

  N/A

• Storage Type:

  Fire Wall

  Torch Cart(if used w/in 24hrs)

  20' Separation

  Multiple

• Striker used for ignition

  Yes

  No

  N/A

• Hoses in good condition

  Yes

  No

  N/A

• Leads in good condition

  Yes

  No

  N/A

• Gauges in good condition

  Yes

  No

  N/A

• Caps on Compressed Gas Cylinders if Gauges are removed

  Yes

  No

  N/A

• Chop Saw Disc in good condition

  Yes

  No

  N/A

Fire Safety

• Fire Extinguisher(s) are charged and in good condition

  Yes

  No

  N/A

• Fire Extinguisher(s) have up-to-date tag(s)

  Yes

  No

  N/A

• All Equipment has an accessible Fire Extinguisher

  Yes

  No

  N/A

• 20lb Fire Extinguisher 25' to 75' from Fuel Containment

  Yes

  No

  N/A

• Combustibles properly stored

  Yes

  No

  N/A

• Fuel Containers labeled

  Yes

  No

  N/A

Electrical

• GFCI working properly

  Yes

  No

  N/A

• Power Tools in good working condition

  Yes

  No

  N/A

• Extension Cords free from defects

  Yes

  No

  N/A

• Overhead Power Lines (proper distance indicated and observed)

  Safe

  At Risk

  N/A

• Under Ground Utilities (properly identified and marked)

  Safe

  At Risk

  N/A

Company Vehicle/Conex Box

• Truck/Conex is reasonably clean

  Yes

  No

  N/A

• Truck/Conex is well organized

  Yes

  No

  N/A

• Back-Up Alarm Operational

  Yes

  No

  N/A

• Mirrors, Seat Belts & Windows in good condition

  Yes

  No

  N/A

• Mechanical deficiencies reported

  Yes

  No

  N/A

Other

• Guards provided for rotating parts

  Yes

  No

  N/A

• Grout Hoses have Whip-Checks

  Yes

  No

  N/A

• Laser Sign visible

  Yes

  No

  N/A

• Tag Lines in use when unloading or flying materials

  Yes

  No

  N/A

• Sheet Shackles in good condition

  Yes

  No

  N/A

• Housekeeping (trash & debris) controlled

  Yes

  No

  N/A

• Other Essential Findings

  Yes

  No

  N/A

Signatures

• Superintendent

  Sign

• Inspector

  Sign