Information
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Document No.
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Project Name
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Project Number
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Conducted on
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Prepared by
Fall Protection
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Project Management aware of Fall Safe Site Specific Plan and is implementing plan
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Employees have received training on fall protection (Toolbox talks, safety meetings, JHA's)
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Guardrails/ cables in - place and properly secured and flagged (Exposure to falls 6' or greater)
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Employees secure from unprotected sides and edges with fall exposure more than 6'
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Employees working on or near leading edges are protected from fall hazards 6' or more
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Employees below protected from falling objects
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All floor openings 2" or greater covered / Secured and Marked
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All manholes are securely covered, marked as required
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All wall openings on walking / working surfaces guarded - 30" x 18" or greater
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Safety Harness and life lines inspected and used properly
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Employees in Aerial lift are tied to the tie-off eyes
Excavation
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Competent Person supervising all excavation work, competent person card is on file
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Permit from Utility Protection Center (800 - 282 - 7411)
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Crew has received training on the hazards (cracking, raveling, water, vibration, vehicular traffic)
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Registered Engineered Design for all excavation 20' or greater
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Excavation Inspected - Excavation Daily Inspection completed prior to shift starting and after rainstorms
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Excavation sloped 1-1/2:1 & spoil piles stored at least 2' from trench edge
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Shoring/ Shield Protection designed by Engineer (OSHA guidelines or Manufactures Tabulated Data- not job made)
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Shoring/ Shield Protection installed with Manufacture's Tabulated Data (Boxes: max 2' above bottom of trench; 18" below toe of slope/box combo)
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Water controlled and Hazardous Atmospheres Tested (Confined Space Requirements)
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Stability of utilities and adjacent structure properly protected and shored
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Employees protected from falling loads (not working below loads, wearing hard hats)
Access / Egress
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A) Ladders, ramps or stairways provided & secured within 25 feet of employee in trench
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B) Equipment Ramps and Stairway properly designed
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Equipment is at a safe distance from edge of trench or excavation (at least as far away from the edge as the trench is deep)
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Excavation Barricaded / Protected from Vehicular Traffic / Adequate lighting provided
Scaffolding
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Employees below protected form falling objects
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Competent Person supervising all scaffold work / certification on file
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Has crew received required training / Documented
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Scaffold inspection sheet completed / Tag system used
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Erected on sound rigid footing, sills, base plates or screw jacks, frames plumb and square
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All connections secured, braced and anchor as required
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All frame components free of cracks or damage; multiple parts are compatible components
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Proper ladder access provided
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Proper access from another scaffold/building provided (within 14" horizontal; within 2' vertical)
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Platform fully decked and free of debris / All planking must meet OSHA criteria (overlap supports 6"-12")
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Secured to building properly (at 4 times the minimum base width; at both ends , every 30' horizontally, every 20' vertically with at least #9 wire or better)
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Guardrails, Intermediate rails, and Toe-boards in place
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Aerial Lift & Scissor Lift Training conducted for employees
Electrical
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Ground fault circuit interrupters being used in temporary electrical systems
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Ground fault circuit interrupters being used when plugging into permanent power supplies
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Has lock out / tag out program been been established and in place
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Receptacles equipped with required covers for the location / Protected from energized equipment
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No materials stored within 30 inches of electrical enclosures
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Live Panels Completely Covered & Locked to prevent Unauthorized Entry, Lock Out & Tag Out Procedures in Place, Electrical Room Door Locked
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Power cords protected on all traffic and walk ways
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Power cords inspected: Cord has Ground Prong/Strain Relief intact/Insulation is not damaged-no electrical tape/Cords away from water and cuts
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All lamps for general illumination protected from accidental contact or breakage
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Are electrical components being used in accordance with intended UL listed use
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Signs, tags, and barricades provided to warn of overhead electrical lines
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Are electrical lines at least 15' away from scaffolding or cranes or they are insullated
Stairs and Ladders
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Employees trained in the proper use of ladders
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Stairways or ladder provided at all personnel points with a break in elevation of 19 inches
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Stairways having four or more risers or rising 30" or more requires handrail on all unprotected sides or edges
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Poured concrete stairs are prevented from being used prior to stair pans being filled
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Elevated work areas with 25 or more employees requires a double - cleated or two or more separate ladders
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All job made ladder rungs cleated level and spacing not over 12" on center
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All points of access clear to permit free passage (No material or trash at base of ladder or stairs)
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Doors opening directly onto a stairway or platform shall have a platform 20" or more
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Ladders and stepladders inspected prior to use / Defective equipment tagged and removed from service
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Metal ladders not used around electrical hazards
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Ladders secured to prevent slipping, sliding or falling and extended at least 36" above landing
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All tools and materials are to be raised and lowered by rope or machine
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Stepladders used in fully open position / Do not use top two rungs of stepladder
Other
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Compliance with PPE: Hard Hats, Safety Glasses (100% of Time), Face Shield, Ear plugs, Dust Masks, Respirators, Eye Protection, Boots
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Housekeeping: trip/slip/puncture hazards; clear stairways entrances and exits
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Charged fire extinguishers throughout
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Cranes: Proper cribbing under outriggers, swing radius barricaded, annual and weekly inspection, check slings, straps, chokers
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Additional Safety Concerns
Concern
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Safety Concern
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Supervisor Responsibility
