HSO - Health Safety Observation Report

• Site conducted

  Select

• Date

  Date

• Project Code

• Prepared by

• Location
  Address

Working from Heights

• 1. 100% Tie Off for all unprotected fall exposures above 6' ?

  Yes

  No

  N/A

• 2. Is each worker using a personal fall arrest system when operating an articulating boom platform? (manlift)

  Yes

  No

  N/A

• 3. On elevated surfaces, is there a standard guardrail system, safety net system, personal fall arrest system?

  Yes

  No

  N/A

• 4. Are all deck holes protected?

  Yes

  No

  N/A

• 5. Does the guardrail system meet OSHA standards? (Top rail 42" - Mid 21" / Toe boards 4")

  Yes

  No

  N/A

• 6. Are open sides protected with standard guard rails and toeboard?

  Yes

  No

  N/A

• 7. Are ladders being used properly?

  Yes

  No

  N/A

• 8. Are ladders tied and extended 3 feet above the landing?

  Yes

  No

  N/A

Loading/Unloading Trucks

• 1. The work being performed is set up in such a manner as to provide for alternate (pedestrian/vehicular) traffic patterns if needed?

  Yes

  No

  N/A

• 2. When loading and unloading, loads are cribbed or blocked properly, and supported properly?

  Yes

  No

  N/A

• 3. Safe methods are used to access the truck bed?

  Yes

  No

  N/A

• 4. Is proper rigging being used and is the Person rigging the load been trained and is a qualified rigger? (Employee has a rigger qualification card)

  Yes

  No

  N/A

• 5. Temporary lighting is adequate and properly maintained? (night work)

  Yes

  No

  N/A

Housekeeping

• 1. Is material properly stacked as not to fall over?

  Yes

  No

  N/A

• 2. Is ladder egress clear of being a trip hazard?

  Yes

  No

  N/A

• 3. Is pathway clear of slipping/tripping hazards, cords, and debris?

  Yes

  No

  N/A

• 4. Is trash/debris located in a designated area?

  Yes

  No

  N/A

• 5. Scrap Lumber has nails removed or bent?

  Yes

  No

  N/A

• 6. Are Oxygen and acetylene bottles in proper containers and separated from each other when stored?

  Yes

  No

  N/A

Manual Material Handling

• 1. Is the employee wearing the proper gloves to protect their hands according to the Safety Guidelines policy?

  Yes

  No

  N/A

• 2. Has each worker lifting a load used their legs and used proper lifting techniques?

  Yes

  No

  N/A

• 3. Is the load secured properly?

  Yes

  No

  N/A

Trenching and Excavations

• 1. At four feet, do you have access and egress in place?

  Yes

  No

  N/A

• 2. At five feet, do you have the proper protection? (sloped, shored or shielded)

  Yes

  No

  N/A

• 3. Is ladder within 25 feet of employees?

  Yes

  No

  N/A

• 4. Is water being controlled?

  Yes

  No

  N/A

• 5. Are spoils a minimum of two feet from the edge?

  Yes

  No

  N/A

• 6. Are ALL utilities marked? Call 811

  Yes

  No

  N/A

• 7. Is competent person on site at all times?

  Yes

  No

  N/A

Personal Protective Equipment

• 1. Hard hats? Proper colors being worn?

  Yes

  No

  N/A

• 2. Safety glasses (always)

  Yes

  No

  N/A

• 3. Face shield (quckie saw), goggles (burning / cutting)

  Yes

  No

  N/A

• 4. Hearing protection when required?

  Yes

  No

  N/A

• 5. Proper Gloves being worn?

  Yes

  No

  N/A

• 6. Work Boots / Foot protection?

  Yes

  No

  N/A

Electrical Safety

• 1. Ground-fault circuit interrupters (GFCI) in place?

  Yes

  No

  N/A

• 2. Electric cords in good condition?

  Yes

  No

  N/A

• 3. Electric tool in good shape?

  Yes

  No

  N/A

• 4. Have electric cords been spliced?

  Yes

  No

  N/A

• 5. Do all hand tools and cords have grounds?

  Yes

  No

  N/A

• 6. Daily inspection been done? (Ask Crew)

  Yes

  No

  N/A

• 7. Are you working near energized overhead lines

  Yes

  No

  N/A

Machinery and Equipment

• 1. Backup alarms working properly?

  Yes

  No

  N/A

• 2. Lights working properly?

  Yes

  No

  N/A

• 3. Seatbelts being worn?

  Yes

  No

  N/A

• 4. Strobe lights or rotary lights working?

  Yes

  No

  N/A

• 5. Gauges working properly?

  Yes

  No

  N/A

• 6. Horns working properly?

  Yes

  No

  N/A

JHA "Job Hazard Analyzes"

• 1. JHA Filled out Properly?

  Yes

  No

  N/A

• 2. All Crew members signed off?

  Yes

  No

  N/A

• 3. Foremen review before shift starts?

  Yes

  No

  N/A

Mobile Cranes

• 1. Manufacturers supplied load charts and manuals are located in the crane cab?

  Yes

  No

  N/A

• 2. Annual sticker current on crane? Daily inspection been done and signed off?

  Yes

  No

  N/A

• 3. Does the mobile crane with outriggers, which is set up for operation, have outriggers fully extended and tires clear of the ground with proper cribbing?

  Yes

  No

  N/A

• 4. The mobile crane set up for operation has the swing radius of the counterweight outlined with high visibility tape or rope?

  Yes

  No

  N/A

• 5. Does crane on site have a functioning Anti-Two Block device?

  Yes

  No

  N/A

• 6. Rigging equipment inspected, used properly, and in good condition?

  Yes

  No

  N/A

• 7. If required, do operators have Crane certification?

  Yes

  No

  N/A

• 8. Do slings have ID Tags?

  Yes

  No

  N/A

• 9. Are you working around overhead powerlines? Are they properly marked with signs?

  Yes

  No

  N/A

• 10. Has communication been established with the signal person?

  Yes

  No

  N/A

Sanitation

• 1. Is adequate supply of potable water provided?

  Yes

  No

  N/A

• 2. Are drinking cups provided?

  Yes

  No

  N/A

• 3. Trash can for cups?

  Yes

  No

  N/A

• 4. Ice Machines working properly?

  Yes

  No

  N/A

• 5. Is there a toilet available?

  Yes

  No

  N/A

• 6. Is the toilet clean?

  Yes

  No

  N/A

REMEMBER-TALK TO THE TEAM

• Unsafe Behavior:
  Hurts Workers, Co-Workers, Equipment, Hurts Production, Company / Team Success
  Not Acceptable for ANY reason.

• Reinforcement of SAFETY culture:

• Praise Hard Work, Praise Safe Hard Work

  Yes

  No

  N/A

• Recognize Above and Beyond Safety

  Yes

  No

  N/A

• Share Your Safety Culture Thoughts

  Yes

  No

  N/A

Sign Off

• Observation Done By

• Comments

• Please list deficiencies and corrective measure

• Name and Signature

  Sign