Title Page
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Interior Specialists Inc
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Job Site Name
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Conducted on
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Prepared by
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Location
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Interior Specialists Foreman and/or Superintendent:
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General Contractor Superintendent and/or Safety Personnel
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Overall pictures of job site
Aerial/Boom Lifts
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Workers tied off to approved anchorage point(s) in basket? 1926.453(b)(2)(v)
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PFARS rigged in such a manor as to limit free fall to no more than 6 feet 1926.502(d)(16)(iii)
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Operator(s) trained and/or authorized 1926.453(b)(2)(ii)
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Both feet on floor of basket 1926.453(b)(2)(iv)
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Aerial lift controls clearly marked/identified 1926.453
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Aerial lifts inspected prior to use 1926.453(b)(2)(i)
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Access gate/opening closed when working in lift (ANSI A92.5)
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Operated on Level surface per equipment spec ANSI A92.5
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Outriggers(if equipped) utilized as needed ANSI A92.5
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Walking/working platform kept reasonably clear of derbies ANSI A92.5
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Good compliance/no safety violations 1926.453
Confined Space(s)
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Work site evaluated/permit spaces identified prior to entry 1926.1203(a)&(b)
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Work site evaluated/permit space(s) identified prior to entry by a competent person 1926.1203(a)&(b)
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Controlling contractor (GC) obtained/shared any relevant information prior to entry 1926.1203
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Steps taken to prevent unauthorized entry 1926.1204
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Hazard(s) evaluated prior to entry 1926.1204
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Procedures in place for safe entry 1926.1204
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Testing/monitoring equipment available 1926.1204
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Have testing/monitoring equipment been calibrated prior to use 1926.1204
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Ventilation equipment available 1926.1204
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Communication equipment (radios) available 1926.1204
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Proper/adequate lighting available as needed 1926.1204
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Tripod(s) available 1926.1204
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Tripod(s) inspected by a competent person prior to use 1926.1204
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Rescue/emergency equipment available 1926.1204
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Atmosphere tested prior to entry 1926.1204
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Periodic and/or continuous monitoring performed 1926.1204
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Personnel equipped with atmospheric monitoring equipment 1926.1204
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Attendant available outside of permit/confined space 1926.1204
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Employee responsibilities clearly identified prior to entry 1926.1204
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Personnel accountability system(s) in place prior to entry (Best practice)
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Entry permit available for review 1926.1205
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Employees received effective training 1926.1207
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Good compliance/no safety violations
Crane(s)
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Cranes are used/operated by a third party. Please ask the crane operator to assist with this section
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Outriggers fully extended/properly deployed 1926.1404(q)(1)
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Blocking material sufficient to sustain loads/maintain stability of the crane 1926.1404(q)(5)(i)
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Blocking placed directly under float/pad 1926.1404(q)(5)(ii)
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Power line(s) identified prior to use of the crane by operator and safety team 1926.1407-1411
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Required safety devices installed/maintained 1926.1415(a)
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Required operational aides installed/maintained 1926.1416(a)
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Crane operated in a safe manor/ within manufacture requirements
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Visual inspection completed by competent person/crane operated conducted prior to use, each shift 1926.1412(d)
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Monthly crane inspection completed by crane operator/crane company, with proper documentation 1926.1412(e)
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Annual crane inspection completed/current, with proper documentation available 1926.1412(f)(1)
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Crane load capabilities/operator manual kept in cab 1926.1417(c)
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Adequate communication between signal person and crane operator 1926.1419(e)
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Radius/swing area identified and barriers installed to keep unauthorized personnel out of area 1926.1424(a)
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Workers kept clear of suspended load(s) 1926.1425(b)
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Only trained riggers allowed to rig loads 1926.1425(c)(3)
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Signal person(s) identified and properly trained 1926.1428(a)
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Fire extinguisher located within cab, fully charged, and inspected 1926.1433(d)(6)
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Tag lines used on loads that swing freely (best practice)
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Good compliance/no safety violations
Demolition
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Wall openings protected to a height of 42 inches, plus or minus 3 inches 1926.850(g)
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Warning signs of falling debris posted as applicable, on each level of possible hazard(s) 1926.850(h)
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Warning signs of falling debris posted as applicable, on each level of possible hazard(s) 1926.850(h)
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Periodic inspections by competent person 1926.859(g)
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Good compliance/no safety violations
Electrical safety
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Worn or frayed cords use 1926.416
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GFCI's being used 1926.404(b)(1)((ii)
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Flexible cords not daisy-chained together 1926.403(b)
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Cords protected/kept clear of work areas/walk ways 1926.416(b)(2)
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Cords kept free of areas of water (Best practice)
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Good compliance/no safety violations
Exits/egress
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Exits free of obstructions 1926.34(a)
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Exits marked with signs/maps 1926.34(b)
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Fire extinguisher located on each level, fully charged, tagged (best practice)
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Good compliance/no safety violations
Fall Protection
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Fall protection provided/being used when working at heights at or above 6 feet 1926.501(b)(1)
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Steps taken to prevent falling object hazards 1926.501(c)
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Steps taken to prevent fall thru openings 1926.501(b)((4)(i)
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Guardrails installed, maintained and compliant (42 inches, plus or minus 3 inches) 1926.502(b)(1)
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Guardrails installed, maintained and compliant (42 inches, plus or minus 3 inches) 1926.502(b)(1)
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Top and mid rail in place and proper height (when used, shall be installed at a height midway between the top edge of the guardrail system and the walking/working level 1926.502(b)(2)(i)
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Guardrails able to withstand 200 pound force 1926.502(b)(3)
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Toe boards erected to prevent falling objects 1926.502(j)(1-4)
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Guardrail posts not more than 8 feet on center Subpart M Appendix B
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Harnesses inspected/maintained in good condition 1926.502(d)(21)
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Harnesses worn properly, and the correct size 1926.503(c)(3)
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Lanyards inspected, maintained, spec tag intact/legible 1926.502(d)(21)
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Suitable anchorage points used 1926.502(d)
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Worker(s) using personal fall arrest systems (PFARS) as required 1926.501(b)(1)
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PFARS rigged in such a manor as to prevent contact with lower surface 1926.502(d)(16)(iii)
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PFARS rigged in such a manor as to limit free fall to no more than 6 feet 1926.502(d)(16)(iii)
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PFARS not attached to guardrail system 1926.502(d)(23)
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Safety monitor used when fall arrest/restraint not utilized 1926.501/502(h)
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Safety monitor has no other assigned duties 1926.502(h)(1)(v)
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Safety monitor on same surface with visual and oral contact 1926.502(h)(1)(iii)
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Floor holes (2 inches or greater) secured, adequate enough to hold at least twice the weight of employees, equipment, and/or materials, painted and/or marked with "HOLE" or "Cover" to provide warning of the hazard 1926.502(i)(2-4)
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Warning line(s) flagged at no more than 6 foot intervals, and suspended at proper height, with no more than 3 inches of deflection in any direction 1926.502(f)(2)(i-ii)
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Workers trained on recognizing/minimizing fall hazards 1926.503(a)
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Fall protection training completed and documented 1926.503(b)
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Good compliance/no safety violations 1926 sub part M
Fire Safety
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Fire extinguisher in good condition/fully charged 1926.150(a)(4)
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Travel distance to fire extinguisher within 100 feet 1926.150(c)(1)(i)
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Fire extinguisher within 50 feet of flammables 1926.150(c)(1)(i)
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Minimum one fire extinguisher per floor 19265.150(c)(1)(iv)
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Flammable liquids stores in approved containers 1926.152(f)(1)
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Smoking prohibited where fire hazards exist 1926.151(a)(3)
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Flammable liquids protected from ignition sources 1926.152(a)(2)
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Fire extinguishers kept in or near powered equipment (Best practice)
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Good compliance/no safety violations Sub part F
Fueling areas/operations
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No smoking within area 1926.152(g)(8)
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Motors shut off during fueling
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Fire extinguisher within 75 feet 1926.152(g)(1)
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Fuel tanks properly labeled NFPA 30
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Spill control means/methods provided 1926.152(e)(1)
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Good compliance/no safety violations 1926.152
Noise
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Noise exposure(s) controlled at or above 90 decibels 1926.52 (Company standard is 85 decibels)
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Noise exposure(s) monitoring conducted (Best practice for a minimum of 10 minutes)
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Good compliance/no safety violation (Best practice)
Housekeeping
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Good compliance/no safety violations
Ladders
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Ladders inspected frequently/no visible defects 1926.1053(b)(15)&(16)
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Ladders at a 4:1 angle 1926.1053(b)(5)(i)
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Ladders on stable/level surface(s) 1926.1053(b)(6)
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Ladders used correctly/as intended by the manufacturer 1926.1053(b)(4)
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Spreaders fully engaged on step/A frame ladders 1926.1053(a)(8)
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Worker(s) not using top two steps on step/A frame ladder 1926.1053(b)(9)
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Three points of contact maintained when climbing/descending from ladder (Best practice)
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Job made ladders compliant 1926.1053(a)
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Area at top/bottom of ladder kept clear/clean 1926.1053(b)(9)
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Good compliance/no safety violations 1926 sub part X
Mechanized equipment (skid steer, mini-excavator, excavator)
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Equipment in good condition/no obvious defects 1926.601(b)(14)
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Seat belts on earth moving equipment with roll over protection system (ROPS) 1926.602(a)(2)(i)
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Seat belts worn while in operation 1926.28(a)
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Backup alarm and/or spotter when backing 1926.601-602(b)(8
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Good compliance/no safety violations
PPE
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PPE provided/used as required 1926.95(a)
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PPE maintained in good condition 1926.95(a)
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Replacement PPE available (Best practice)
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Eye protection used as required 1926.102(a)(1)
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Face protection(shields) used as required 1926.102(a)(1)
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Hard hats worn 1926.100(a)
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Hand protection worn 1926.28(a)
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Safety footwear worn 1926.28(a)
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Respiratory protection provided/used as required 1910.134(a)
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Hearing protection used as required 1926.52(a)
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Safety vests and/or high visibility clothing worn 1926.28(a)
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Good compliance/no safety violations 1926.28(a)
Safety signs
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OSHA 300 summary posted 2/1-4/30 1904.32(a)(4)
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Danger/warning signs/tape posted as needed 1926.200(a)
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Good compliance/no safety violations
Safety training
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Daily toolbox talks completed 1926.21(b)(2)
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Weekly toolbox talks completed 1926.21(b)(2)
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Documentation of toolbox talks (Best practice)
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Equipment/machine operator training documented (Best practice)
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Job specific training provided/documented OSHA publication 2254
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Good compliance/no safety violations
Scaffolding (Rolling)
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Scaffolding inspected by a competent person/free of defects 1926.451(f)
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Working platforms fully decked/planked 1926.451(b)(1)
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Platform clean/free of excessive debris 1926.451(f)(3)
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Only supplies needed stored on scaffolding 1926.250(b)(5)
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Scaffolding and components do not exceed rated capacities 1926.451(f)(1)
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Fall protection provided above 10 feet 1926.451(g)(1)
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Employee(s) remain within wheels/supports of scaffold 1926.452(w)(6)(v)
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Scaffolding bracing is secured, squared and aligned 1926.452(w)(1)
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Brakes on scaffolding operate and set as required 1926.452(w)(2)
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Wheel stems pinned/secured to scaffold legs 1926.452(w)(9)
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Good compliance/no safety violations
Scaffolds (Supported)
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Working platforms fully planked/decked 1926.451(b)(1)
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Fall protection provided above 10 feet 1926.451(g)(1)
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Scaffolding inspected by a competent person/free of defects 1926.451(f)
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Footing(s) level, rigid, no visible settling 1926.451(c)(2)(i)
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Ladder provided/used to access platform 1926.451(e)(1)
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Platform clean/free of excessive derbies 1926.451(f)(13)
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When platforms overlap, overlap is 12 inches of more 1926.451(b)(7)
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Platform braced to prevent swaying 1926.451
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Toe boards used to prevent tools/materials from falling 1926.451(h)(2)(ii)
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Only materials needed stored on scaffolding 1926.250(b)(5)
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Non-cleated platforms extend at least 6 inches over support 1926.451(b)(4)
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Platforms <10 feet do not extend more than 12 inches past support 1926.451(b)(5)(i)
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Platforms (10 feet+) do not extend more than 18 inches past supports 1926.451(b)(5)(ii)
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Scaffolds not moved horizontally when occupied 1926.451(f)(8)
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Workers not allowed on scaffolds when covered in snow/ice 1926.451(c)(1)
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Guys, ties, braces installed/maintained 1926.451(c)(1)
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Cross braces installed/maintained 1926.451(c)(1)
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Midrail cross bracing between 20-30 inches 1926.451(g)(4)(xv)
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Top rail cross bracing midpoint between 38-48 inches 1926.451(g)(4)(xv)
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Good compliance/no safety violations Subpart L
Scissor lifts
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Lift inspected by a competent person/free of defects 1926.451(f)(3)
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Lift operated on level surface free of obstructions 1926.452(w)(6)(i)
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Outriggers (if equipped/required) used as needed 1926.452(w)(5)
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Operator has both feet on floor of lift 1926.453(b)(2)(iv)
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Access gate closed when working in lift ANSI A92.6
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Floor of lift kept reasonably clean
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Fall personal fall arrest (PAFA) used if equipped by manufacturer (Best practice)
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Good compliance/no safety violations
Silica exposure
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Table 1 compliant tools being used 1926.1153(c)(1)
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Exhaust used for indoor tasks where silica exposure occurs 1925.1153(c)(2)(i)
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When wet methods used, is water being applied at proper rate to minimize dust 1926.1153(c)(2)(ii)
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Proper respirator used when not using table 1 tools 1926.1153(e)
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Wet sweeping or HEPA vacuums used to clean up silica dust 1926.1153(f)(1)
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Written exposure plan being followed 1926.1153(g)(1)
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Competent person conducting regular inspections 1926.1153(g)(4)
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Employees trained on hazards associated with silica exposure 1926.1153(i)(2)
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Air sampling conducted 1926.1153(d)(2)
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Work area limited to those employees and/or other trades that are only actively working in the area (best practice)
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Good compliance/no safety violations 1926.1153
Is follow up needed for any above items
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Follow up plan details/time frame
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