Title Page

  • Interior Specialists Inc

  • Job Site Name

  • Conducted on

  • Prepared by

  • Location
  • Interior Specialists Foreman and/or Superintendent:

  • General Contractor Superintendent and/or Safety Personnel

  • Overall pictures of job site

Aerial/Boom Lifts

  • Workers tied off to approved anchorage point(s) in basket? 1926.453(b)(2)(v)

  • PFARS rigged in such a manor as to limit free fall to no more than 6 feet 1926.502(d)(16)(iii)

  • Operator(s) trained and/or authorized 1926.453(b)(2)(ii)

  • Both feet on floor of basket 1926.453(b)(2)(iv)

  • Aerial lift controls clearly marked/identified 1926.453

  • Aerial lifts inspected prior to use 1926.453(b)(2)(i)

  • Access gate/opening closed when working in lift (ANSI A92.5)

  • Operated on Level surface per equipment spec ANSI A92.5

  • Outriggers(if equipped) utilized as needed ANSI A92.5

  • Walking/working platform kept reasonably clear of derbies ANSI A92.5

  • Good compliance/no safety violations 1926.453

Confined Space(s)

  • Work site evaluated/permit spaces identified prior to entry 1926.1203(a)&(b)

  • Work site evaluated/permit space(s) identified prior to entry by a competent person 1926.1203(a)&(b)

  • Controlling contractor (GC) obtained/shared any relevant information prior to entry 1926.1203

  • Steps taken to prevent unauthorized entry 1926.1204

  • Hazard(s) evaluated prior to entry 1926.1204

  • Procedures in place for safe entry 1926.1204

  • Testing/monitoring equipment available 1926.1204

  • Have testing/monitoring equipment been calibrated prior to use 1926.1204

  • Ventilation equipment available 1926.1204

  • Communication equipment (radios) available 1926.1204

  • Proper/adequate lighting available as needed 1926.1204

  • Tripod(s) available 1926.1204

  • Tripod(s) inspected by a competent person prior to use 1926.1204

  • Rescue/emergency equipment available 1926.1204

  • Atmosphere tested prior to entry 1926.1204

  • Periodic and/or continuous monitoring performed 1926.1204

  • Personnel equipped with atmospheric monitoring equipment 1926.1204

  • Attendant available outside of permit/confined space 1926.1204

  • Employee responsibilities clearly identified prior to entry 1926.1204

  • Personnel accountability system(s) in place prior to entry (Best practice)

  • Entry permit available for review 1926.1205

  • Employees received effective training 1926.1207

  • Good compliance/no safety violations

Crane(s)

  • Cranes are used/operated by a third party. Please ask the crane operator to assist with this section

  • Outriggers fully extended/properly deployed 1926.1404(q)(1)

  • Blocking material sufficient to sustain loads/maintain stability of the crane 1926.1404(q)(5)(i)

  • Blocking placed directly under float/pad 1926.1404(q)(5)(ii)

  • Power line(s) identified prior to use of the crane by operator and safety team 1926.1407-1411

  • Required safety devices installed/maintained 1926.1415(a)

  • Required operational aides installed/maintained 1926.1416(a)

  • Crane operated in a safe manor/ within manufacture requirements

  • Visual inspection completed by competent person/crane operated conducted prior to use, each shift 1926.1412(d)

  • Monthly crane inspection completed by crane operator/crane company, with proper documentation 1926.1412(e)

  • Annual crane inspection completed/current, with proper documentation available 1926.1412(f)(1)

  • Crane load capabilities/operator manual kept in cab 1926.1417(c)

  • Adequate communication between signal person and crane operator 1926.1419(e)

  • Radius/swing area identified and barriers installed to keep unauthorized personnel out of area 1926.1424(a)

  • Workers kept clear of suspended load(s) 1926.1425(b)

  • Only trained riggers allowed to rig loads 1926.1425(c)(3)

  • Signal person(s) identified and properly trained 1926.1428(a)

  • Fire extinguisher located within cab, fully charged, and inspected 1926.1433(d)(6)

  • Tag lines used on loads that swing freely (best practice)

  • Good compliance/no safety violations

Demolition

  • Wall openings protected to a height of 42 inches, plus or minus 3 inches 1926.850(g)

  • Warning signs of falling debris posted as applicable, on each level of possible hazard(s) 1926.850(h)

  • Warning signs of falling debris posted as applicable, on each level of possible hazard(s) 1926.850(h)

  • Periodic inspections by competent person 1926.859(g)

  • Good compliance/no safety violations

Electrical safety

  • Worn or frayed cords use 1926.416

  • GFCI's being used 1926.404(b)(1)((ii)

  • Flexible cords not daisy-chained together 1926.403(b)

  • Cords protected/kept clear of work areas/walk ways 1926.416(b)(2)

  • Cords kept free of areas of water (Best practice)

  • Good compliance/no safety violations

Exits/egress

  • Exits free of obstructions 1926.34(a)

  • Exits marked with signs/maps 1926.34(b)

  • Fire extinguisher located on each level, fully charged, tagged (best practice)

  • Good compliance/no safety violations

Fall Protection

  • Fall protection provided/being used when working at heights at or above 6 feet 1926.501(b)(1)

  • Steps taken to prevent falling object hazards 1926.501(c)

  • Steps taken to prevent fall thru openings 1926.501(b)((4)(i)

  • Guardrails installed, maintained and compliant (42 inches, plus or minus 3 inches) 1926.502(b)(1)

  • Guardrails installed, maintained and compliant (42 inches, plus or minus 3 inches) 1926.502(b)(1)

  • 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)

  • Guardrails able to withstand 200 pound force 1926.502(b)(3)

  • Toe boards erected to prevent falling objects 1926.502(j)(1-4)

  • Guardrail posts not more than 8 feet on center Subpart M Appendix B

  • Harnesses inspected/maintained in good condition 1926.502(d)(21)

  • Harnesses worn properly, and the correct size 1926.503(c)(3)

  • Lanyards inspected, maintained, spec tag intact/legible 1926.502(d)(21)

  • Suitable anchorage points used 1926.502(d)

  • Worker(s) using personal fall arrest systems (PFARS) as required 1926.501(b)(1)

  • PFARS rigged in such a manor as to prevent contact with lower surface 1926.502(d)(16)(iii)

  • PFARS rigged in such a manor as to limit free fall to no more than 6 feet 1926.502(d)(16)(iii)

  • PFARS not attached to guardrail system 1926.502(d)(23)

  • Safety monitor used when fall arrest/restraint not utilized 1926.501/502(h)

  • Safety monitor has no other assigned duties 1926.502(h)(1)(v)

  • Safety monitor on same surface with visual and oral contact 1926.502(h)(1)(iii)

  • 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)

  • 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)

  • Workers trained on recognizing/minimizing fall hazards 1926.503(a)

  • Fall protection training completed and documented 1926.503(b)

  • Good compliance/no safety violations 1926 sub part M

Fire Safety

  • Fire extinguisher in good condition/fully charged 1926.150(a)(4)

  • Travel distance to fire extinguisher within 100 feet 1926.150(c)(1)(i)

  • Fire extinguisher within 50 feet of flammables 1926.150(c)(1)(i)

  • Minimum one fire extinguisher per floor 19265.150(c)(1)(iv)

  • Flammable liquids stores in approved containers 1926.152(f)(1)

  • Smoking prohibited where fire hazards exist 1926.151(a)(3)

  • Flammable liquids protected from ignition sources 1926.152(a)(2)

  • Fire extinguishers kept in or near powered equipment (Best practice)

  • Good compliance/no safety violations Sub part F

Fueling areas/operations

  • No smoking within area 1926.152(g)(8)

  • Motors shut off during fueling

  • Fire extinguisher within 75 feet 1926.152(g)(1)

  • Fuel tanks properly labeled NFPA 30

  • Spill control means/methods provided 1926.152(e)(1)

  • Good compliance/no safety violations 1926.152

Noise

  • Noise exposure(s) controlled at or above 90 decibels 1926.52 (Company standard is 85 decibels)

  • Noise exposure(s) monitoring conducted (Best practice for a minimum of 10 minutes)

  • Good compliance/no safety violation (Best practice)

Housekeeping

  • Good compliance/no safety violations

Ladders

  • Ladders inspected frequently/no visible defects 1926.1053(b)(15)&(16)

  • Ladders at a 4:1 angle 1926.1053(b)(5)(i)

  • Ladders on stable/level surface(s) 1926.1053(b)(6)

  • Ladders used correctly/as intended by the manufacturer 1926.1053(b)(4)

  • Spreaders fully engaged on step/A frame ladders 1926.1053(a)(8)

  • Worker(s) not using top two steps on step/A frame ladder 1926.1053(b)(9)

  • Three points of contact maintained when climbing/descending from ladder (Best practice)

  • Job made ladders compliant 1926.1053(a)

  • Area at top/bottom of ladder kept clear/clean 1926.1053(b)(9)

  • Good compliance/no safety violations 1926 sub part X

Mechanized equipment (skid steer, mini-excavator, excavator)

  • Equipment in good condition/no obvious defects 1926.601(b)(14)

  • Seat belts on earth moving equipment with roll over protection system (ROPS) 1926.602(a)(2)(i)

  • Seat belts worn while in operation 1926.28(a)

  • Backup alarm and/or spotter when backing 1926.601-602(b)(8

  • Good compliance/no safety violations

PPE

  • PPE provided/used as required 1926.95(a)

  • PPE maintained in good condition 1926.95(a)

  • Replacement PPE available (Best practice)

  • Eye protection used as required 1926.102(a)(1)

  • Face protection(shields) used as required 1926.102(a)(1)

  • Hard hats worn 1926.100(a)

  • Hand protection worn 1926.28(a)

  • Safety footwear worn 1926.28(a)

  • Respiratory protection provided/used as required 1910.134(a)

  • Hearing protection used as required 1926.52(a)

  • Safety vests and/or high visibility clothing worn 1926.28(a)

  • Good compliance/no safety violations 1926.28(a)

Safety signs

  • OSHA 300 summary posted 2/1-4/30 1904.32(a)(4)

  • Danger/warning signs/tape posted as needed 1926.200(a)

  • Good compliance/no safety violations

Safety training

  • Daily toolbox talks completed 1926.21(b)(2)

  • Weekly toolbox talks completed 1926.21(b)(2)

  • Documentation of toolbox talks (Best practice)

  • Equipment/machine operator training documented (Best practice)

  • Job specific training provided/documented OSHA publication 2254

  • Good compliance/no safety violations

Scaffolding (Rolling)

  • Scaffolding inspected by a competent person/free of defects 1926.451(f)

  • Working platforms fully decked/planked 1926.451(b)(1)

  • Platform clean/free of excessive debris 1926.451(f)(3)

  • Only supplies needed stored on scaffolding 1926.250(b)(5)

  • Scaffolding and components do not exceed rated capacities 1926.451(f)(1)

  • Fall protection provided above 10 feet 1926.451(g)(1)

  • Employee(s) remain within wheels/supports of scaffold 1926.452(w)(6)(v)

  • Scaffolding bracing is secured, squared and aligned 1926.452(w)(1)

  • Brakes on scaffolding operate and set as required 1926.452(w)(2)

  • Wheel stems pinned/secured to scaffold legs 1926.452(w)(9)

  • Good compliance/no safety violations

Scaffolds (Supported)

  • Working platforms fully planked/decked 1926.451(b)(1)

  • Fall protection provided above 10 feet 1926.451(g)(1)

  • Scaffolding inspected by a competent person/free of defects 1926.451(f)

  • Footing(s) level, rigid, no visible settling 1926.451(c)(2)(i)

  • Ladder provided/used to access platform 1926.451(e)(1)

  • Platform clean/free of excessive derbies 1926.451(f)(13)

  • When platforms overlap, overlap is 12 inches of more 1926.451(b)(7)

  • Platform braced to prevent swaying 1926.451

  • Toe boards used to prevent tools/materials from falling 1926.451(h)(2)(ii)

  • Only materials needed stored on scaffolding 1926.250(b)(5)

  • Non-cleated platforms extend at least 6 inches over support 1926.451(b)(4)

  • Platforms <10 feet do not extend more than 12 inches past support 1926.451(b)(5)(i)

  • Platforms (10 feet+) do not extend more than 18 inches past supports 1926.451(b)(5)(ii)

  • Scaffolds not moved horizontally when occupied 1926.451(f)(8)

  • Workers not allowed on scaffolds when covered in snow/ice 1926.451(c)(1)

  • Guys, ties, braces installed/maintained 1926.451(c)(1)

  • Cross braces installed/maintained 1926.451(c)(1)

  • Midrail cross bracing between 20-30 inches 1926.451(g)(4)(xv)

  • Top rail cross bracing midpoint between 38-48 inches 1926.451(g)(4)(xv)

  • Good compliance/no safety violations Subpart L

Scissor lifts

  • Lift inspected by a competent person/free of defects 1926.451(f)(3)

  • Lift operated on level surface free of obstructions 1926.452(w)(6)(i)

  • Outriggers (if equipped/required) used as needed 1926.452(w)(5)

  • Operator has both feet on floor of lift 1926.453(b)(2)(iv)

  • Access gate closed when working in lift ANSI A92.6

  • Floor of lift kept reasonably clean

  • Fall personal fall arrest (PAFA) used if equipped by manufacturer (Best practice)

  • Good compliance/no safety violations

Silica exposure

  • Table 1 compliant tools being used 1926.1153(c)(1)

  • Exhaust used for indoor tasks where silica exposure occurs 1925.1153(c)(2)(i)

  • When wet methods used, is water being applied at proper rate to minimize dust 1926.1153(c)(2)(ii)

  • Proper respirator used when not using table 1 tools 1926.1153(e)

  • Wet sweeping or HEPA vacuums used to clean up silica dust 1926.1153(f)(1)

  • Written exposure plan being followed 1926.1153(g)(1)

  • Competent person conducting regular inspections 1926.1153(g)(4)

  • Employees trained on hazards associated with silica exposure 1926.1153(i)(2)

  • Air sampling conducted 1926.1153(d)(2)

  • Work area limited to those employees and/or other trades that are only actively working in the area (best practice)

  • Good compliance/no safety violations 1926.1153

Is follow up needed for any above items

  • Follow up plan details/time frame

  • Add signature

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