Jacobson & Company Site Safety

• Jobsite Name

• Client

• Lead Jacobson Foreman

• Conducted on

  Date
• Location
  Address

• Prepared by

COVID-19 Procedures

• Does the general contractor have safety measures before allowing persons on-site?

  Compliant

  Non-Compliant

  N/A

• Does the building management have their own safety measures before allowing persons into the building?

  Yes

  No

  N/A

• Does the GC have proper signage about COVID-19 in conspicuous locations throughout the job site?

  Compliant

  Non-Compliant

  N/A

• Does Jacobson have visible COVID-19 signage around the shanty/coffee/lunch areas?

  Compliant

  Non-Compliant

  N/A

• Are Jacobson employees filling out COVID-19 daily questionnaires, worker location logs, equipment cleaning logs?

  Compliant

  Non-Compliant

  N/A

• Are all Jacobson employees wearing adequate face masks that cover nose and mouth?

  Compliant

  Non-Compliant

  N/A

• Is the GC enforcing social distancing and mask use on site for all subcontractors?

  Yes

  No

  N/A

• Is the GC practicing social distancing and mask use themselves?

  Yes

  No

  N/A

• Is there potable drinking water provided on site for Jacobson employees?

  Yes

  No

  N/A

• Is there a location on site where employees can wash their hands?

  Yes

  No

  N/A

• Is social distancing observed when using the freight/elevator?

  Yes

  No

  N/A

Working at Heights

• Fall risks of 4' or more? (including shafts, leading edges, working at heights, floor openings, etc.)

  Safe

  At Risk

  N/A

• Proper edge protection installed?

  Safe

  At Risk

  N/A

• Unsafe or incomplete edge protection?

  Safe

  At Risk

  N/A

• Correct use of Garlock (pins, toe-kicks, pads, etc.)

  Yes

  No

  N/A

• Are there harnesses, retractables (yo-yos), anchor points available onsite?

  Yes

  No

  N/A

Scaffolds/Lifts

• Unsafe or incomplete scaffold/lift?

  Safe

  At Risk

  N/A

• Safe Work Load? (tools, stored materials, number of persons)

  Safe

  At Risk

  N/A

• Safe access to platform

  Yes

  No

  N/A

• Properly secured & planked

  Yes

  No

  N/A

• Guardrails at regulation height; modified for tight work spaces

  Yes

  No

  N/A

• Green scaffold tag signed & dated

  Yes

  No

  N/A

• For work in stairwell - castors replaced with plates?

  Yes

  No

  N/A

• If any, how many employees had to be reminded to sign off on the scaffold tag?

Harness and Equipment

• Incompatible hooks/equipment?

  Safe

  At Risk

  N/A

• Safe & certified anchor points

  Safe

  At Risk

  N/A

• Condition of harnesses

  Safe

  At Risk

  N/A

• Where are harnesses being stored?

• Are workers donning harnesses appropriately?

  Yes

  No

  N/A

Tools

• General condition of tools

  Safe

  At Risk

  N/A

• Working GFCI

  Yes

  No

  N/A

• Saw guards working/in use

  Yes

  No

  N/A

• Shrouds for saws to prevent metal/wood debris from harming others?

  Yes

  No

  N/A

• Extension cords - minimizing use, keeping up off ground, organization of cords not in use?

  Safe

  At Risk

  N/A

• Proper guards & cords

  Yes

  No

  N/A

• Any damaged or broken tools or equipment?

  No

  Yes

  N/A

• Has the equipment been red-tagged and sent back to supplier or warehouse?

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• Head protection

  Yes

  No

  N/A

• Proper foot protection

  Yes

  No

  N/A

• Eye protection

  Yes

  No

  N/A

• Gloves <br>

  Yes

  No

  N/A

• Cut resistant sleeves being worn for tasks above ceiling grid, with heavy gauge metal, while cutting metal?

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

• Hi-Visibility vest, suspender, or shirt?

  Yes

  No

  N/A

• Dust masks for Tapers

  Yes

  No

  N/A

• If any, how many employees had to be told to put on a hard hat, glasses, gloves?

Ladders

• Are ladders in good working order?

  Safe

  At Risk

  N/A

• Were defective ladders removed from service?

  Yes

  No

  N/A

• Safe positioning of ladders?

  Safe

  At Risk

  N/A

• Proper use of ladders? (example: no one standing on the top two rungs, ladder not folded and leaning against wall, etc.)

  Compliant

  Non-Compliant

  N/A

• Ladder suitable for job?

  Safe

  At Risk

  N/A

Site conditions

• Is all required safety signage, posters, and emergency action plans created by the GC visible?

  Good

  Fair

  Poor

  N/A

• Is a first-aid kit readily available and properly stocked on site?

  Compliant

  Non-Compliant

  N/A

• Are fire extinguishers (whether supplied by Jacobson or GC) visible and available?

  Compliant

  Non-Compliant

  N/A

• Is Jacobson's material stored out of walking/working paths and up off the ground? (on dunnage, metal trees/carts, dollies, etc.)

  Yes

  No

  N/A

• Is the general contractor keeping up with housekeeping?

  Good

  Fair

  Poor

  N/A

• Are Jacobson employees keeping created dunnage and debris center-piled so as to not create a tripping hazard for others?

  Safe

  At Risk

  N/A

• Are other trades using Jacobson's equipment?

  No

  Yes

  N/A

• Was the other trades-person asked to not use Jacobson's equipment?

  Yes

  No

  N/A

• "Laser in Use" signs visible?

  Yes

  No

  N/A

• Are there any air quality issues that need to be addressed, ex. fumes, excessive dust, irritants?

  No

  Yes

  N/A

• Cutting stations set up and off the floor?

  Yes

  No

  N/A

• Is there adequate lighting throughout the job?

  Yes

  No

  N/A

• Heat Stress Hazards?

  No

  Yes

  N/A

• Cold Stress Hazards?

  No

  Yes

  N/A

Administrative Procedures

• Jacobson & Company "PIECE of the Puzzle" poster on site and displayed

  Yes

  No

  N/A

• All new hires thru Jacobson orientation

  Yes

  No

  N/A

• MSDS, HASP, and Blue Book on site

  Yes

  No

  N/A

• PTPs conducted and submitted to GC; returned to Elizabeth office or picture sent via email

  Yes

  No

  N/A

• Are weekly Tool Box Talks conducted and paperwork stored on site?

  Yes

  No

  N/A

• Crews made aware of safety raffle program

  Yes

  No

  N/A

• Subcontractors following Jacobson/Client HASP

  Yes

  No

  N/A

Corrective Actions

• Enter corrective actions, if any, that were addressed or need to be addressed

Sign Off

• Auditor's signature

  Sign