Information
-
Job Number(s)
-
Job Name
General Project Information
-
Safety Manager Assigned to this project:
-
Site hours of operation:
-
List Sub-Contractors and Competent Persons per sub:
-
Prepared by
-
Weather Conditions
-
Conducted on
-
Location
1. Planned / Scheduled work for the day.
-
1a. Pre-Task / Safety Briefing prior to start of work?
-
1b. Work performed according to plan?
-
1c. Adequate tools, materials and Safety controls to perform work?
2. Ladders
-
2a. Unsafe or damaged ladders discarded, destroyed, and removed from site?
-
2b. Ladders properly positioned?
-
2c. Ladder properly secured?
3. Emergency Response
-
3a. Adequate emergency plans for site?
-
3b. Emergency procedures displayed at site?
-
3c. Adequate first aid kits and equipment for site?
4. Personal Protective Equipment (PPE)
-
4a. Adequate PPE supplied / utilized?<br>
-
4b. Appropriate training in safe use, clean-up and inspection of PPE?
5. Fall / Perimeter Protection
-
5a. Guard rails at required height?
-
5b. Holes greater than 2" covered, secured, and clearly marked?
-
5c. Fall arrest plan, equipment, & personnel properly trained?
6. Lifting Equipment
-
6a. Hoisting Equipment adequate for task at hand? (Right machine for the task?)
-
6b. All workers, and operators aware of hoisting loads over head and near power lines, practices and procedures according to company policy and OSHA Standards?
-
6c. Unsafe or damaged lifting equipment, including ropes, slings, chains, hooks removed from service?
7. Work Environment
-
7a. Sufficient lighting?
-
7b. Adequate housekeeping?
8. incidents, Accident, Injury, Near Miss
-
Were there any incidents, injuries, accidents or near miss' to report today?
-
8b. Detailed information narrative?
-
8a. Detailed Information Photo's
9. Electrical Hazards
-
9a. GFCI outlets inspected regularly?
-
9b. Electrical equipment placed away from water?
-
9c. Extension cords inspected prior to use?
-
9d. Electrical equipment at safe distance from flammables?
-
9e. Lock-out/tag-out (LOTO) procedures for electrical equipment?
10. Excavations
-
10a. Will excavation work be performed today?
-
10b. Has an excavator Corporate Safety Program been submitted to Superintendent?
-
10c. Is there a competent person for excavating on site?
-
10d. Is there an excavation plan, with associated "DIG" numbers reviewed and approved?
-
10e. Are Safety restraint belts in place and being used?
-
10f. Are 'BACK-UP'or other movement alarms in place and functioning properly?
-
10g. Is traffic control required, and in place according to 'traffic control plan'?
-
10h. Are Flaggers required?
-
Are the Flaggers certified according to City, State, & OSHA standards?
-
Are the Flaggers trained for the task at hand, and familiar with surrounding activities?
-
10i. Have open excavations been protected?
-
10j. Is shoring designed by a Structural Engineer?
-
10k. Is contaminated material being handled according to plan and disposed of properly in accordance to EPA expectations?
-
10L. Is erosion control in place? I.e: silt fence, drain screens, pump sock - filter bag, etc...
-
10m. Has all earth work been inspected by the competent person prior to entering?
-
10n. Are precautionary measures in place for dewatering trenches / excavations?
-
10o. Have proper permits been acquired prior to digging?
-
10p. Has the soil been tested to determine classification by the competent person?
-
10q. Is benching, sloping, shoring, or shielding required?
-
10r. Is any special insurance required, if so, has it been obtained? (RR Prospective, etc..)
-
10s. Are dust control and street sweeping equipment being used? ie... Water truck - Street sweeper
-
10t. Are there any atmospheric hazards?
-
10u. Are access & egress points in place according to standards?
11. Administrative Procedures
-
11a. Procedure for incident reporting followed? (Incident, witness, injury, etc.)
-
11b. Proper induction for workers, contractors, visitors?
-
11c. Proper permits acquired prior to task? (Hot Works, Confined Space etc)
-
11d. Site Safety Plan readily available?
-
11e. Supervision on site? (List Supt. & PM)
-
11f. Appropriate consultative arrangements? (Ability to get resolution to concerns)
-
11g. Routine inspections, monitoring, audits submitted regularly?
12. Tower & Mobile Cranes
-
Is there a crane on site today?
-
Are crane inspections current and copies available?
-
Is the load chart readily available, legible, and being followed?
-
Are signal persons and riggers qualified with proof readily available?
-
Are all hook 'Safety Locks' in working order?
-
Is crane positioned at the correct safe distance from over-head power lines?
-
Are outriggers properly padded?
-
Are access ladders and steps properly protected and in good condition?
-
Does the operator have appropriate licensing accord to Job, City, & State requirements?
-
Is all rigging properly tagged and regularly inspected?
13. Corrective Actions
-
13a. Enter any corrective actions that will be undertaken
-
Add media
Sign Off
-
Auditor's signature