James McHugh Construction UPRR

• Date - Initials - 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

  Date
• Location
  Address

1. Planned / Scheduled work for the day.

• 1a. Pre-Task / Safety Briefing prior to start of work?

  Yes

  No

  N/A

• Railroad EIC/Flagger assigned to project.

• Railroad Job Briefing held before beginning of shift?

  Yes

  No

  N/A

• 1b. Work performed according to plan?

  Yes

  No

  N/A

• 1c. Adequate tools, materials and Safety controls to perform work?

  Yes

  No

  N/A

2. Ladders

• 2a. Unsafe or damaged ladders discarded, destroyed, and removed from site?

  Yes

  No

  N/A

• 2b. Ladders properly positioned?

  Yes

  No

  N/A

• 2c. Ladder properly secured?

  Yes

  No

  N/A

3. Emergency Response

• 3a. Adequate emergency plans for site?

  Yes

  No

  N/A

• 3b. Emergency procedures displayed at site?

  Yes

  No

  N/A

• 3c. Adequate first aid kits and equipment for site?

  Yes

  No

  N/A

4. Personal Protective Equipment (PPE)

• 4a. Adequate PPE supplied / utilized?<br>

  Yes

  No

  N/A

• 4b. Appropriate training in safe use, clean-up and inspection of PPE?

  Yes

  No

  N/A

5. Fall / Perimeter Protection

• 5a. Guard rails at required height?

  Yes

  No

  N/A

• 5b. Holes or openings covered, secured, and clearly marked?

  Yes

  No

  N/A

• 5c. Fall arrest plan, equipment, & personnel properly trained?

  Yes

  No

  N/A

6. Lifting Equipment

• 6a. Hoisting Equipment adequate for task at hand? (Right machine for the task?)

  Yes

  No

  N/A

• 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?

  Yes

  No

  N/A

• 6c. Unsafe or damaged lifting equipment, including ropes, slings, chains, hooks removed from service?

  Yes

  No

  N/A

7. Work Environment

• 7a. Sufficient lighting?

  Yes

  No

  N/A

• 7b. Adequate housekeeping?

  Yes

  No

  N/A

8. Flammable Liquids

• 8a. Are flammable liquids being properly stored?

  Yes

  No

  N/A

9. Incidents, Accident, Injury, Near Miss

• Were there any incidents, injuries, accidents or near miss' to report today?

  Yes

  N/A

• 9a. Detailed information narrative?

• 9b. Detailed Information Photo's

  Media

10. Electrical Hazards

• 10a. GFCI outlets inspected regularly?

  Yes

  No

  N/A

• 10b. Electrical equipment placed away from water?

  Yes

  No

  N/A

• 10c. Extension cords inspected prior to use?

  Yes

  No

  N/A

• 10d. Electrical equipment at safe distance from flammables?

  Yes

  No

  N/A

11. Lock/Out Tag Out: Hazardous Equipment, Energy or Other.

• 11. Lock-out/tag-out (LOTO) procedures for electrical or other hazardous equipment?

  Yes

  No

  N/A

12. Excavations

• 12 Will excavation work be performed today?

  Yes

  N/A

• 12a. Are all utility locations current for the area of excavation?

  Yes

  No

  N/A

• Are all areas around locates hand dug to determine exact location of utilities?

  Yes

  No

  N/A

• 12b. Have proper permits been acquired prior to digging?

  Yes

  No

  N/A

• 12c. Has an excavator Safety Program been submitted to Superintendent?

  Yes

  No

  N/A

• 12d. Does the sub-contractor have a competent person for excavating on site?

  Yes

  No

  N/A

• 12e. Is there an excavation plan, with associated "DIG" numbers reviewed and approved?

  Yes

  No

  N/A

• 12f. If required are Safety restraint belts in place and being used?

  Yes

  No

  N/A

• 12g. Are 'BACK-UP'or other movement alarms in place and functioning properly?

  Yes

  No

  N/A

• Are UPRR vehicle and equipment back-up procedures being followed?

  Yes

  No

  N/A

• 12h. Is traffic control required, and in place according to 'traffic control plan'?

  Yes

  No

  N/A

• 12i. Are Flaggers required?

  Yes

  No

  N/A

• Are the Flaggers certified according to City, State, & OSHA standards?

  Yes

  No

  N/A

• Are the Flaggers trained for the task at hand, and familiar with surrounding activities?

  Yes

  No

  N/A

• 12j. Have open excavations been protected?

  Yes

  No

  N/A

• 12k. Is shoring designed by a Structural Engineer or meeting OSHA standards?

  Yes

  No

  N/A

• 12l. Is contaminated material being handled according to plan and disposed of properly in accordance to EPA expectations?

  Yes

  No

  N/A

• 12m. Is erosion control in place? I.e: silt fence, drain screens, pump sock - filter bag, etc...

  Yes

  No

  N/A

• 12n. Has all earth work been inspected by the competent person prior to entering?

  Yes

  No

  N/A

• 12o. Are precautionary measures in place for dewatering trenches / excavations?

  Yes

  No

  N/A

• 12p. Has the soil been tested to determine classification by the competent person?

  Yes

  No

  N/A

• 12q. Is benching, sloping, shoring, or shielding required?

  Yes

  No

  N/A

• 12r. Is any special insurance required, if so, has it been obtained? (RR Protective, etc..)

  Yes

  No

  N/A

• 12s. Are dust control and street sweeping equipment being used? ie... Water truck - Street sweeper

  Yes

  No

  N/A

• 12t. Are there any atmospheric hazards?

  Yes

  No

  N/A

• Continuous air monitoring being done during all excavation activities with appropriate detection equipment?

  Yes

  No

  N/A

• 12u. Are access & egress points in place according to standards?

  Yes

  No

  N/A

13. Administrative Procedures

• 13a. Procedure for incident reporting followed? (Incident, witness, injury, etc.)

  Yes

  No

  N/A

• 13b. Proper induction for workers, contractors, visitors?

  Yes

  No

  N/A

• All current employees on-site have presented Roadway Worker Protection & E-Railsafe documentation. All current employees properly badged?

  Yes

  No

  N/A

• 13c. Proper permits acquired prior to task? (Hot Works, Confined Space etc)

  Yes

  No

  N/A

• UPRR Hot Work permits submitted daily to field supervision from sub-contractors?

  Yes

  No

  N/A

• 13d. Site Safety Plan readily available?

  Yes

  No

  N/A

• 13e. Supervision on site? (List Supt. & PM)

  Yes

  No

  N/A

• 13f. Appropriate consultative arrangements? (Ability to get resolution to concerns)

  Yes

  No

  N/A

• 13g. Routine inspections, monitoring, audits submitted regularly?

  Yes

  No

  N/A

14. Tower & Mobile Cranes

• 14. Is there a crane on site today?

  Yes

  N/A

• 14a. Are crane inspections current and copies available?

  Yes

  No

  N/A

• 14b. Is the load chart readily available, legible, and being followed?

  Yes

  No

  N/A

• 14c. Are signal persons and riggers qualified with proof readily available?

  Yes

  No

  N/A

• 14d. Are all hook 'Safety Locks' in working order?

  Yes

  No

  N/A

• 14e. Is crane positioned at the correct safe distance from over-head power lines?

  Yes

  No

  N/A

• 14f. Are outriggers properly padded?

  Yes

  No

  N/A

• 14g. Are access ladders and steps properly protected and in good condition?

  Yes

  No

  N/A

• 14h. Does the operator have appropriate licensing accord to Job, City, & State requirements?

  Yes

  No

  N/A

• 14i. Is all rigging properly tagged and regularly inspected?

  Yes

  No

  N/A

15. Other Safety Observations

• 15. Were safety observations made that don't fit a previously listed category?

  N/A

  Details

16. Corrective Actions

• 16a. Enter any corrective actions that will be undertaken

• Add media

  Media

17. Site exterior condition.

• 17a. Is all public protection in place and in good visible / functional condition?

  Yes

  No

  N/A

• 17b. Are all worker pathways clean, clear of debris and clearly marked or identified?

  Yes

  No

  N/A

• 17c. Is all signage for detoured walk ways in place? i.e. 'Sidewalk closed' 'use other side' 'over head work'

  Yes

  No

  N/A

Sign Off

• Auditor's signature

  Sign