Information

  • 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

  • Location

1. Planned / Scheduled work for the day.

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

  • Railroad EIC/Flagger assigned to project.

  • Railroad Job Briefing held before beginning of shift?

  • 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 or openings 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. Flammable Liquids

  • 8a. Are flammable liquids being properly stored?

9. Incidents, Accident, Injury, Near Miss

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

  • 9a. Detailed information narrative?

  • 9b. Detailed Information Photo's

10. Electrical Hazards

  • 10a. GFCI outlets inspected regularly?

  • 10b. Electrical equipment placed away from water?

  • 10c. Extension cords inspected prior to use?

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

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

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

12. Excavations

  • 12 Will excavation work be performed today?

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

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

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

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

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

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

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

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

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

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

  • 12i. 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?

  • 12j. Have open excavations been protected?

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

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

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

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

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

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

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

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

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

  • 12t. Are there any atmospheric hazards?

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

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

13. Administrative Procedures

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

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

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

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

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

  • 13d. Site Safety Plan readily available?

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

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

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

14. Tower & Mobile Cranes

  • 14. Is there a crane on site today?

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

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

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

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

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

  • 14f. Are outriggers properly padded?

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

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

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

15. Other Safety Observations

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

16. Corrective Actions

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

  • Add media

17. Site exterior condition.

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

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

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

Sign Off

  • Auditor's signature

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