JMCC RR 3.0

• 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. Daily pre-task/safety

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

  Yes

  No

  N/A

• 1b. Rail road flagman/EIC on site and safety briefing given?

  Yes

  No

  N/A

• Were track authority/protection parameters communicated during the briefing?

  Yes

  No

  N/A

• Track Protection Type and Restriction Number

• Enter LImits, Time, and verification

• 1c. Were workers questioned throughout the day to verify their knowledge of the protection in place?

  Yes

  No

  N/A

• Note employees questioned below. Note any negative outcomes in this field.

• Employee Name Signature

  Sign

• Employee Name Signature

  Sign

• Employee Name Signature

  Sign

• Employee Name Signature

  Sign

• Employee Name Signature

  Sign

• 1d. Method of communication or warning has been established with the EIC and/or flagmen?

  Yes

  No

  N/A

• 1e. Were risk assessment findings or any planned work specific hazards communicated during the job safety briefing? Note those discussed.

  Yes

  No

  N/A

• 1f. Are job briefings updated as personnel/conditions change?

  Yes

  No

  N/A

• 1g. Supervision on site? (List Supt., PM, Railroad Rep/EIC, and Flagmen)

  Yes

  No

  N/A

• 1h. Are safety zones around equipment established and communicated?

  Yes

  No

  N/A

• 1i. Required permits acquired prior to task? (Hot Works, Confined Space etc)

  Yes

  No

  N/A

2. Orientation and Training

• 2a. Has site orientation been provided to workers, subcontractors, visitors?

  Yes

  No

  N/A

• 2b. All personnel have completed a Railroad Specific Training if required? (i.e. BNSF Contractor Orientation, UPRR SMS)

  Yes

  No

  N/A

• 2c. All personnel have an e-RAILSAFE ID?

  Yes

  No

  N/A

• 2d. All personnel have FRA Part 214 Sub C Roadway Worker Protection training and card as required?

  Yes

  No

  N/A

• 2e. All personnel have FRA Part 214 Sub B (bridge work) training as required?

  Yes

  No

  N/A

3. Site Administration

• 3a. Site safety plan on site and readily available?

  Yes

  No

  N/A

• 3b. Required State, Federal, sexual harassment and ethics posters are conspicuously posted in areas accessible to workers?

  Yes

  No

  N/A

• 3c. SDS for materials on site are on site and readily available?

  Yes

  No

  N/A

• 3d. Were there any Staff, Owner, Sub-contractor, or other scheduled meetings today?

  Yes

  No

  N/A

• 3e. Are weekly toolbox talks being held and documented?

  Yes

  No

  N/A

• 3f. Are there an adequate number of port-a-potties on site in areas adjacent to work to meet requirements and standards? (i.e. 1 unit per 10 workers)

  Yes

  No

  N/A

• 3g. Are stretch and flex exercises performed at the beginning of shift?

  Yes

  No

  N/A

4. Emergency Response

• 4a. Are Emergency Plans/Procedures in place and communicated to employees?

  Yes

  No

  N/A

• 4b. Are emergency procedures and phone numbers conspicuoously displayed at site?

  Yes

  No

  N/A

• 4c. Are first aid kits and equipment on site and readily available?

  Yes

  No

  N/A

• 4d. Are first aid trained personnel available on site?

  Yes

  No

  N/A

• 4e. Are weather forecasts monitored and plans in place for weather related emergencies?

  Yes

  No

  N/A

5. Personal Protective Equipment (PPE)

• 5a. Is all company supplied PPE on site (stocked) and readily available?<br>

  Yes

  No

  N/A

• 5b. Is PPE provided to employees and employees are trained to use PPE as needed and required to protect against injury?

  Yes

  No

  N/A

• Select all that have been provided

  Select Hard Hats Safety Glasses Hi-Vis Vests/Clothing Gloves Hearing Protection Face Shield

  • Hard Hats
  • Safety Glasses
  • Hi-Vis Vests/Clothing
  • Gloves
  • Hearing Protection
  • Face Shield

6. Respiratory Protection

• 6a. Will work that requires respiratory protection be performed today?

  Yes

  N/A

• 6b. Has a written respiratory protection program been implemented and is being followed?

  Yes

  No

  N/A

• 6c. Have all respirator wearers been medically screened?

  Yes

  No

  N/A

• 6d. Have all respirator wearers been quantitatively fit tested?

  Yes

  No

  N/A

• 6e. Have provisions for the cleaning and storage of respirators been made?

  Yes

  No

  N/A

• 6f. Have all respirator wearers been trained in the use, cleaning and storage of respirators?

  Yes

  No

  N/A

• 6g. Are all respirator wearers clean shaven to insure a proper seal?

  Yes

  No

  N/A

7. Fall / Perimeter Protection

• 7a. Is there a comprehensive Fall Protection Program in place?

  Yes

  No

  N/A

• 7b. Have all Fall From Height hazards been addressed and controlled?

  Yes

  No

  N/A

• 7c. Is all fall arrest equipment (harnesses, lanyards, SRL's, anchorage connectors, etc) inspected and in good working order?

  Yes

  No

  N/A

• 7d. Are all guard rails in place and built according to standard requirements?

  Yes

  No

  N/A

• 7e. Are all holes greater than 2 inches in working walking surfaces covered securely and marked "HOLE Do Not Remove"?

  Yes

  No

  N/A

8. Ladders / Scaffold

• 8a. Are ladders present in use on site?

  Yes

  N/A

• 8b. Were any unsafe or damaged ladders destroyed, discarded, and removed from site?

  Yes

  No

  N/A

• 8c. Ladders properly positioned?

  Yes

  No

  N/A

• 8d. Ladders properly secured?

  Yes

  No

  N/A

• 8e. Are Instructions, Warning Labels, and Capacities conspicuously located and legible on extensionand step ladders?

  Yes

  No

  N/A

• 8f. Are all job built ladders built according to ANSI standard?

  Yes

  No

  N/A

• 8g. Is scaffold present on site?

  Yes

  N/A

• 8h. Was scaffolding erected according to plan, and by qualified person?

  Yes

  No

  N/A

• 8i. Is inspection tag present and completed by competent person?

  Yes

  No

  N/A

• List responsible party for scaffold, type of scaffold, inspection frequency and competent person:

9. Hot Work (Welding, Torch Work)

• 9a. Will welding or torch work be performed today?

  Yes

  N/A

• 9b. Have the required hot work permits been obtained, signed and posted? (i.e. JMCC hot work permit and/or Railroad specific required permit)

  Yes

  No

  N/A

• 9c. Are only authorized and trained personnel permitted to use welding or cutting equipment?

  Yes

  No

  N/A

• 9d. Are fire watchers assigned when welding or cutting is performed in locations where a risk of fire exists?

  Yes

  No

  N/A

• 9e. Is fire extinguishing equipment available and in a state of readiness for immediate use in all hot work locations?

  Yes

  No

  N/A

10. Fire Prevention

• 10a. Are there an adequate number of fire extinguishers present and in working order?

  Yes

  No

  N/A

• 10b. Are flammable liquids being properly stored?

  Yes

  No

  N/A

• 10c. Are flammable liquids are stored in safety cans with the wire mesh flame arrestor intact?

  Yes

  No

  N/A

• 10d. Are compressed gas cylinders located or stored in a secure and upright position?

  Yes

  No

  N/A

• 10e. Are gas cylinders clearly marked as to what gas they contain?

  Yes

  No

  N/A

• 10f. Are valve protectors placed on cylinders when not in use or connected for use?

  Yes

  No

  N/A

• 10g. Are valves closed before a cylinder is moved, when the cylinder is empty, and at the completion of each job?

  Yes

  No

  N/A

• 10h. Are oxygen cylinders stored a minimum of 20 feet from other combustible/flammable liquids or gases?

  Yes

  No

  N/A

11. Electrical Hazards

• 11a. Are all GFCI outlets inspected regularly, at least monthly?

  Yes

  No

  N/A

• 11b. Has all electrical equipment been placed away from water?

  Yes

  No

  N/A

• 11c. Are extension cords inspected for damage prior to use?(missing ground lug, cuts in insulation, etc)

  Yes

  No

  N/A

• 11d. Is all electrical equipment at safe distance from flammables?

  Yes

  No

  N/A

• 11e. Have all power tools been inspected for damage and proper function prior to use?

  Yes

  No

  N/A

12. Cranes and Hoisting Equipment

• 12a. Is there a crane on site today?

  Yes

  N/A

• 12b. Are crane inspections current and copies available?

  Yes

  No

  N/A

• 12c. Are there any critical lifts scheduled for the day? (In excess of 75% capacity, 2 crane picks, etc)

  Yes

  N/A

• 12d. Have critical lift plans been submitted to the Safety Department for review?

  Yes

  No

  N/A

• 12e. Is the load chart readily available, legible, and being followed?

  Yes

  No

  N/A

• 12f. Are signal persons and riggers qualified with proof readily available?

  Yes

  No

  N/A

• 12g. Are all hook 'Safety Locks' in working order?

  Yes

  No

  N/A

• 12h. Is crane positioned at the correct safe distance from over-head power lines?

  Yes

  No

  N/A

• 12i. Are outriggers properly padded?

  Yes

  No

  N/A

• 12j. Are access ladders and steps properly protected and in good condition?

  Yes

  No

  N/A

• 12k. Are Navigation lights required and functioning? (Boom Lights)

  Yes

  No

  N/A

• 12l. Does the operator have appropriate licensing accord to Job, City, & State requirements?

  Yes

  No

  N/A

• 12m. Will rigging be used today?<br>

  Yes

  N/A

• 12n. Is all rigging properly tagged and regularly inspected?

  Yes

  No

  N/A

• 12o. Was any unsafe or damaged rigging removed from service?

  Yes

  No

  N/A

• 12p. Will chain falls be used for hoisting?

  Yes

  N/A

• 12q. Have chain falls been inspected for defects and deformed chains?

  Yes

  No

  N/A

• 12r. Have all safety mechanisms been inspected? (i.e. directional locks, anchor points,etc)

  Yes

  No

  N/A

• 12s. Are all weight capacities available, identifiable, and observed?

  Yes

  No

  N/A

13. Motorized Equipment (Heavy Equipment, Arial Lifts, Etc)

• 13a. Will motorized equipment be used?

  Yes

  N/A

• 13b. Was equipment inspected prior to use?

  Yes

  No

  N/A

• 13c. Are all employees who intend to use equipment trained and records available?

  Yes

  No

  N/A

• 13d. Do all motion alarms function properly?

  Yes

  No

  N/A

• 13e. Are safety restraint belts in place and being used?

  Yes

  No

  N/A

• 13f. Are all fall protection requirements pertaining to equipment being followed? (i.e. harnesses, lanyards, mid rail chains, etc.)

  Yes

  No

  N/A

• 13g. Are areas free of holes, debris, and obstructions to the safe movement of equipment?

  Yes

  No

  N/A

• 13h. Are machines shutoff, keys removed and secured when unattended?

  Yes

  No

  N/A

• 13i. Are load capacities being observed and followed?

  Yes

  No

  N/A

14. Excavations

• 14a. Will excavation work be performed today?

  Yes

  N/A

• 14b. Has an excavator Corporate Safety Program been submitted to Superintendent?

  Yes

  No

  N/A

• 14c. Have proper permits (ground disturbance, etc) been acquired prior to digging?

  Yes

  No

  N/A

• 14d. Is there a competent person for excavating on site?

  Yes

  No

  N/A

• 14e. Is there an excavation plan, with associated "DIG" numbers reviewed and approved?

  Yes

  No

  N/A

• 14f. Is contaminated material being handled according to plan and disposed of properly in accordance to EPA expectations?

  Yes

  No

  N/A

• 14g. Has the soil been tested to determine classification by the competent person?

  Yes

  No

  N/A

• 14h. Have open excavations been protected?

  Yes

  No

  N/A

• 14i. Is erosion control in place? I.e: silt fence, drain screens, pump sock - filter bag, etc...

  Yes

  No

  N/A

• 14j. Are dust control and street sweeping equipment being used? ie... Water truck - Street sweeper

  Yes

  No

  N/A

• 14k. Are precautionary measures in place for dewatering trenches / excavations?

  Yes

  No

  N/A

• 14l. Is benching, sloping, shoring, or shielding required?

  Yes

  No

  N/A

• 14m. Is shoring designed by a Structural Engineer?

  Yes

  No

  N/A

• 14n. Have all excavations been inspected by the competent person prior to entering?

  Yes

  No

  N/A

• 14o. Are access & egress points in place according to standards?

  Yes

  No

  N/A

• 14p. Is any special insurance required, if so, has it been obtained? (RR Prospective, etc..)

  Yes

  No

  N/A

15. Confined Spaces

• 15a. Will any work requiring a confined space entry be performed today?

  Yes

  N/A

• 15b.Has the safety department been notified of the intended Confined Space work?

  Yes

  No

  N/A

• 15c. Has a Confined Space Entry Permit been completed?

  Yes

  No

  N/A

• 15d. Has a rescue plan been developed, communicated, and distributed to all parties involved?

  Yes

  No

  N/A

• 15e. Has the atmosphere in the space been tested with a gas meter that has been fully calibrated within the last 6 months and the results accepted by the competent person?

  Yes

  No

  N/A

• 15f. Is the space being continuously monitored for changes in atmospheric and physical changes?

  Yes

  No

  N/A

• 15g. Have all intended entrants been trained in the last 12 months for confined space entry?

  Yes

  No

  N/A

• 15h. Is there an attendant stationed at the entry to space?

  Yes

  No

  N/A

• 15i. Does the attendant have the ability to keep in communication with the entrants at all times?

  Yes

  No

  N/A

16. Intersection of the Public Way

• 16a. Will any work intersect or be performed in the public way(sidewalk, roadway)?

  Yes

  N/A

• 16b. Do public walkways go through the work area?

  Yes

  N/A

• 16c. Are public walkways through the area properly barricaded and clearly marked?

  Yes

  No

  N/A

• 16d. Does the work affect the public roadway?

  Yes

  No

  N/A

• 16e. Are traffic control devices in place in accordance with the Traffic Control Plan and in compliance with MUTCD?

  Yes

  No

  N/A

• 16f. Are roadway flaggers require and if so have they received the required training to do so?

  Yes

  No

  N/A

• 16g. Is all construction equipment kept inside the barricaded area?

  Yes

  No

  N/A

17. Site Conditions

• 17a. Are site access points clear and maintained?

  Yes

  No

  N/A

• 17b. Is the public roadway at site access points clear of dirt and debris which could cause a roadway hazard?

  Yes

  No

  N/A

• 17c. Adequate access/egress provided to the site and all work areas?

  Yes

  No

  N/A

• 17d. Is there sufficient lighting natural or provided in work areas?

  Yes

  No

  N/A

• 17e. Is there adequate housekeeping throughout the work site? Work areas are free of debris, scraps, trip hazards. Storage areas are neat, organized, and maintained.

  Yes

  No

  N/A

• 17f. Are erosion and sediment control measures in place, adequate, and in accordance with SWPPP?

  Yes

  No

  N/A

18. Site Security

• 18a. Is the site fenced to prevent un-authorized entrance?

  Yes

  No

  N/A

• 18b. Are equipment and job trucks locked at the end of shift to prevent un-authorized use?

  Yes

  No

  N/A

• 18c. Are materials and equipment stored in a secure area to prevent theft?

  Yes

  No

  N/A

• 18d. List any site security measures that are currently in place for the site, i.e. security cameras or night time security personnel.

19. Hazardous Material, Atmospheres, Conditions

• 19a. Have potential Material or Atmospheric hazards been Identified and exist on site? (i.e. lead, asbestos, etc)<br>

  Yes

  No

  N/A

• 19b.Has formal testing been performed prior to beginning of task to identify hazard and exposure levels?

  Yes

  No

  N/A

• 19c. Will work be performed on surfaces or substances containing lead?

  Yes

  N/A

• 19d. Have all employees working with lead containing substances been medically screened for blood lead and ZPP?

  Yes

  No

  N/A

• 19e. Is medical monitoring ongoing?

  Yes

  No

  N/A

• 19f. Have employees received training on the hazards, health effects, and prevention of exposure to lead hazards?

  Yes

  No

  N/A

• 19g. Have employees been provided with task specific clothing and PPE to be worn when working with lead?

  Yes

  No

  N/A

• 19h. Have decontamination and laundry provisions been provided for employees?

  Yes

  No

  N/A

• 19i. Will work be performed on surfaces or substances containing asbestos?

  Yes

  N/A

• 19j. Has asbestos been remediated / abated, if yes, by whom? (please provide copies of completion reports)

  Yes

  No

  N/A

• 19k. Have areas containing asbestos been posted with signs noting the hazard to employees?

  Yes

  No

  N/A

• 19l. Is containment in place around asbestos work areas?

  Yes

  No

  N/A

20. General Duty Clause, Miscellaneous Findings & Other Safety Observations

• 20a. Were observations or miscellaneous findings that pose a potential hazard discovered during audit process?

  N/A

  Details

• Brief description & photo:

  Media

21. Incidents, Accident, Injury, Near Miss

• 21a. Were there any incidents, injuries, accidents or near misses to report today?

  Yes

  N/A

• 21b. Detailed information narrative? (who, what, when, where, why)

• 21c. Detailed Information Photo's

  Media

22. Corrective Actions

• 22a. Enter any corrective actions that will be undertaken to correct noted conditions.

• Add media

  Media

Sign Off

• Auditor's signature

  Sign