JMCC RR2.0

• 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. Planned / Scheduled work for the day:

• 1a. Pre-Task / Safety Briefing conducted prior to task?

  Yes

  No

  N/A

• 1b. Work performed according to plan?

  Yes

  No

  N/A

• 1c. Correct tools, materials and equipment to perform task?

  Yes

  No

  N/A

• Brief description of work performed today:

• General job / work in progress photo's:

  Media

2. Ladders / Scaffold

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

  Yes

  N/A

  No

• 2b. Ladders correctly positioned?

  Yes

  No

  N/A

• 2c. Ladders correctly secured?

  Yes

  N/A

  No

• 2d. Is scaffold present on site?

  Yes

  No

  N/A

• 2e. Was scaffolding erected according to plan, and by qualified person?

  Yes

  No

  N/A

• 2f. 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:

• List corrective actions taken for this section:

3. Emergency Procedures

• 3a. Have emergency action plans been developed, distributed and communicated?

  Yes

  No

  N/A

• 3b. Emergency procedures posted and available at site?

  Yes

  No

  N/A

• 3c. Assembly area / gathering point established and communicated to all employees?

  Yes

  No

  N/A

• 3d. First aid kits and equipment readily available and inspected?

  Yes

  No

  N/A

• 3e. Are Hazcom/SDS present, available and up to date?

  Yes

  No

  N/A

4. Personal Protective Equipment (PPE)

• 4a. Is required PPE supplied, utilized and maintained for the task?<br>

  Yes

  No

  N/A

• 4b. Training in the safe use, maitenance and inspection of PPE?

  Yes

  No

  N/A

• List any specialized PPE required for this job?

5. Fall / Perimeter Protection

• 5a. Is fall prevention and protection plan developed, documented and communicated to all employees?

  Yes

  No

  N/A

• 5b. Guardrail systems constructed and maintained according to code or other contractual requirments

  Yes

  No

  N/A

• 5c. Holes greater than 2" covered, secured, and clearly marked?

  Yes

  No

  N/A

• 5d. Fall arrest equipment provided & personnel trained?

  Yes

  No

  N/A

• 5e. Fall exposures protected according to fall protection plan?

  Yes

  No

  N/A

• 5f. Has any FALL-ARREST equipment been removed from service due to wear, defects, or fall experience?

  Yes

  No

  N/A

• List corrective actions taken for its section

6. Restricted Access Zones

• 6a. Are restricted access zones being used for Grinding, Window Installation, Look-Out, Hoisting Path, Excavation, etc.?

  Yes

  No

  N/A

• 6b. Are Restricted Access Zones being erected and maintained where needed?

  Yes

  No

  N/A

• 6c. Are barricades, flagging and signage in use?

  Yes

  No

  N/A

7. Lifting Equipment

• 7a. Correct Hoisting Equipment chosen for task at hand? (Right machine for the task?)

  Yes

  No

  N/A

• 7b. Hoisting plan developed and documented?

  Yes

  No

  N/A

• 7c. 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

• 7d. Has any lifting equipment, including ropes, slings, chains been removed from service? If so, explain in comment section.

  Yes

  N/A

8. Work Environment

• 8a. Are work areas lighted according to standards?

  Yes

  No

  N/A

• 8b. Is task lighting required and utilized in specific areas?

  Yes

  No

  N/A

• 8c. Have house keeping deficiencies been identified and addressed?

  Yes

  No

  N/A

• 8d. Are access and egress points provided to the site and all work areas?

  Yes

  No

  N/A

• List corrective actions taken for this section:

9. Fire Prevention and Protection

• 9a. Are flammable liquids and gases being stored correctly?

  Yes

  No

  N/A

• 9b. Are flammable liquid containers in good working order and properly labeled?

  Yes

  No

  N/A

• 9c. Are compressed gas cylinders properly stored, secured and in a upright position?

  Yes

  No

  N/A

• 9d. Are Oxygen cylinders stored a minimum of 20 feet from any other combustible/flammable liquids or gases?

  Yes

  No

  N/A

• 9e. Are fire extinguishers available in all work areas and regularly inspected?

  Yes

  No

  N/A

10. Incidents, Accident, Injury, Near Miss

• 10a. Were any incidents, injuries, accidents or near miss' to report today?

  Yes

  N/A

• Detailed information and narrative?

• Photo's

  Media

• 10b. Have investigation reports been completed and submitted to required parties?

  Yes

  No

  N/A

11. Electrical Hazards

• 11a. GFCI outlets inspected regularly?

  Yes

  No

  N/A

• 11b. Electrical equipment placed away from water?

  Yes

  No

  N/A

• 11c. Extension cords inspected prior to use?

  Yes

  No

  N/A

• 11d. Electrical equipment at safe distance from flammables?

  Yes

  No

  N/A

• 11e. Are all power tools inspected prior to use?

  Yes

  No

  N/A

• 11f. Are electrical panels covered and clearly marked?

  Yes

  No

  N/A

• 11g. Have any electrical cords or power tools been removed from service?

  Yes

  N/A

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

• 12a. Lock-out/tag-out (LOTO) for electrical or other hazardous equipment necessary? Please specify in detail section.

  Yes

  No

  N/A

13. Excavations

• 13a. Will excavation work be performed today?

  Yes

  N/A

  No

• 13b. Has an excavator Site Safety Program been submitted to Superintendent?

  Yes

  No

  N/A

• 13c. Is there a competent person for excavating on site?

  Yes

  No

  N/A

• 13d. Have all permits, Including McHugh Ground Disturbance Planning Form, been obtained and completed prior to digging?

  Yes

  No

  N/A

• 13e. Have all surface encumbrances been identified and support planned?

  Yes

  No

  N/A

• 13f. Have underground utilities been located and identified?

  Yes

  No

  N/A

• Have "DIG" numbers been acquired and current?

  Yes

  No

  N/A

• 13g. Are 'BACK-UP'or other movement alarms in place and functioning properly?

  Yes

  No

  N/A

• 13h. Have open excavations been protected against accidental entry?

  Yes

  No

  N/A

• 13i. Have you confirmed if shoring requires design by a structural engineer?

  Yes

  No

  N/A

• 13j. Is contaminated material being handled according to plan and disposed of properly in accordance with contractual and regulatory obligations?

  Yes

  No

  N/A

• 13k. Is erosion control in place and being maintained? i.e: silt fence, drain screens, pump sock - filter bag, etc.

  Yes

  No

  N/A

• 13m. Has the Competent Person performed tests as specified by OSHA, or used an engineering soils report, to determine classification? (A,B,C)

  Yes

  No

  N/A

• 13n. Has all earthwork been inspected by the competent person prior to persons entering and after any rain or other event?

  Yes

  No

  N/A

• 13o. Are precautionary measures in place for dewatering trenches / excavations?

  Yes

  No

  N/A

• 13p. Is benching, sloping, shoring, or shielding (support system) required?

  Yes

  N/A

• 13r. Are documents for support system readily available?

  Yes

  No

  N/A

• 13r. Is support system being inspected and maintained daily? (work days)

  Yes

  No

  N/A

• 13s. Is any special insurance required, if so, has it been obtained? (RR Prospective, etc..)

  Yes

  No

  N/A

• 13t. Are dust control and street sweeping equipment being used? ie... Water truck - Street sweeper

  Yes

  No

  N/A

• 13u. Have potential atmospheric hazards been identified?

  Yes

  No

  N/A

• 13v. Are access & egress devices in place according to standards (Ladders, Stairs, Ramps)?

  Yes

  No

  N/A

• List any corrective actions taken for this section:

14. Traffic Control

• 14a. Are safety restraint / seat belts in place and being used?

  Yes

  No

  N/A

• 14b. Are 'BACK-UP' or other movement alarms in place and functioning?

  Yes

  No

  N/A

• 14c. Is traffic control required, and in place according to Traffic Control Plan, MUTCD Standards and other governing bodies?

  Yes

  No

  N/A

• 14d. Are all traffic control devices inspected, maintained, and kept in good visible condition?

  Yes

  No

  N/A

• List responsible party for traffic control devices, placement, and maintenance:

• Are Flaggers required?

  Yes

  No

  N/A

• Are the flaggers certified according to City, State and OSHA standards?

  Yes

  No

  N/A

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

  Yes

  N/A

• List any corrective actions taken for this section:

15. Administrative Procedures

• 15a. Procedure for incident reporting followed? (Incident, witness, injury, etc.)

  Yes

  No

  N/A

• 15b. Has Company / Site Specific orientation-training been provided to workers, contractors, visitors?

  Yes

  No

  N/A

• 15c. Correct permits acquired and filled out completely prior to task? (Hot Works, Confined Space etc)

  Yes

  No

  N/A

• 15d. Site Safety Plan readily available?

  Yes

  No

  N/A

• 15e. Supervision on site? (List Supt. & PM)

  Yes

  No

  N/A

• 15f. Are there consultative arrangements in place? (Ability to get resolution to concerns)

  Yes

  No

  N/A

• 15g. Routine inspections, monitoring, audits submitted regularly?

  Yes

  No

  N/A

16. Tower & Mobile Cranes

• 16a. Is there a crane on site today?

  Yes

  N/A

  No

• 16b. Are crane inspections current and copies available?

  Yes

  No

  N/A

• 16c. Is the load chart readily available, legible, and being followed?

  Yes

  No

  N/A

• 16d. Are signal persons and riggers qualified with proof readily available?

  Yes

  No

  N/A

• 16e. Are all hook 'Safety Locks' in working order?

  Yes

  No

  N/A

• 16f. Is crane positioned at the correct safe distance from over-head power lines?

  Yes

  No

  N/A

• 16g. Is cribbing provided under outriggers for support and load dispersion?

  Yes

  No

  N/A

• 16h. Is swing radius protected / barricaded to prevent entry?

  Yes

  No

  N/A

• 16i. Are access ladders and steps protected and in good condition?

  Yes

  No

  N/A

• 16j. Does the operator have correct licensing according to Job, City, & State requirements?

  Yes

  No

  N/A

• 16k. Is all rigging properly tagged and regularly inspected?

  Yes

  No

  N/A

• Notes for this section of any special or precautionary actions taken:

17. Site exterior condition.

• 17a. Are all perimeter side walks clean?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 17e. Are canopies being used, if YES, have all hazards been eliminated? i.e.(falling debris/material, sharp edges, trip hazards)

  Yes

  No

  N/A

• 17f. Are there any temporary walkways, if yes, are the ADA (American Disability Act) compliant?

  Yes

  No

  N/A

• List any corrective actions taken for this section:

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. Atmospheric: Lead, Asbestos, Silica

• 19a. Have potential atmospheric hazards been Identified? (If yes, please describe)<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. Has the hazard been remediated / abated, if yes, by whom? (please provide copies of completion reports)

  Yes

  No

  N/A

• 19d. Are employee's provided with appropriate PPE to be protected from exposure to hazard?

  Yes

  No

  N/A

• 19e. Will respirators be required as part of PPE for the task at hand?

  Yes

  No

  N/A

• Has employee been Medically Cleared & F.I.T Tested to utilize respirator?

  Yes

  No

  N/A

• Has employee been assigned a respirator for task at hand?

  Yes

  No

  N/A

• Has the employee been formally trained to use and clean Respirator correctly?

  Yes

  No

  N/A

• Are F.I.T test's & training records current and accessible?

  Yes

  No

  N/A

• Has employee been assigned a respirator for task at hand?

  Yes

  No

  N/A

• 19f. Is equipment on site to monitor potential atmospheric hazards?

  Yes

  No

  N/A

• List corrective actions taken for this section:

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. Observational Notes:

• 21a. List additional notes and observations of concern generated by other activities unrelated to project:

• Add media

  Media

Sign Off

• Auditor's signature

  Sign