Title Page
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Job name and number
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Conducted on
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Prepared by
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Location
General PPE
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Does everyone have an Aggregate Group issued hard hat?
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Ensure that you create an Action Item and correct this situation!
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Is everyone's hard hat free from damage and within date?
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Ensure that you create an Action Item and correct this situation!
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What was done to correct?
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Does everyone have Aggregate Group issued safety vests?
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Ensure that you create an Action Item and correct this situation!
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What was done to correct?
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Does everyone have ANSI Z87 safety glasses?
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Ensure that you create an Action Item and correct this situation!
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What was done to correct?
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Does everyone have safety-toe footwear?
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Ensure that you create an Action Item and correct this situation!
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What was done to correct?
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Does everyone have gloves and access to hearing protection?
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Ensure that you create an Action Item and correct this situation!
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What was done to correct?
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Take a picture of everyone wearing their general PPE
- Activity
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Briefly describe the task that you will be performing today
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Select the hazards associated with this task
- Working from height
- Grading and/or Excavating
- Power tool use
- Equipment use
- Material handling and/or lifting
- Concrete placing & finishing
- Cutting silica-containing material
- Drilling into silica-containing material
- Chipping silica-containing material
- Grinding silica-containing material
- Rock breaking
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Will anyone be six (6) feet or higher above the ground?
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What is being done to prevent a fall?
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Is a scaffolding system being used?
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Has it been inspected?
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What was done to correct?
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Are all power tool cords AND extension cords free from defect?
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Ensure that you create an Action Item and correct this situation!
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What was done to correct?
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Are all tools in proper working order, with applicable guards in place?
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Ensure that you create an Action Item and correct this situation!
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What was done to correct?
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Will a generator be used?
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Do you have gas for the day? Is it stored in an OSHA compliant can?
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Ensure that you create an Action Item and correct this situation!
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What was done to correct?
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Do you have a charged fire extinguisher, with up-to-date inspections?
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Ensure that you create an Action Item and correct this situation!
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What was done to correct?
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Have existing utilities been located?
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DO NOT PROCEED WITH WORK. Quickly do what needs to be done to ensure that there are no underground utilities and that we can safely proceed with excavations. Public utilities can be located by contacting 811. Private utilities may need to be located by the client or a private locating company.
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Are any excavations going to be four (4) feet deep, or more?
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Is/Will the soil be appropriately stabilized based on its class OR have compliant cave-in protection?
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DO NOT PROCEED WITH WORK UNTIL THIS IS CORRECTED.
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Is/Will there be safe entry/exit locations every 25 feet?
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DO NOT PROCEED WITH WORK UNTIL THIS IS CORRECTED.
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Is/Will all material be kept AT LEAST two (2) feet away from the edge of excavation?
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DO NOT PROCEED WITH WORK UNTIL THIS IS CORRECTED.
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Will the competent person inspect the excavation conditions prior to allowing anyone entry to look for other potential hazards?
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DO NOT PROCEED WITH WORK UNTIL THIS IS CORRECTED.
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Has/Will daily equipment inspections be performed prior to using them?
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Explain why
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Where will cutting take place?
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Ensure that no single team member performs outdoor HAND-HELD saw cutting of silica-containing material for more than four (4) hours in a single day. Outdoor walk-behind saw cutting of silica-containing material does not have single day time limitations.
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Is the cutting equipment for silica-containing material equipped with an INTEGRATED water delivery system, and do we have the manufacturer's documentation showing silica exposure compliance?
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DO NOT PROCEED WITH THIS PORTION OF WORK UNTIL THIS HAS BEEN CORRECTED.
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When cutting silica-containing material indoors or in an enclosed area, APF 10 dust masks must be worn in addition to having an INTEGRATED water delivery system. PLEASE INFORM YOUR AGGREGATE GROUP SUPERVISOR OF THIS SITUATION NOW, BEFORE PROCEEDING WITH WORK.
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Is the cutting equipment for silica-containing material equipped with an INTEGRATED water delivery system, and do we have the manufacturer's documentation showing silica exposure compliance?
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Have the team members involved/near in the cutting activity been fit-tested to wear APF 10 dust masks, and are the dust masks available to them?
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Are the drills for silica-containing material equipped with manufacturer-approved shrouds/cowlings with dust collection systems AND do we have the manufacturer's documentation showing silica-exposure compliance?
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DO NOT PROCEED WITH THIS PORTION OF WORK UNTIL THIS HAS BEEN CORRECTED
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Do we have a HEPA-filtered vacuum for cleaning out holes after we drill into the silica-containing material?
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DO NOT PROCEED WITH THIS PORTION OF WORK UNTIL THIS HAS BEEN CORRECTED (or select N/A, if this is not applicable)
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Where will the chipping be performed?
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Ensure that no single team member performs outdoor HAND-HELD chipping for more than four (4) hours in a single day.
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Does the chipping equipment have a manufacturer-approved water delivery system OR a shroud/cowling with a dust collection system AND do we have the manufacturer's documentation showing silica-exposure compliance?
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DO NOT PROCEED WITH THIS PORTION OF WORK UNTIL THIS HAS BEEN CORRECTED
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When chipping silica-containing material indoors or in an enclosed area, APF 10 dust masks must be worn in addition to having a manufacturer approved water delivery system OR shroud/cowling with dust collection system. PLEASE INFORM YOUR AGGREGATE GROUP SUPERVISOR OF THIS SITUATION NOW, BEFORE PROCEEDING WITH WORK.
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Does the chipping equipment have a manufacturer-approved water delivery system OR a shroud/cowling with a dust collection system AND do we have the manufacturer's documentation showing silica-exposure compliance?
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DO NOT PROCEED WITH THIS PORTION OF WORK UNTIL THIS HAS BEEN CORRECTED
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Have the team members involved/near in the cutting activity been fit-tested to wear APF 10 dust masks, and are the dust masks available to them?
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DO NOT PROCEED WITH THIS PORTION OF WORK UNTIL THIS HAS BEEN CORRECTED
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Where will work be performed?
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Does the grinding equipment for silica-containing material have a manufacturer approved water delivery system OR a shroud/cowling with a dust collection system AND do we have the manufacturer's documentation showing silica-exposure compliance?
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DO NOT PROCEED WITH THIS PORTION OF WORK UNTIL THIS HAS BEEN CORRECTED
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Ensure that no single team member performs indoor/enclosed area HAND-HELD grinding for more than four (4) hours in a single day.
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Does the grinding equipment for silica-containing material have a manufacturer approved water delivery system OR a shroud/cowling with a dust collection system AND do we have the manufacturer's documentation showing silica-exposure compliance?
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DO NOT PROCEED WITH THIS PORTION OF WORK UNTIL THIS HAS BEEN CORRECTED
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If any other team members (who are outside of the equipment cab) are engaged in rock breaking activities, then water should be used to suppress dust created from the rock breaking.
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Does our rock breaking equipment have an enclosed cab?
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DO NOT PROCEED WITH THIS PORTION OF WORK UNTIL THIS HAS BEEN CORRECTED
