Information

  • Job Number

  • Job Name

  • Conducted on

  • Prepared by

  • Location
  • Personnel

1.0 Safety Plans

  • 1.1 Site Specific Safety Plan for ACCO?

  • 1.2 Site Specific Safety Plan for Subcontractors?

  • 1.3 Jobsite Crisis Management Plan? Phone Tree?

  • Complete? Posted?

  • 1.05 Other?

2.0 JHA/JSA/PTP/Work Permits

  • 2.1 Job description adequate?

  • Complete Description?

  • 2.2 JHA completely understood by all?

  • 2.3 JHA hazards and precautions match?

  • 2.4 Quality of JHA steps and hazards?

  • 2.05 Other?

3.0 Personal Protection

  • 3.1 Proper PPE worn by all workers?

  • 3.1.3 Hi-viz clothing?

  • 3.1.4 Shirts with sleeves and long pants? (No sweatpants)

  • 3.1.5 Proper footwear? Substantial, leather, ankle supporting boots or shoes; no tennis shoes.

  • 3.1.1 Hard hats?

  • 3.1.2 Glasses? Side shields?

  • 3.2 Proper gloves in use?

  • 3.3 Job-specific PPE as required?

  • Double eye/face protection (glasses and face shield or goggles) while performing abrasive cutting, chipping, grinding, roto-hammering above waist level, or overhead drilling, cutting or demolition?

  • 3.4 Locks and tags in place?

  • 3.05 Other?

4.0 Safety Equipment

  • 4.1 Fire extinguisher(s) in place?

  • 4.2 Fire extinguisher(s) inspections complete?

  • 4.3 Eyewash available? Not expired?

  • 4.4 First aid kit available?

  • 4.5 First aid kit stocked properly?

  • 4.05 Other?

5.0 General

  • 5.1 Lighting?

  • 5.2 Ventilation?

  • 5.3 Nails removed from lumber?

  • 5.05 Other?

6.0 Tools and Equipment

  • 6.1 Proper tools in use/used properly?

  • 6.2 Guards/safety devices in place?

  • 6.3 Tools in good condition?

  • 6.05 Other?

7.0 Body Positioning/Movement

  • 7.1 Line of fire risk?

  • 7.2 Attention to task?

  • 7.3 Pinch points?

  • 7,4 Proper lifting?

  • 7.5 Pushing/pulling under control/balance?

  • 7.6 Avoid/protected from sharp edges?

  • 7.05 Other?

8.0 Housekeeping

  • 8.1 Work areas clean and neat?

  • 8.2 Trash cans available/emptied?

  • 8.3 Hoses rolled and stowed?

  • 8.4 Materials properly staged/stored?

  • 8.5 Barricades up where applicable?

  • 8.6 Barricades maintained?

  • 8.05 Other?

9.0 Fall Protection

  • 9.1 Guardrails in place?

  • 9.2 Warning lines used?

  • 9.3 Guardrails/warning lines installed correctly?

  • 9.4 100% fall protection over 6' achieved?

  • 9.5 Proper fall protection equipment?

  • 9.6 Fall Protection Work Plan for work over 6'?

  • 9.05 Other?

10.0 Working at Height/Scaffolding/Ladders

  • 10.1 Decking complete w/o holes?

  • 10.2 Scaffold tag in place/current?

  • 10.3 Area below barricaded?

  • 10.4 Ladder (portable) inspection complete?

  • 10.5 Proper ladder use?

  • 10.6 Ladder extends 3' above landing?

  • 10.7 Cage on vertical ladder over 25'? Rest platform(s)?

  • 10.05 Other?

11.0 Walking Working Surfaces

  • 11.1 Aisles/stairs/floors clear/clean?

  • 11.2 Designated walking area?

  • 11.3 Holes/depressions guarded?

  • 11.4 Planks/mats on rebar for walking?

  • 11.05 Other?

12.0 Vehicles/Mobile Equipment

  • 12.1 Pre-use inspection complete?

  • 12.01 Tires and body in good condition?

  • 12.02 Vehicle lights, horn, etc. operational?

  • 12.2 Speed limit and traffic controls followed?

  • 12.3 Spotter used when appropriate?

  • 12.05 Other?

13.0 Electrical

  • 13.1 Assured Grounding complete? Correct color (Q1-white, Q2-green, Q3-red, Q4-orange)?

  • 13.2 GFCI use on all power cords/tools?

  • 13.3 Panel covers installed? Dead fronts installed?

  • 13.4 Panels labeled and unobstructed?

  • 13.5 Exposed wiring/knockouts?

  • 13.6 Extension cords in good shape?

  • 13.05 Other?

14.0 Welding/Grinding/Temporary Power

  • 14.1 Hoses, leads, cords hung properly?

  • 14.2 Welding cables/temp cords free of damage?

  • 14.3 Portable welding machine grounded?

  • 14.4 Double eye/face protection (glasses and face shield or goggles) while performing abrasive cutting, chipping, or grinding?

  • 14.5 Sparks controlled?

  • 14.6 Fire watch present?

  • 14.7 Fire watch trained?

  • 14.05 Other?

15.0 Cranes/Lifting/Hoisting/Rigging

  • 15.1 Crane(s) inspected/documented?

  • 15.2 Operator NCCCO certificate?

  • 15.3 Qualified signal-person? Documentation onsite?

  • 15.4 Qualified rigger? Documentation onsite?

  • 15.5 Ground is level/firm?

  • 15.6 Rigging is inspected/undamaged?

  • 15.7 Tag lines/softeners used?

  • 15.8 Critical Lift Plan done, if required?

  • 15.9 Overhead powerlines considered?

  • 15.10 Personnel not under suspended loads?

  • 15.05 Other?

16.0 Excavation Work

  • 16.1 Daily inspection conducted?

  • 16.2 Daily inspection documented?

  • 16.3 Over 4' inspected by competent person?

  • 16.4 Excavation shored/sloped/benched?

  • 16.5 Spoils pile at least 2' from edge?

  • 16.05 Other?

17.0 Confined Space

  • 17.1 Attendant trained and alert?

  • 17.2 Confined space signs posted at entrance(s)?

  • 17.3 Personnel in confined space(s) checked in/out?

  • 17.4 Ventilation in place/adequate?

  • 17.05 Other?

18.0 Cylinders/Hazardous Materials/Flammables/Combustibles

  • 18.1 Flammable/O2 bottles stored separately?

  • 18.2 Gas cylinders upright/secured/capped?

  • 18.3 Cylinder valves closed when not in use?

  • 18.4 Proper storage containers for flammables/combustibles?

  • 18.5 Secondary labeling for chemicals?

  • 18.6 Hazardous materials survey complete?

  • 18.6.3 Areas of work containing lead identified?

  • 18.6.4 Lead products abated properly?

  • 18.6.5 All other hazardous materials identified?

  • 18.6.6 All other hazardous materials abated properly?

  • 18.6.1 Asbestos containing materials identified?

  • 18.6.2 Asbestos containing materials abated properly?

  • 18.05 Other?

19.0 Iterim Life Safety Measures

  • 19.1 Signage?

  • 19.2 Dust control? Barriers? Penetrations blocked?

  • 19.3 Badging?

  • 19.4 Fire extinguishers?

  • 19.5 Clear stairwells/exits?

  • 19.05 Other?

Correctios

  • Section 1. Corrections made? By whom? When?

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