Jobsite Safety Survey CFC

• Job Name:

• Job Number:

• Job Location:

• Superintendent Name:

• Safety Representative:

• Conducted on

  Date

• Prepared by:

• Select "Safe", " At Risk", or "N/A" (Not Applicable). If at risk is selected explain why it is at risk in the note section and add a photo if possible.

Fall Protection:

• Competent Person:

• Hazard(s)

  Safe

  At Risk

  N/A

• Protection (Guardrail, Personal Fall Arrest System, Hide Covers)

  Safe

  At Risk

  N/A

• Equipment selection/use/training

  Safe

  At Risk

  N/A

• Anchorage/Tie-Off

  Safe

  At Risk

  N/A

• Body Harness and Laynards

  Safe

  At Risk

  N/A

Drill Rig(s):

• Daily Inspection

  Safe

  At Risk

  N/A

• Properly Set Up

  Safe

  At Risk

  N/A

• Operator's Manual

  Safe

  At Risk

  N/A

• Proper Shut Down and Storage

  Safe

  At Risk

  N/A

• Employee's aware of equipment's work area(s)

  Safe

  At Risk

  N/A

Heavy Equipment (Endloaders/Forklifts/Bobcats):

• Daily Inspection

  Safe

  At Risk

  N/A

• Back Up Alarm

  Safe

  At Risk

  N/A

• Qualified Operators

  Safe

  At Risk

  N/A

• Operator's Manual

  Safe

  At Risk

  N/A

• Proper Shut Down and Storage

  Safe

  At Risk

  N/A

• Employee's aware of equipment's work area(s)

  Safe

  At Risk

  N/A

Rigging:

• Nylon Slings (Remove if stitches are ripped, core shows, cuts, etc.)

  Safe

  At Risk

  N/A

• Shackles

  Safe

  At Risk

  N/A

• Wire Rope Slings (Remove if broken wire: 10 in one layer, 5 in 1 strand of a layer, 2 in eye)

  Safe

  At Risk

  N/A

• Spreaders

  Safe

  At Risk

  N/A

• Hooks (Remove if bent, twisted, excessively worn, welded on, pitted)

  Safe

  At Risk

  N/A

• Turnbuckles

  Safe

  At Risk

  N/A

• Other (If "At Risk" put in the notes what type of rigging it is, and why it is at risk)

  Safe

  At Risk

  N/A

Personal Protective Equipment (PPE):

• Hardhats

  Safe

  At Risk

  N/A

• Safety Glasses

  Safe

  At Risk

  N/A

• Gloves

  Safe

  At Risk

  N/A

• Respiratory Protection (if required, must be fit tested)

  Safe

  At Risk

  N/A

• Hearing Protection

  Safe

  At Risk

  N/A

• Safety Vests

  Safe

  At Risk

  N/A

• Face Shields (used for any grinding and chipping activities)

  Safe

  At Risk

  N/A

• Buoyant Work Vest

  Safe

  At Risk

  N/A

Hand/Power Tools:

• Tools used for their intended purpose

  Safe

  At Risk

  N/A

• Guards provided where required

  Safe

  At Risk

  N/A

• Impact tools inspected for mushrooming or cracking

  Safe

  At Risk

  N/A

Confined Space/Excavations:

• Competent Person:

• Type of Confined Space

  Permit Required

  Non-Permit Required

• Gas Detector/Air Monitor

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Retrieval System

  Safe

  At Risk

  N/A

• Training

  Safe

  At Risk

  N/A

• Shoring/Sloping/Benching

  Safe

  At Risk

  N/A

Electrical:

• GFCI/assured grounding/tools grounded

  Safe

  At Risk

  N/A

• Overhead wires?

  Safe

  At Risk

  N/A

• Underground wires?

  Safe

  At Risk

  N/A

• Generator in proper working condition

  Safe

  At Risk

  N/A

• Condition of power tools and cords

  Safe

  At Risk

  N/A

• Generators grounded

  Safe

  At Risk

  N/A

Housekeeping and Storage:

• Trash/debris controlled

  Safe

  At Risk

  N/A

• Material storage

  Safe

  At Risk

  N/A

• Proper containers

  Safe

  At Risk

  N/A

Welding and Cutting:

• Fire Extinguisher

  Safe

  At Risk

  N/A

• Area clear of combustible

  Safe

  At Risk

  N/A

• Proper storage of compressed cylinders

  Safe

  At Risk

  N/A

• Strikers used

  Safe

  At Risk

  N/A

• Hoses/Leads inspected

  Safe

  At Risk

  N/A

• Gauges in working order

  Safe

  At Risk

  N/A

Materials Handling:

• Proper lifting/bending/twisting

  Safe

  At Risk

  N/A

• Mechanical assist or two-man lift when too heavy

  Safe

  At Risk

  N/A

• Hands free of pinch points

  Safe

  At Risk

  N/A

Fire Safety:

• Fire extinguishers in working order

  Safe

  At Risk

  N/A

• Housekeeping-storage

  Safe

  At Risk

  N/A

• Flammable/combustible liquids storage

  Safe

  At Risk

  N/A

• Fire watch

  Safe

  At Risk

  N/A

Project Set-Up:

• Emergency numbers/facilities identified

  Safe

  At Risk

  N/A

• Utilities locate provided

  Safe

  At Risk

  N/A

• Project safety plan completed

  Safe

  At Risk

  N/A

• Site-specific training-OSHA 10/30hr, MSHA 24hr

  Safe

  At Risk

  N/A

Other:

• Safety Manual/MSDS onsite

  Safe

  At Risk

  N/A

• First-aid supplies/eyewash available

  Safe

  At Risk

  N/A

• Weekly TBT- Toolbox talk completed

  Safe

  At Risk

  N/A

• Job Hazard Analysis (JHA)/Daily Task Analysis (DTA)

  Safe

  At Risk

  N/A

• Guards/covers/grates provided for rotating parts

  Safe

  At Risk

  N/A

• Hoses whip-checked/pinned

  Safe

  At Risk

  N/A

• Note any comment, corrective actions or other safety observations:

• Superintendent's Signature:

  Sign

• Safety Representative's Signature

  Sign