Johnson-Peltier Weekly Safety Summary

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Job Name:

• Job # :

• Select date

  Date

Housekeeping

• General Neatness of Work Areas

• Passageways/Walkways

  Yes

  No

  N/A

• Sanitary Facilities Adequate and Clean?

  Yes

  No

  N/A

• Trash Containers

  Safe

  At Risk

  N/A

• Adequate Lighting?

  Yes

  No

  N/A

• Trade Clean Up

  Safe

  At Risk

  N/A

• Sub-Contractors

  Safe

  At Risk

  N/A

• Other Contractors?

  Safe

  At Risk

  N/A

Personal Protective Equipment

• Hard Hat

  Safe

  At Risk

  N/A

• Eye Protection

  Safe

  At Risk

  N/A

• Cutting/Grinding?

  Safe

  At Risk

  N/A

• Chemicals?

  Safe

  At Risk

  N/A

• Welding?

  Safe

  At Risk

  N/A

• Gloves

  Safe

  At Risk

  N/A

• Hearing Protection

  Safe

  At Risk

  N/A

• Clothing

  Safe

  At Risk

  N/A

• Safety Vest

  Safe

  At Risk

  N/A

• Gas Monitor

  Safe

  At Risk

  N/A

• H2S

  Safe

  At Risk

  N/A

• Bump Test

• 4-Way

  Safe

  At Risk

  N/A

• Calibration Up-To-Date

• Safety Harness

  Safe

  At Risk

  N/A

• Lanyard

• D-Rings

• Face Shield

  Safe

  At Risk

  N/A

• Respirator/Dust Mask

  Safe

  At Risk

  N/A

• Arc Flash Protection

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Body Movement/Positioning

• Straining

  Safe

  At Risk

  N/A

• Body Movement Awareness

  Safe

  At Risk

  N/A

• Teamwork(Communication)

  Safe

  At Risk

  N/A

• Visibility

  Safe

  At Risk

  N/A

• Positioning/Stability

  Safe

  At Risk

  N/A

• Lifting

  Safe

  At Risk

  N/A

• Firm Base

  Safe

  At Risk

  N/A

• Pinch Points

  Safe

  At Risk

  N/A

• Horseplay

  Safe

  At Risk

  N/A

Vehicle Use

• Jobsite Trucks

  Yes

  No

  N/A

• Traffic Laws

  Safe

  At Risk

  N/A

• Vehicle Condition

  Safe

  At Risk

  N/A

• Forklift Operation

  Safe

  At Risk

  N/A

• Aerial Lift Operation

  Safe

  At Risk

  N/A

• Crane Operation

  Yes

  No

  N/A

Electrical

• LO/TO

  Safe

  At Risk

  N/A

• Extension Cords

  Safe

  At Risk

  N/A

• GFCI

  Safe

  At Risk

  N/A

• Power Skids

  Safe

  At Risk

  N/A

• Generators

  Safe

  At Risk

  N/A

• Energized Equipment

  Safe

  At Risk

  N/A

• Temporary Lighting

  Safe

  At Risk

  N/A

• Electric Tools

  Safe

  At Risk

  N/A

• Welding

  Safe

  At Risk

  N/A

Misccellaneous

• Ladders

  Safe

  At Risk

  N/A

• Trenches/Excav.

  Safe

  At Risk

  N/A

• Scaffolding

  Safe

  At Risk

  N/A

• Barricades

  Safe

  At Risk

  N/A

• Hand Tools

  Safe

  At Risk

  N/A

• Flammable Liquids

  Safe

  At Risk

  N/A

• First Aid

  Safe

  At Risk

  N/A

• Floor, Wall Openings, & Stairways

  Safe

  At Risk

  N/A

• Confined Space

  Safe

  At Risk

  N/A

• Fire Extinguishers

  Safe

  At Risk

  N/A

• Postings

  Safe

  At Risk

  N/A

• OSHA

• DIR

• Emergency Action Plan

• MSDS

• IIPP

• Other:

• Comments:

• Routing: Client (copy), Job File (copy), Safety Department (original)

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