J.S.A. Removal of Dasher Boards

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Please add any additional information that pertains to this specific job task.

STEP 1 Remove back side sheeting

Hazards

• None

• New hazard?

  No

  Yes

Safe Work Procedures/PPE for Step 1

• Remove screws

STEP 2 Remove anchor bolts and connectors bolts

Hazards

• Noise
  Potential for frame to fall

• New hazard?

  No

  Yes

Safe Work Procedures/PPE for Step 2

• Recommended use of ear plugs
  Have co-worker assist in steadying the frame

STEP 3 Carry away frame

Hazards

• Heavy
  Hard on hands
  

Safe Work Procedures/PPE for Step 3

• Use enough man power
  Wear gloves

STEP 4

Hazards

Safe Work Procedures/PPE for Step 4

Job Site and Task Checklist

• Are permits required? ( hot work, confined spaces, etc. )

  No

  Yes

  N/A

• Is special training needed ( forklift, lift, etc)

  No

  Yes

  N/A

• Can weather conditions affect safety?

  No

  Yes

  N/A

• Is lighting a problem?

  No

  Yes

  N/A

• Are you in contact with acids or toxic products? ( MSDS)

  No

  Yes

  N/A

• Will there be exposure to dust, fumes or mist? ( MSDS)

  No

  Yes

  N/A

• Is the employee working with sharp or rough materials that require PPE?

  No

  Yes

  N/A

• Can the worker slip, trip or fall?

  No

  Yes

  N/A

• Do tools, machines or equipment present any hazards?

  No

  Yes

  N/A

• Can any body part get caught in, struck by, or caught between objects? This includes hands. Think before you reach.

  No

  Yes

  N/A

• Can pushing, pulling, lifting, bending or twisting cause strain?<br>

  No

  Yes

  N/A

• Is there a danger of falling objects?

  No

  Yes

  N/A

• Is excessive noise or vibration a problem?

  No

  Yes

  N/A

• Are there flammable, explosive or electrical hazards?

  No

  Yes

  N/A

• Any fall arrest hazards?

  No

  Yes

  N/A

Signatures

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign

• Add signature

  Sign