Kleins Restoration & Environmental Services, LLC Site Assessment

• Client / Site

• Prepared by

• Project Manager

• Conducted on

  Date
• Location
  Address

• Personnel

• Subcontractors On Site

Comments on site operations.

• General Notes:

First Aid, Bloodborne Pathogens, & Emergency Action Plan

• First Aid Kit available on site.

  Yes

  No

  N/A

• Emergency Action Plan is completed and reviewed with crew.

  Safe

  At Risk

  N/A

• Bloodborne Pathogen Kit available on site.

  Yes

  No

  N/A

• Snake Bit Kit available on site

  Yes

  No

  N/A

• Daily Job Safety Analysis is availabile and has been reviewed with crew.

  Yes

  No

  N/A

• Water is available onsite for workers.

  Safe

  At Risk

  N/A

Personal Protective Equipment

• High Visibility Vest.

  Safe

  At Risk

  N/A

• Hardhats

  Safe

  At Risk

  N/A

• T shirt, Pants, Footwear

  Safe

  At Risk

  N/A

• Safety Glasses, Face Shield, Goggles

  Safe

  At Risk

  N/A

• Hearing Protection

  Safe

  At Risk

  N/A

• Respirators and Dust Masks

  Safe

  At Risk

  N/A

• Gloves

  Safe

  At Risk

  N/A

Traffic Control

• Proper Signs, Barricades, Cones, Barrels, Delineators present and in good condition.

  Safe

  At Risk

  N/A

• Spotter used when required.

  Safe

  At Risk

  N/A

• Cones placed around staged equipment.

  Safe

  At Risk

  N/A

• Flagging Operation Present?

  Yes

  No

  N/A

• If flagger has their vehicle on site, is it parked out of the way with a running becon?

  Safe

  At Risk

  N/A

• Flaggers in proper position?

  Safe

  At Risk

  N/A

• Flaggers have good communication with radio or sight?

  Safe

  At Risk

  N/A

• Flaggers have proper PPE and Stop/Slow Paddle

  Safe

  At Risk

  N/A

• Pilot Car Operation?

  Yes

  No

  N/A

Hazard Communication and Employee Right to Know

• Secondary containers labeled.

  Safe

  At Risk

  N/A

• SDS for all chemicals available to crew.

  Safe

  At Risk

  N/A

Trucks and Mobile Equipment

• Vehicle & Equipment cleanliness is satisfactory.

  Safe

  At Risk

  N/A

• Seat Belts used where provided

  Safe

  At Risk

  N/A

• Tires, Seats, Work Platforms, Becons, and Back-Up Alarms in good condition.

  Safe

  At Risk

  N/A

• Chock blocks used when required.

  Yes

  No

  N/A

• Vehicle Inspection Completed and Accurate?

  Safe

  At Risk

  N/A

• Trailer beds free from debris.

  Safe

  At Risk

  N/A

• Loads are properly secured against displacement.

  Safe

  At Risk

  N/A

• Driver has medical card and license/CDL available for inspection.

  Safe

  At Risk

  N/A

• Chains and straps in serviceable condition.

  Yes

  No

  N/A

Utilities

• Overhead utilities identified, marked, and communicated to trucks and crew.

  Safe

  At Risk

  N/A

• Underground utilities located by hand when digging within 2 feet of locates.

  Safe

  At Risk

  N/A

• Underground utilities marked before digging

  Safe

  At Risk

  N/A

• Workers wearing electrical PPE when working near energized lines or parts.

  Yes

  No

  N/A

Fire Protection

• Fire Extinguishers available and inspections up to date.

  Safe

  At Risk

  N/A

• Gasoline in metal safety can with self closing lid and spark arrester.

  Safe

  At Risk

  N/A

• Fire extinguisher properly mounted on vehicle

  Safe

  At Risk

  N/A

Hand & Power Tools

• Electric power tools and extension cords on site?

  Yes

  No

  N/A

• Cords in good condition.

  Safe

  At Risk

  N/A

• Ground plug present on cords.

  Safe

  At Risk

  N/A

• Hand & Power Tools in use?

  Yes

  No

  N/A

• Hand & Power Tools in good condition.

  Safe

  At Risk

  N/A

Excavations

• Is there an open excavation on site?

  Yes

  No

  N/A

• Competent Person inspection and approval prior to entry.

  Safe

  At Risk

  N/A

• A means of egress is present within 25 ft of all workers.

  Yes

  No

  N/A

• Sloping, benching, shoring, or a trench box is in place for excavations 5 ft in depth or greater.

  Safe

  At Risk

  N/A

• Excavation is properly covered and barricaded for public protection.

  Safe

  At Risk

  N/A

Housekeeping & Sanitation

• Housekeeping on site is satisfactory.

  Safe

  At Risk

  N/A

• Laydown yard is organized and well maintained.

  Safe

  At Risk

  N/A

• Restrooms and hand wash facilities available to crew.

  Yes

  No

  N/A

Subcontractors

• Are subcontractors being held to Klein's Restoration Services, LLC safety standards (hardhats, footwear, vests utility locates, backup alarms, beacons, etc.)

  Safe

  At Risk

  N/A