Kodiak - CapRock Daily Safety Report - duplicate

• Conducted On:

  Date

• Prepared By:

  Select David Nash Jesus Oliva Kelly Butler Alexis Ruiz

  • David Nash
  • Jesus Oliva
  • Kelly Butler
  • Alexis Ruiz

• Personnel Present:

  Select

Documentation & Health Requirements

• Copy of the Site Specific Safety Plan On-site?

  Yes

  No

• Medical Provider Information Included?

  Yes

  No

• Current Copy of the Kodiak IIPP & Code of Safe Practices On-site?

  Yes

  No

• Applicable Safety Data Sheets (SDS) On-Site for All Chemical Hazards Present?

  Yes

  No

  N/A

• Job Hazard Analysis JHA Completed Daily & Signed By Personnel Present

  Yes

  No

• Tailgate Safety Meeting Completed The Current Week?

  Yes

  No

• Fall Rescue Plan Available Onsite?

  Yes

  No

  N/A

• Fall Rescue Plan Specific to This Site, Completed and Signed by Crew Members?

  Yes

  No

  N/A

• All Personnel Familiar With The Content of the Fall Rescue Plan?

  Yes

  No

  N/A

• What Type of Equipment Will Be Used to Rescue a Fallen Coworker?

  Select Kodiak Personnel Pulling Individual Back to Roof Ladder Portable Scaffold Aerial Boom or Scissor Lift Fork Lift Fall Rescue Equipment Other

  • Kodiak Personnel Pulling Individual Back to Roof
  • Ladder
  • Portable Scaffold
  • Aerial Boom or Scissor Lift
  • Fork Lift
  • Fall Rescue Equipment
  • Other

• Kodiak Silica Exposure Prevention Plan Required for this Project?

  YES

  NO

• Is it Complete and Specific to this Project

  Yes

  No

• Kodiak Heat Illness Prevention Plan Checklist Included?

  Yes

  No

  N/A

• Is it Completed and Specific to This Project?

  Yes

  No

  N/A

• What is the Current Temperature On-site?

  Less than 70 Degrees F

  Between 70 - 80 Degrees F

  Between 80 - 90 Degrees F

  Between 90 - 100 Degrees F

  Over 100 Degrees F

• Adequate Supply of Water Available Onsite?

  Yes

  No

• Drinking Water Provided By:

  Select Water Bottles Purchased by Company Individual Supplied Water Water Not Available N/A

  • Water Bottles Purchased by Company
  • Individual Supplied Water
  • Water Not Available
  • N/A

• Is The Water Supply Being Maintained & Is Water Suitably Cool?

  Yes

  No

• Do Water Bottles Have Identifiable Markings?

  Yes

  No

• Water must not be too cold or warm. Coolers should be arranged so that water bottles are not submerged in icy water.

• Waste Container for Used Drinking Cups/Bottles Available?

  Yes

  No

• First Aid Kit Available and On-site?

  Yes

  No

• First Aid Contents in Good Condition, Stocked and Sterile?

  Yes

  No

• Is Work Performed or Equipment in Use That Requires a Fire Extinguisher to be Present? ( Hot, Single Ply, Generator, Spark or Heat Producing Equipment)

  YES

  NO

• Fire Extinguisher(s) Charged and Free From Damage?

  Yes

  No

• Fire Extinguisher(s) Inspected & Inspection Tag Complete & Current?

  Yes

  No

• Fire Extinguisher(s) Available & Within 50 Feet of Where Hot Work is Performed?

  Yes

  No

  N/A

• Hot Work Permit Required?

  YES

  NO

• Is Hot Work Permit Complete?

  Yes

  No

• Has a Fire Watch Been Assigned?

  Yes

  No

• Eye Wash Station Required On-site?

  YES

  NO

• Container or Appropriate Means for Draining Used Eyewash Solution Available?

  Yes

  No

• Eyewash Station Clean and Accessible?

  Yes

  No

• Weekly Inspections & Operational Checks Completed?

  Yes

  No

• Site Weather or Other Conditions Present

  Select Clear Sunny Partly Sunny Partly Cloudy Cloudy Rain Humid Foggy Icy Snowing Smokey Windy

  • Clear
  • Sunny
  • Partly Sunny
  • Partly Cloudy
  • Cloudy
  • Rain
  • Humid
  • Foggy
  • Icy
  • Snowing
  • Smokey
  • Windy

• Notes:

Personal Protective Equipment (PPE)

• Employees Compliant with Kodiak / OSHA Dress Standards (Pants, Work Boots, Shirt with at least 4" sleeves)?

  Yes

  No

• Hard Hats in Use by All Kodiak Personnel?

  Yes

  No

• Safety Glasses in Use by All Kodiak Personnel?

  Yes

  No

• Are the Correct Type of Safety Glasses Utilized for Conditions (Clear, Shaded etc.)?

  Yes

  No

• Does the Foreman Have Spare Safety Glasses On-site?

  Yes

  No

• Kodiak Personnel Exposed to Vehicle Traffic Wearing Class II Hi-Visible Vests or Work-Wear?

  Yes

  No

  N/A

• Hearing Protection Required?

  Not Required

  Yes & In Use

  Yes, But Not Utilized

  Foreman Does Not Have Available For Personnel

• If You are Unable Carry-on a Normal Conversation with Another Person 3-4 Feet Away Without Raising Your Voice, Hearing Protection is Required.

• Hand Protection Required?

  Not Required

  Yes & In Use

  Yes, But Not Utilized

  Foreman Does Not Have Available For Personnel

• Type of Hand Protection Required?

  Select Leather/Canvas/Cotton Rubber/Vinyl Dipped Cut Resistant Chemical Resistant Other Type Specific

  • Leather/Canvas/Cotton
  • Rubber/Vinyl Dipped
  • Cut Resistant
  • Chemical Resistant
  • Other Type Specific

• Face Shield Required for Work Performed?

  Not Required

  Yes & In Use

  Yes, But Not Utilized

  Foreman Does Not Have Available For Personnel

• Face Shield Utilized in Addition to Safety Glasses?

  Yes

  No

  N/A

• Safety Goggles Required for Work Performed?

  YES

  NO

• Safety Goggles in Use as Required?

  Yes

  No

• Silica Dust Abated per the Kodiak Silica Exposure Control Plan?

  Yes

  No

  Control Measures Not Compliant/Effective

  N/A

• Workers Exposed to Silica Dust Operations Trained on the Proper Use of Tools, Methods?

  Yes

  No

  N/A

• Tools and Equipment Utilized Properly to Control Silica Dust Exposure?

  Yes

  No

• Notes:

Fall Protection

• Scope of Work

  Select Single Ply Metal ACM HOT/BUR Cold Applied Tile/Shingle Other

  • Single Ply
  • Metal
  • ACM
  • HOT/BUR
  • Cold Applied
  • Tile/Shingle
  • Other

• Fall Protection Required on This Project?

  YES

  NO

• Personal Fall Arrest System (PFAS) Required

  YES

  NO

• PFAS Utilized Per Kodiak Policy & OSHA Standards?

  Yes

  No

• PFAS Components in Good Condition?

  Yes

  No

• Anchors Attached to Structural Members with Approved Screws and/or Hardware?

  Yes

  No

  N/A

• Kodiak Personnel Utilizing PFAS in Fall Restraint Rather Than Fall Arrest or Excess Slack in Lifelines Minimized?

  Yes

  No

• Kodiak Personnel Observing Swing Fall Conditions (< or = to 30 Degrees to Either Side of Anchorage)?

  Yes

  No

• Specialty Anchors in Use (Beam Straps, Standing Seam, Sky Mast, Fall Cart, Horizontal Lifeline etc.)?

  YES

  NO

• Fall Protection Cart Set-up Properly and Inspected Daily?

  Yes

  No

  N/A

• Specialty Anchors Attached to Structural Elements of Roof/Structure?

  Yes

  No

  N/A

• Self Retracting Lifelines in Use?

  YES

  NO

• Condition of Self Retracting Lifeline

  Good/Acceptable

  Good but Labels/Decals Not Legible

  Needs Repair or Re-Certification

• Warning Line Required?

  YES

  NO

• Warning Line: System Condition

  Compliant

  Not Compliant

  No Warning Line Set-up

• Non-Compliant Conditions

  Select Too Much Sag in 2 or More Sections Height too High Flagging Set-Back From Edge Incomplete Path of Travel From Access Section(s) Tipped Over Other

  • Too Much Sag in 2 or More Sections
  • Height too High
  • Flagging
  • Set-Back From Edge
  • Incomplete
  • Path of Travel From Access
  • Section(s) Tipped Over
  • Other

• Guardrails in Use?

  YES

  NO

• Guardrail Type

  Select Job Made Wood/Metal Manufactured Portable Fiberglass, Metal Parapet Clamp Style Portable Permanent Fixed Other

  • Job Made Wood/Metal
  • Manufactured Portable Fiberglass, Metal
  • Parapet Clamp Style Portable
  • Permanent Fixed
  • Other

• Guardrails Compliant (Top, Mid Rails & Toe Boards)?

  Yes

  No

• Parapet Walls Used for Fall Protection at Least 39" high ?

  Yes

  No

  N/A

• Skylights, Holes & Roof/Floor Openings Covered or Barricaded, secured and Identified?

  Yes

  No

  N/A

• Wall Openings Barricaded?

  Yes

  No

  N/A

• Roof Access Hatches Guarded or Barricaded?

  Yes

  No

  N/A

• Notes:

Ladders / Access

• Ladder type(s) in use?

  Select Extension Ladder Step Ladder Job Made Other N/A

  • Extension Ladder
  • Step Ladder
  • Job Made
  • Other
  • N/A

• Access Ladder(s) Tied-off to Prevent Displacement?

  Yes

  No

  N/A

• Ladder(s) Set-up Outside of Traffic Areas (Foot, Vehicle)?

  Yes

  No

  N/A

• Top of Ladder 3' (36") Above Landing Surface?

  Yes

  No

  N/A

• Step Ladders Used Properly (Not Leaning Against Wall or Vertical Surface etc.) ?

  Yes

  No

  N/A

• Spreaders or Extension Locks Engaged Fully?

  Yes

  No

  N/A

• Non-conductive Ladders Used Around Electrical Elements (Power Lines, Panes etc.) ?

  Yes

  No

  N/A

• Ladder Condition

  Safe, No Defects or Damage

  Not Safe

• Unsafe Ladder Conditions:

  Select Rungs Spreader / Locks Side Rails Decals / Labels Feet Other

  • Rungs
  • Spreader / Locks
  • Side Rails
  • Decals / Labels
  • Feet
  • Other

• Notes:

Scaffolds

• Are Scaffolds Utilized by Kodiak Personnel?

  YES

  NO

• Who Is Supplying The Scaffolding?

  Kodiak

  General Contractor

  Other

• Type of Scaffold in Use?

  Select Self supported Mobile Swing Stage Utility Mobile Work Platform (Baker Style) Stair Tower

  • Self supported
  • Mobile
  • Swing Stage
  • Utility Mobile Work Platform (Baker Style)
  • Stair Tower

• Inspected & Tagged for Use? (green=safe, red=unsafe)?

  Yes

  No

• Safe access provided?

  Yes

  No

  N/A

• Scaffold Legs Resting on Jacks or Base Plates and Mud Sills (2x10x10)?

  Yes

  No

  N/A

• Cross-bracing, Guardrails, Mid Rails, End Rails in Place?

  Yes

  No

• Scaffold Fully Planked?

  Yes

  No

• Inside Edge Within 14" of Structure or 16" When Utilized by Stucco Contractors?

  Yes

  No

  N/A

• Toe Boards in Place Above Areas Where Personnel are Exposed to Falling Debris/Objects?

  Yes

  No

  N/A

• Tie Backs in Place When Scaffold Exceeds 3:1 (California) or 4:1 (Federal) Base to Height Ratio?

  Yes

  No

  N/A

• Notes:

Electrical

• Are Corded Electrical Tools or Extension Cords in Use on this Project?

  YES

  NO

• Extension/Power Cords

  Safe, No Defects or Damage

  Not Safe

• Unsafe Extension Cord / Power Cord Conditions:

  Select Torn/Cut/Burnt Outer Insulation Plug Ends Ground Prong Missing Exposed Conductors Electrical Tape Covering Damaged Cord Damaged/Defective Switch Other

  • Torn/Cut/Burnt Outer Insulation
  • Plug Ends
  • Ground Prong Missing
  • Exposed Conductors
  • Electrical Tape Covering Damaged Cord
  • Damaged/Defective Switch
  • Other

• Proper Size Extension Cords Used?

  Yes

  No

  N/A

• Extension Cords Routed Safely to Avoid Hazards (Vehicle Traffic, Sharp Edges, Wet Surfaces etc.) ?

  Yes

  No

  N/A

• Extension Cords Used Properly? (no Daisy-Chaining, Suspending Power Tools)

  Yes

  No

• Power Strips Plugged Directly into Electrical Outlets & Not Extension Cords?

  Yes

  No

  N/A

• Electrical Power Feed Cable (from Generator on Truck/Ground) Secured to Prevent it From Falling From Roof?

  Yes

  No

  N/A

• Spider box in use?

  YES

  NO

• Condition of Spider Box?

  Safe

  At Risk

  N/A

• Ground Fault Circuit Interrupters (GFCI) Utilized?

  Yes

  No

  N/A

• Generator Electrical Control Panel & Outlets in Good Repair

  Yes

  No

  N/A

• Notes:

Hand / Power Tools

• Hand Tool Condition

  Safe

  At Risk

  N/A

• Hand Tools Used Properly?

  Yes

  No

  N/A

• Utility Knives Account for a Large Number of Injuries Each Year. Hook Blades should only be used by workers when they are cutting long pieces of Single Ply Membrane, Ice and Water or Other Types of Underlayment. Hook Blades are not Allowed to be Used for Detail Work!!!

• Utilization of Utility Knives

  Select Safely Used and Stored Unsafe Use, Storage N/A

  • Safely Used and Stored
  • Unsafe Use, Storage
  • N/A

• Unsafe Use

  Select Non-Retractable Blades in Use Blades not Retracted When Not in Use Hook Blades Used for Detail Work Workers Cutting Toward Body / Body Parts Other

  • Non-Retractable Blades in Use
  • Blades not Retracted When Not in Use
  • Hook Blades Used for Detail Work
  • Workers Cutting Toward Body / Body Parts
  • Other

• Notes:

Housekeeping

• Material Storage Areas Free From Trip/Slip Hazards?

  Yes

  No

  N/A

• Materials/Debris Stored on Roof or Elevated Surfaces at Least 6 Feet From Roof Edge?

  Yes

  No

  N/A

• Materials/Debris Secured to Prevent Displacement by Wind?

  Yes

  No

  N/A

• Work Areas Free From Excess Debris/Garbage?

  Yes

  No

• Slip/Trip Hazards Identified & Barricaded or Mitigated?

  Yes

  No

  N/A

• Flammable Materials/Chemicals Stored/Used Away From Heat/Flame/Spark Producing Activities?

  Yes

  No

  N/A

• Loading/Unloading Areas Barricaded During Loading/Unloading Activities?

  Yes

  No

  N/A

• General Public/Other Trades Protected from Potential Hazards Created by Kodiak Activities?

  Yes

  No

• Are Intake Vents and A/C Units Covered to Prevent Fumes from Entering into Building/Work Spaces?

  Yes

  No

  N/A

• New or Existing Construction?

  New

  Existing

  New & Existing

• Material Storage Area Barricaded to Prevent Unauthorized Personnel Access?

  Yes

  No

  N/A

• Are Fall Zones Barricaded to Prevent Exposure to Unauthorized Personnel?

  Yes

  No

  N/A

• Paths of Travel Provided to Allow Unauthorized Personnel Safe Passage Around Potential Danger Zones?

  Yes

  No

  N/A

• Warning and/or Directional Signs Posted on Barricades & Paths of Travel?

  Yes

  No

  N/A

• Notes:

Lifts / Cranes

• Fork Lifts or Aerial Lifts Currently in Use by Kodiak Personnel ?

  YES

  NO

• Type of Lift In Use?

  Select Fork Lift Aerial Boom Aerial Scissor

  • Fork Lift
  • Aerial Boom
  • Aerial Scissor

• Operator(s) Certified?

  Yes

  No

• Equipment & Site Inspections Completed Today?

  Yes

  No

• Riggers / Spotters Wearing ANSI Class II Vests ot Shirts?

  Yes

  No

  N/A

• Lifts Operated in Safe Manner (Speed, Observing Clearances, Looking Behind before Backing etc.)

  Yes

  No

• Notes:

Miscellaneous

• Fuel Storage Containers OSHA Compliant?

  Yes

  No

  N/A

• Propane Cylinders Stored Upright & Secured in Company Vehicle or On-Site?

  Yes

  No

  N/A

• Notes:

• Kodiak Personnel Observed Lifting Material / Objects etc.?

  YES

  NO

• Observed Worker Lifting Properly?

  Yes

  No

  N/A

• Approximate Weight of the Material/Object Lifted?

  Select < 10 lbs 10 - 20 lbs 20 - 30 lbs 30 - 40 lbs 40 - 50 lbs 50 - 60 lbs > 60 lbs N/A

  • < 10 lbs
  • 10 - 20 lbs
  • 20 - 30 lbs
  • 30 - 40 lbs
  • 40 - 50 lbs
  • 50 - 60 lbs
  • > 60 lbs
  • N/A

• How Were They Lifting?

  Select Using Mechanical Equipment Using Proper Lifting Techniques Buddy Lift Unsafe Lifting Techniques Other

  • Using Mechanical Equipment
  • Using Proper Lifting Techniques
  • Buddy Lift
  • Unsafe Lifting Techniques
  • Other

• Kodiak Personnel Observed Moving Materials or Objects by Pushing and/or Pulling?

  YES

  NO

• Observed Worker Pushing/ Pulling Properly?

  Yes

  No

• What was the Approximate Weight of the Material or Objects Lifted or Moved?

  Select < 10 lbs 10 - 20 lbs 20 - 30 lbs 30 - 40 lbs 40 - 50 lbs 50 - 60 lbs > 60 lbs N/A

  • < 10 lbs
  • 10 - 20 lbs
  • 20 - 30 lbs
  • 30 - 40 lbs
  • 40 - 50 lbs
  • 50 - 60 lbs
  • > 60 lbs
  • N/A

• Unsafe Behaviors Observed During Inspections?

  YES

  NO

• Unsafe Behaviors Observed

  Select N/A Awkward Positions Repetitive Motions Forceful Exertion Contact Stress (Working on Knees, Striking /Kicking Object) Prolonged Vibration Slip/Trip/Fall Caught In/Between Hazard Struck By Hazard Using Tools Improperly Other

  • N/A
  • Awkward Positions
  • Repetitive Motions
  • Forceful Exertion
  • Contact Stress (Working on Knees, Striking /Kicking Object)
  • Prolonged Vibration
  • Slip/Trip/Fall
  • Caught In/Between Hazard
  • Struck By Hazard
  • Using Tools Improperly
  • Other

• How Was the Unsafe Behavior Addressed?

  Select Demonstrated/Explained Safe Behavior Stopped the Unsafe Behavior Verbal Warning Written Warning Informed the Foreman/Supervisor Other

  • Demonstrated/Explained Safe Behavior
  • Stopped the Unsafe Behavior
  • Verbal Warning
  • Written Warning
  • Informed the Foreman/Supervisor
  • Other

• Every employee is expected to work in a safe manner as they go throughout the day performing their tasks. Occasionally employees may go above and beyond what is expected of them. When this behavior is observed, we want to reward them in some way that recognizes this. If you don't directly observe this, ask the foreman in charge if he has observed this and who it is so that we can recognize this with a reward or recognition of some kind. The following questions should be answered after an observation by you or the foreman.

• Safe Behavior Observed that is above and beyond normal expectations?

  YES

  NO

• Safe Behavior Observed (Behavior performed that goes above and beyond normal expectations)

  Select Asking for Help Lifting Warning Another Person of a Hazard Helping a Person Don or Adjust Harness Stopping a Person From Using the Wrong Tool Encouraging a Person to Wear PPE Stopping Work That Is Unsafe Correcting or Mitigating a Hazard Other N/A

  • Asking for Help Lifting
  • Warning Another Person of a Hazard
  • Helping a Person Don or Adjust Harness
  • Stopping a Person From Using the Wrong Tool
  • Encouraging a Person to Wear PPE
  • Stopping Work That Is Unsafe
  • Correcting or Mitigating a Hazard
  • Other
  • N/A

• What was Done When Safe Behavior Was Observed?

  Select Praised the Person Pointed Out Safe Behavior to Crew Positive Element Created Gift Card Awarded Movie/Sports Tickets Other

  • Praised the Person
  • Pointed Out Safe Behavior to Crew
  • Positive Element Created
  • Gift Card Awarded
  • Movie/Sports Tickets
  • Other

• Name of Worker Praised / Rewarded for Safe Behavior:

  Select

• Note Other Safe / Unsafe Behaviors (i.e. Climbing or Descending Ladder While Carrying Objects, Throwing Objects from Roof, Carrying Too Many Items etc.) :

• Did You Have A Safety Conversation During This Visit?

  YES

  NO

• Who Did You Have the Conversation With?

  Select

• Conversation Topic?

  Select Documentation Safety Glasses/ Eye & Face Protection Hard Hat ANSI Class II Vest or Hi-Viz Shirt Other PPE PFAS Fall Protection Warning Line/Guardrails Skylight/Hole Protection Ladders Scaffold Fire Prevention Equipment Certification / Inspections Other

  • Documentation
  • Safety Glasses/ Eye & Face Protection
  • Hard Hat
  • ANSI Class II Vest or Hi-Viz Shirt
  • Other PPE
  • PFAS Fall Protection
  • Warning Line/Guardrails
  • Skylight/Hole Protection
  • Ladders
  • Scaffold
  • Fire Prevention
  • Equipment Certification / Inspections
  • Other

• Notes/Description

Review

• I Have Reviewed This Inspection & I Will Take the Necessary Actions Needed To Correct and/or Mitigate Any Deficiencies Noted Here-in.

  Sign