KP NCAL Safety Inspection

• Document No.

• Project name:

• Site/Location:
  Address

• Conducted on:

  Date

• e-Builder Project Number (Format is CAP123456):

• Project Superintendent:

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Project Foreman:

  Select Yes No N/A

  • Yes
  • No
  • N/A

• Prepared by:

• Open items:

• Add media

  Media

• Have all open items been corrected?

  Yes

  No

  N/A

• Is required PPE being worn?

  Yes

  No

  N/A

• Are safe work practices being followed by CPFC employees?

  Yes

  No

  N/A

• Are subcontractors compliant with subcontractor performance safety standards?

  Yes

  No

  N/A

• Is the Project Safety Checklist correctly completed, posted, and signed by each subcontractor?

  Yes

  No

  N/A

• Is the Project Safety Check List accurate in identifying need for lockout/tagout in all applications?

  Yes

  No

  N/A

• Is the Project Safety Check List accurate in other areas of hazard identification?

  Yes

  No

  N/A

• Is lockout/tagout adequate in protection and identification (locked & tagged)?

  Yes

  No

  N/A

• Is energized electrical work adequately documented including a contingency plan and safe work practices being followed per plan?

  Yes

  No

  N/A

• Is the PCRA correctly filled out and posted on site?

  Yes

  No

  N/A

• Is the Infection Control Risk Assessment level accurate to risk and exposure level per site exposure?

  Yes

  No

  N/A

• Are ICRA/PCRA dust control measures in compliance?

  Yes

  No

  N/A

• Have ILSM been implemented?

  Yes

  No

  N/A

• Is there an inventory list and a Safety Data Sheets (SDS) for material on the project per company?

  Yes

  No

  N/A

• Are engineering controls, work practices, training and supervision adequate for asbestos exposures?

  Yes

  No

  N/A

• Are engineering controls, work practices, training and supervision adequate for lead exposures?

  Yes

  No

  N/A

• Are confined spaces identified and controlled by recordkeeping downgrading or by engineering, administrative or PPE controls per project requirements?

  Yes

  No

  N/A

Response required

• Please correct all documented violations within 5 business days upon receipt of this notification. In response to this report you will need to provide documentation of all corrections. Documentation shall be provided in the form of pictures, uploaded via e-builder to the appropriate folder. This report also addresses all repeat violations that have been identified in previous inspections and have yet to be corrected. Repeat findings will continue to be documented until they are formally documented and closed out. Please contact me via telephone or e-mail if you have any questions.