Leadership/Support Safety Walk

• Project/Job #

• Project/Job

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

BEHAVIOR

• TSSP reviewed and signed

  Safe

  At Risk

  N/A

• TSSP for each task?

  Safe

  At Risk

  N/A

• Mentors assigned?

  Safe

  At Risk

  N/A

• Task Hazard Boards Complete

  Safe

  At Risk

  N/A

WORK AREAS

• General Housekeeping

  Safe

  At Risk

  N/A

• Walking - Working Surfaces

  Safe

  At Risk

  N/A

• Unprotected Sides or Holes

  Safe

  At Risk

  N/A

• Impalement Hazards

  Safe

  At Risk

  N/A

• Material Storage/Lay Down

  Safe

  At Risk

  N/A

• Conex, Box 4 U, Gang Box

  Safe

  At Risk

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Hard Hats

  Safe

  At Risk

  N/A

• Safety Glasses with Side Shields

  Safe

  At Risk

  N/A

• Face Shield / Goggles (If Required)

  Safe

  At Risk

  N/A

• Respiratory Protection (If Required)

  Safe

  At Risk

  N/A

• Hearing Protection (If required)

  Safe

  At Risk

  N/A

• Clothing (FRC etc. if required)

  Safe

  At Risk

  N/A

• Gloves

  Safe

  At Risk

  N/A

• Foot Protection

  Safe

  At Risk

  N/A

FALL PROTECTION

• Worn Properly

  Safe

  At Risk

  N/A

• Suitable Anchorage Points

  Safe

  At Risk

  N/A

• Inspected/Color Coded

  Safe

  At Risk

  N/A

LADDERS

• Base/Footing/Set Up

  Safe

  At Risk

  N/A

• Proper Type for Task

  Safe

  At Risk

  N/A

TOOLS AND EQUIPMENT

• In Good Condition

  Safe

  At Risk

  N/A

• Inspected/Color Coded

  Safe

  At Risk

  N/A

• Right Tool for the Task

  Safe

  At Risk

  N/A

EXCAVATIONS

• Access/Egress

  Safe

  At Risk

  N/A

• Shoring/Shielding/Sloping

  Safe

  At Risk

  N/A

• Barricades

  Safe

  At Risk

  N/A

• Spoil Pile

  Safe

  At Risk

  N/A

ELECTRICAL

• G.F.C.I.'s

  Safe

  At Risk

  N/A

• Extension Cords

  Safe

  At Risk

  N/A

• Power Tools

  Safe

  At Risk

  N/A

EQUIPMENT

• Equipment Inspections

  Safe

  At Risk

  N/A

• Flagman with Vest

  Safe

  At Risk

  N/A

• Proper setup and use

  Safe

  At Risk

  N/A

PEOPLE

• Behavior

  Safe

  At Risk

  N/A

• Struck by/Caught in/between

  Safe

  At Risk

  N/A

• Proper Lifting

  Safe

  At Risk

  N/A

COMMENTS/RECOMMENDATIONS

• Enter any corrective actions that will be undertaken

SIGN OFF

• Leadership/Support Representative

  Sign

• Production Leader

  Sign

• Construction Supervisor

  Sign

• Field Hourly Rep / Others

  Sign

• Field Hourly Rep / Others

  Sign

• Field Hourly Rep / Others

  Sign