MDS Site Safety Report

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

JOB INFORMATION

• General Contractor

• Safety personnel designated for this site- GC

  Yes

  No

  N/A

• Name

• Site Safety walk through frequency?

  Daily

  Weekly

  Monthly

• OSHA 300 forms complete and posted from February 1 - April 30?<br>

  Yes

  No

  N/A

• OSHA and DOL posters posted?

  Yes

  No

  N/A

• Emergency phone numbers posted?

  Yes

  No

  N/A

• Tool box safety talks log up to date?

  Yes

  No

  N/A

• Competent Person Identified

  Yes

  No

  N/A

• Name

• MSDS filed?

  Yes

  No

  N/A

• Site Specific Requirements (above/beyond SAC requirements)

HOUSEKEEPING

• Work areas neat?

  Yes

  No

  N/A

• Work areas properly signed and barricaded?

  Yes

  No

  N/A

• Projecting nails or screws bent over or removed?

  Yes

  No

  N/A

• Waste containers provided and used?

  Yes

  No

  N/A

• Passageways and walkways clear?

  Yes

  No

  N/A

• Is rebar capped properly?

  Yes

  No

  N/A

• Cords and leads off the floor?

  Yes

  No

  N/A

FIRE PREVENTION

• Adequate fire extinguishers, checked and accessible?

  Yes

  No

  N/A

• "No Smoking" posted and enforced near flammables?

  Yes

  No

  N/A

ELECTRICAL

• Extension wires with bare wires or missing ground prongs taken out of service?

  Yes

  No

  N/A

• Ground fault interrupters being used?

  Yes

  No

  N/A

• Terminal boxes equipped with required covers?

  Yes

  No

  N/A

HAND, POWER & POWDER ACTUATED TOOLS

• Hand tools inspected regularly?

  Yes

  No

  N/A

• Cords in safe working order?

  Yes

  No

  N/A

• Guards in place on machines?

  Yes

  No

  N/A

• Correct tool being used for job at hand?

  Yes

  No

  N/A

FALL PROTECTION

• Safety harnesses worn properly?

  Yes

  No

  N/A

• Safety rails and cables secured properly?

  Yes

  No

  N/A

• Employees exposed to fall hazards tied off?

  Yes

  No

  N/A

• Appropriate anchorage points used by employees?

  Yes

  No

  N/A

• What is being used as an anchorage point?

• Are harnesses required to be worn in lifts?

  Yes

  No

  N/A

• What type of lanyard is worn inside the lift?

  Shock absorber

  Straight

  Retractable

• Stairwells have handrails?

  Yes

  No

  N/A

• Employees below protected from falling objects?

  Yes

  No

  N/A

LADDERS

• Ladders extended at least 36" above landing?

  Yes

  No

  N/A

• Are employees tied off while working from a ladder?

  Yes

  No

  N/A

• Ladders are secure to prevent slipping, sliding or falling?

  Yes

  No

  N/A

• Ladders with split or missing rungs taken out of service?

  Yes

  No

  N/A

• Stepladders used in fully open position?

  Yes

  No

  N/A

• Are ladders protected from accidental displacement near walkways or doorways?

  Yes

  No

  N/A

• No step at top two rungs of stepladder?

  Yes

  No

  N/A

• Any wooden ladders on site that need removed?

  Yes

  No

  N/A

SCAFFOLDING

• All scaffolding inspected daily?

  Yes

  No

  N/A

• Erected on sound rigid footing?

  Yes

  No

  N/A

• Tied to structure as required?

  Yes

  No

  N/A

• Guardrails, intermediate rails, toe boards and screens in place?

  Yes

  No

  N/A

• Proper access provided?

  Yes

  No

  N/A

• Employees below protected from falling objects?

  Yes

  No

  N/A

FLOOR & WALL OPENINGS

• All floor openings that cannot be planked properly flagged and barricaded?

  Yes

  No

  N/A

• Are hole covers properly secured to prevent displacement?

  Yes

  No

  N/A

• Can hole covers handle working loads from workers, equipment etc?

  Yes

  No

  N/A

• Perimeter protection in place?

  Yes

  No

  N/A

• Fall protection anchorage points installed in landing zones for workers?

  Yes

  No

  N/A

• Materials stored away from edge?

  Yes

  No

  N/A

• Ladders or stilts used near protected leading edges?

  Yes

  No

  N/A

TRENCHES, EXCAVATION & SHORING

• Competent person identified and present?

  Yes

  No

  N/A

• Excavations are shored and sloped back?

  Yes

  No

  N/A

• Was a documented daily inspection conducted for the excavation?

  Yes

  No

  N/A

• Materials are stored at least 2' away from trench?

  Yes

  No

  N/A

• Ladders provided every 25' in trench?

  Yes

  No

  N/A

• Equipment is at a safe distance from edge of trench or excavation?

  Yes

  No

  N/A

MATERIAL HANDLING

• Materials properly stored or stacked?

  Yes

  No

  N/A

• Proper number of workers for each operation?

  Yes

  No

  N/A

• Are work tables at the correct height to reduce bending?

  Yes

  No

  N/A

• Employees using proper lifting techniques?

  Yes

  No

  N/A

• Are carts on site and being used properly?

  Yes

  No

  N/A

• Are there any rough edges that could cause lacerations or injury.

  Yes

  No

  N/A

• Is material staged on the floor? If yes- why?

  Yes

  No

  N/A

WELDING AND BURNING

• Gas cylinders stored upright and secured?

  Yes

  No

  N/A

• Are regulators removed prior to being placed in storage?

  Yes

  No

  N/A

• Proper separating distances between fuels & oxygen?

  Yes

  No

  N/A

• Goggles or shields used?

  Yes

  No

  N/A

• Fire extinguishers readily available?

  Yes

  No

  N/A

• Hoses in good condition?

  Yes

  No

  N/A

CRANES

• Outriggers extended and swing radius barricade in place?

  Yes

  No

  N/A

• Hand signal charts on crane?

  Yes

  No

  N/A

• Employees kept from under suspended loads?

  Yes

  No

  N/A

• Chains and slings inspected and tagged as required?

  Yes

  No

  N/A

• Tag lines used to guide loads?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Hard hats being worn?

  Yes

  No

  N/A

• Safety glasses being worn?

  Yes

  No

  N/A

• Respirators used when required? Proper respirator documentation available?

  Yes

  No

  N/A

• Hearing protection being worn when required?

  Yes

  No

  N/A

• Traffic vests or high visibility clothing material being worn?

  Yes

  No

  N/A

• Are the appropriate gloves being worn for the task at hand?

  Yes

  No

  N/A

EQUIPMENT-FORKLIFTS

• Are operators properly certified?

  Yes

  No

  N/A

• Has equipment been properly inspected that day?

  Yes

  No

  N/A

• Is the inspection documented?

  Yes

  No

  N/A

• Are seat belts worn?

  Yes

  No

  N/A

• Is the equipment working properly? This includes back-up alarms, safety devices and all operating mechanisms. If no- please note and inform equipment team in corporate.

  Yes

  No

  N/A

• Are attachments proper?

  Yes

  No

  N/A

EQUIPMENT-SCISSORS LIFTS

• Are operators properly trained?

  Yes

  No

  N/A

• Is the chain properly pulled?

  Yes

  No

  N/A

• Are lift trays used?

  Yes

  No

  N/A

• Has the daily inspection checklist been properly filled out?

  Yes

  No

  N/A

• Lift numbers on site and last service date.

CLOSING

• Overall Safety Rating of Site (0 being lowest, 10 being highest)

• Safety Manager

  Sign

• Superintendent/Foreman/PM

  Sign