Midwest Caissons Inc. (Job-Site Safety Survey)

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Daily Paperwork & General Safety

• Daily JHA/Toolbox Talk completed

  Yes

  No

  N/A

• Daily Drill Rig & Equipment Inspection completed

  Yes

  No

  N/A

• Safety Manual & MSDS on site

  Yes

  No

  N/A

• Job specific paperwork available (FLHA & Daily Tailgate Meeting)

  completed

  not completed

  completed but not effective

• Emergency numbers and facilities identified

  Yes

  No

  N/A

• Proper First Aid Kit on site

  Yes

  No

  N/A

• Alberta First Call done..... Ticket #<br>

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• Employee(s) dressed properly for work (Hard Hat, Steel Toe Boots, Reflective Vest, Safety Glasses, Hearing Protection and Gloves.

  Yes

  No

  N/A

• Hardhats

  Yes

  No

  N/A

• Safety Glasses

  Yes

  No

  N/A

• Gloves (if required)

  Yes

  No

  N/A

• High Visibility Clothing and/or Reflective Vest

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Type:

  Muffs

  Plugs

  Mutliple

• Face Sheild

  Yes

  No

  N/A

• Activity:

  Chipping

  Grinding

  Saw Cutting

  Multiple

• Respiratory Protection (if required, fit test needed)

  Yes

  No

  N/A

• Type:

  Disposable N95

  Half Face w/ cartridges

  Multiple

• All suppliers and sub contractors involved with Midwest Caissons Inc are in compliance w/ PPE requirements

  Yes

  No

  N/A

Fall Protection

• Competent Person(s)

  Yes

  No

  N/A

• Hazard(s)

  Yes

  No

  N/A

• Proper System/Equipment used

  Yes

  No

  N/A

• Type:

  Guardrail

  Personal Fall Arrest System

  Hole Covers

  Multiple

• Full Body Harness and lanyards in good working condition

  Yes

  No

  N/A

• Proper Anchorage/Tie-Off

  Yes

  No

  N/A

• Rebar Caps in use

  Yes

  No

  N/A

Foundation Drilling Rig ( Track or Truck-Mount )

• Qualified Operator(s)

  Yes

  No

  N/A

• Emergency Stop Functional ( Mait )

  Yes

  No

  N/A

• Operator's Manual in drill rig

  Yes

  No

  N/A

• Swing Alarm Operational

  Yes

  No

  N/A

• Back Up Alarm Operational

  Yes

  No

  N/A

• Fire Extinguisher (ABC)

  Yes

  No

  N/A

• Warning and/or Operational Decals

  Yes

  No

  N/A

• Steps and/or Ladder

  Yes

  No

  N/A

• Mirrors & Windows in good condition

  Yes

  No

  N/A

• Mechanical deficiencies reported

  Yes

  No

  N/A

• Catwalks (clear of debris)

  Yes

  No

  N/A

• Cable in good repair, free from frays and cuts?

  Yes

  No

  N/A

Rigging

• Competent Rigger(s)/Signal Person(s)

  Yes

  No

  N/A

• Nylon Straps

  Safe

  At Risk

  N/A

• Casing Slings

  Safe

  At Risk

  N/A

• Type:

  Chain

  Wire Rope

  Multiple

• Chains

  Safe

  At Risk

  N/A

• Spreaders

  Yes

  No

  N/A

• Sorting Hook

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

• Shackles

  Safe

  At Risk

  N/A

Material Handling

• Proper Lifting

  Safe

  At Risk

  N/A

• Hands free of Amputation Zones

  Safe

  At Risk

  N/A

• Mechanical Assist or 2-Man Lift when too heavy

  Safe

  At Risk

  N/A

Skid-Steer / Loader

• Daily Inspection Completed

  Yes

  No

  N/A

• Qualified Operator(s)

  Yes

  No

  N/A

• Machine Type:

  Skid steer

  Loader

• Operator's Manual in machine

  Yes

  No

  N/A

• Emergency Stop is Operational

  Yes

  No

  N/A

• Back-Up Alarm Operational

  Yes

  No

  N/A

• Mirrors and Windows in good condition

  Yes

  No

  N/A

• Tracks Clean

  Yes

  No

  N/A

• Rims/ Lug Nuts inspected

  Safe

  At Risk

  N/A

• Mechanical deficiencies reported

  Yes

  No

  N/A

Confined Spaces/Excavations

• Competent Person(s)

  Yes

  No

  N/A

• Permit Required

  Yes

  No

  N/A

• Air Monitoring completed

  Yes

  No

  N/A

• Decibel Monitoring completed

  Yes

  No

  N/A

• Access/Egress

  Safe

  At Risk

  N/A

• Type:

  Ladder

  Ramp

  Other

  Multiple

• Proper Excavation Protection

  Yes

  No

  N/A

• Type:

  Benching

  Shoring

  Sloping

  Multiple

• Soil Type (if known)

  Solid Rock

  Stable Rock

  A

  B

  C

Cutting & Welding

• Hot Work Permit Pulled

  Yes

  No

  N/A

• Fire Watch

  Yes

  No

  N/A

• Area clear of combustibles

  Yes

  No

  N/A

• Compressed Gas Cylinders properly stored

  Yes

  No

  N/A

• Storage Type:

  Fire Wall

  Torch Cart(if used w/in 24hrs)

  20' Separation

  Multiple

• Striker used for ignition

  Yes

  No

  N/A

• Hoses in good condition

  Yes

  No

  N/A

• Leads in good condition

  Yes

  No

  N/A

• Gauges in good condition

  Yes

  No

  N/A

• Caps on Compressed Gas Cylinders if Gauges are removed

  Yes

  No

  N/A

• Chop Saw Disc in good condition

  Yes

  No

  N/A

Fire Safety

• Fire Extinguisher(s) are charged and in good condition

  Yes

  No

  N/A

• Fire Extinguisher(s) have up-to-date tag(s)

  Yes

  No

  N/A

• All Equipment has an accessible Fire Extinguisher

  Yes

  No

  N/A

• 20lb Fire Extinguisher 25' to 75' from Fuel Containment

  Yes

  No

  N/A

• Combustibles properly stored

  Yes

  No

  N/A

• Fuel Containers labeled

  Yes

  No

  N/A

Electrical

• Power Tools in good working condition

  Yes

  No

  N/A

• Extension Cords free from defects

  Yes

  No

  N/A

• Overhead Power Lines (proper distance indicated and observed)

  Safe

  At Risk

  N/A

• Under Ground Utilities (properly identified and marked)

  Safe

  At Risk

  N/A

Company Vehicle

• Service Truck is reasonably clean

  Yes

  No

  N/A

• Image of Service Truck

  Media

• Truck toolbox is well organized

  Yes

  No

  N/A

• Back-Up Alarm Operational

  Yes

  No

  N/A

• Mirrors, Seat Belts & Windows in good condition

  Yes

  No

  N/A

• Mechanical deficiencies reported

  Yes

  No

  N/A

Knaack Box

• Clean and orderly?

  Yes

  No

  N/A

• Image of Knaack Box

  Media

• Copy of the OH&S Handi-Guide Available?

  Yes

  No

  N/A

• Copy of MSDS Available

  Yes

  No

  N/A

• Chop Saw in working order?

  Yes

  No

  N/A

• Vibrator in working order?<br>

  Yes

  No

  N/A

• Generator in working order?

  Yes

  No

  N/A

• Lens wipes and hearing protection available?

  Yes

  No

  N/A

• Electrical Cord in good repair (Free from cuts or exposed wires, ground plug still intact)

  Yes

  No

  N/A

• Gas can available for both mixed and regular?

  Yes

  No

  N/A

• Spill-kit available and properly stocked?

  Yes

  No

  N/A

Operation of Equipment

• Is the skid steer being run smoothly and effectively?

  Yes

  No

  N/A

• Is the park brake applied and the throttle turned down when the operator is approached for discussion?

  Yes

  No

  N/A

• Is the swing zone of the rig clear of workers and other hazards?

  Yes

  No

  N/A

• Does the swamper make eye contact before moving in to change a tool?

  Yes

  No

  N/A

• Is the work area cleared of personnel prior to lifting/ hoisting?

  Yes

  No

  N/A

• Are the tracks set up on stable, level soil?

  Yes

  No

  N/A

• Did the skidsteer operator test to ensure that the attachment was secured once it was changed over?

  Yes

  No

  N/A

• Are workers standing a safe distance away from the tool while it is being spun off?

  Yes

  No

  N/A

• Yes

  No

  N/A

Other

• Guards provided for rotating parts

  Yes

  No

  N/A

• Tag Lines in use when unloading or flying materials

  Yes

  No

  N/A

• Housekeeping (trash & debris) controlled

  Yes

  No

  N/A

• Other Essential Findings

  Yes

  No

  N/A

Signatures

• Driller

  Sign

• Inspector

  Sign

• Add drawing

  Drawing