MIOSHA job Hazard Analysis And Inspection Checklist

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Job Information

• Written Accident Prevention Program on site and available to all employees?

  Yes

  No

  N/A

• Haz Com with SDS?

  Yes

  No

  N/A

• Is each employee trained in hazard recognition and avoidance of unsafe conditions?

  Yes

  No

  N/A

• MIOSHA Poster posted?

  Yes

  No

  N/A

• First Aid Supplies readily accessible?

  Yes

  No

  N/A

• Is there protection for blood borne pathogens?

  Yes

  No

  N/A

• First aid trained employees on site?

  Yes

  No

  N/A

• Drinking water, toilets, and hand washing facilities?

  Yes

  No

  N/A

Housekeeping

• General neatness of job site.

  Safe

  At Risk

  N/A

• Projecting nails removed or bent over?

  Yes

  No

  N/A

• Waste containers provided and used?

  Yes

  No

  N/A

• Passageways clear of obstructions?

  Yes

  No

  N/A

• Other housekeeping notes:

  Safe

  At Risk

  N/A

Fire Protection

• Adequate fire extinguishers, inspected, and accessible?

  Yes

  No

  N/A

• "No smoking" posted and enforced near flammables?

  Yes

  No

  N/A

• Other fire protection notes:

  Safe

  At Risk

  N/A

Electrical

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

  Yes

  No

  N/A

• GFCI being used?

  Yes

  No

  N/A

• Terminal boxes equipped with required covers?

  Yes

  No

  N/A

• Are cords protected from being damaged?

  Yes

  No

  N/A

• Are unused openings in cabinet boxes covered?

  Yes

  No

  N/A

• Are all circuit panels covered with minimum deadman cover, no live exposures, and sign "danger, live electrical circuit" posted?

  Yes

  No

  N/A

• Other Electrical hazard notes:

  Safe

  At Risk

  N/A

Tools

• Hand tools inspected regularly?

  Yes

  No

  N/A

• Broken tools, guards, mushroom heads chisels?

  Yes

  No

  N/A

• Guards in place?

  Yes

  No

  N/A

• Correct tools being used for tasks?

  Safe

  At Risk

  N/A

• Operators of power actuated tools are licensed?

  Yes

  No

  N/A

Fall Protection

• Have all employees been trained on fall hazards and protection methods used by company?

  Yes

  No

  N/A

• Employees working at 6 ft or greater protected by guard rails, PFAS, or nets?

  Safe

  At Risk

  N/A

• Guard rails 39-45" and secured?

  Yes

  No

  N/A

• Are employees using PFAS?

  Yes

  No

  N/A

• Have total fall distances been calculated?

  Yes

  No

  N/A

• Name of competent person. Are they on site?

  Yes

  No

  N/A

• Employees below protected from falling objects?

  Yes

  No

  N/A

• Is there a location and or task that is I feasible or a greater hazard to accomplish with conventional fall protection? If yes, comment on research and thought process used to come to this conclusion.

  Yes

  No

  N/A

• Can the above task be accomplished using ladders, scaffolding, aerial lifts, or other means of safe access?

  Yes

  No

  N/A

• Other fall protection hazard notes:

  Safe

  At Risk

  N/A

Ladders

• Ladders extent 3' above landings?

  Yes

  No

  N/A

• Ladders are secured to prevent slipping, tipping, and falling?

  Yes

  No

  N/A

• Step ladders used in fully open position?

  Yes

  No

  N/A

• Ladders with damage removed from service?

  Yes

  No

  N/A

Scaffolding

• All scaffolding inspected daily? Name competent person.

  Yes

  No

  N/A

• Base plates and mud sills?

  Yes

  No

  N/A

• Tied and braced to structure?

  Yes

  No

  N/A

• Guard rails in place?

  Yes

  No

  N/A

• Fully planked at work area?

  Yes

  No

  N/A

• Proper access?

  Yes

  No

  N/A

• Employees below protected from falling objects?

  Yes

  No

  N/A

• Other scaffolding hazard notes:

  Safe

  At Risk

  N/A

Floor and Wall Openings

• All floor openings are covered or barricaded?

  Yes

  No

  N/A

• Materials stored away from edges?

  Yes

  No

  N/A

Excavations

• Qualified person on site inspecting frequently? Name.

  Yes

  No

  N/A

• Excavations over 5' protected per part 9?

  Yes

  No

  N/A

• Materials stored more than 2' from edge?

  Yes

  No

  N/A

• Access and egress for workers per part 9?

  Yes

  No

  N/A

• Utilities identified, MISS DIG?

  Yes

  No

  N/A

• Employees exposed to vehicles wearing high visibility vests?

  Yes

  No

  N/A

• Other excavation hazard notes:

  Safe

  At Risk

  N/A

Material handling

• Materials properly stored and stacked?

  Yes

  No

  N/A

• Employees using proper lifting methods?

  Yes

  No

  N/A

• Tag lines used to guide loads?

  Yes

  No

  N/A

• Other material handling notes:

  Safe

  At Risk

  N/A

Concrete and Masonry Walls

• Employees are protected from silica?

  Yes

  No

  N/A

• Has air monitoring been done? Results?

  Yes

  No

  N/A

• Are all protruding reinforcement rods covered?

  Yes

  No

  N/A

• Walls over 8 feet supported?

  Yes

  No

  N/A

• Yes

  No

  N/A

• Plan on site?

  Yes

  No

  N/A

• Everyone trained per Part 2?

  Yes

  No

  N/A

• Yes

  No

  N/A

• Restricted zone in place?

  Yes

  No

  N/A

• Other concrete and masonry wall notes:

  Safe

  At Risk

  N/A

• Yes

  No

  N/A

Personal Protective Equipment

• Hart hats?

  Yes

  No

  N/A

• Eye and face protection?

  Yes

  No

  N/A

• Respirators

  Yes

  No

  N/A

• Hearing protection?

  Yes

  No

  N/A

• Foot and toe protection?

  Yes

  No

  N/A

• Other PPE notes:

  Safe

  At Risk

  N/A

Vehicles

• Do vehicles and mobile equipment have back up alarms; if not are they being used with signal person?

  Yes

  No

  N/A

• Seat belts? Being used?

  Yes

  No

  N/A

• Reflective high visibility vests?

  Yes

  No

  N/A

• If working within right a way, Part 22/ MMUTCD PART 6. Being followed?

  Yes

  No

  N/A

• Other Vehicle hazard notes:

  Safe

  At Risk

  N/A

Miscellaneous

• Lead, asbestos exposure?

  Safe

  At Risk

  N/A

• Notes

  Safe

  At Risk

  N/A