Title Page
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Conducted on
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Prepared by
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Location
- Hazard Identified
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Document the findings with a photo:
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List Hazard:
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MMA's Recommendation:
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Ensure Written program is updated annually with goals and objectives.
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Ensure Guards are properly adjusted to 1/8" on tool rest & 1/4 inch on top guard. See photo for additional information:
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Ensure that all cranes and hoists are inspected regularly, and that the inspection is documented.
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Ensure that all excavations greater than 5 feet are protected with a protection system, trench box, sloping, shielding.
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Ladders should be used for depths greater than 4 feet and should be spaced 25 feet apart.
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Spoil Piles should be set back at least 2 feet from the edge of the excavation.
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No bare wires should be seen through the insulation of wires.
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Ensure all wiring components are guarded properly.
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Electrical components should be grounded or double insulated.
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Construction equipment should be used with a Ground Fault Circuit Interrupter (GFCI) at all times.
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Strain Relief should be intact.
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Ensure that all employees are Personal Fall Arrest System while in the work basket.
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Ensure all hazardous substance containers are labeled properly with a GHS complaint label.
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Ensure all employees are trained annually.
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Ensure that all Fall Protection is inspected daily.
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Guard all Open Side, Hole, Wall Opening
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Ensure that fall protection is used when within 15’ of fall hazard on flat roof
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Ensure that all fire extinguishers are not blocked at all times.
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Ensure that all fire extinguishers are inspected at least monthly (in-house) & Annual (third party).
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Ensure that all fire extinguishers gauges are in the green.
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Ensure that all ladders are stored properly to prevent falling.
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Ensure that all ladders are inspected before use, and any damaged ladders are removed from service or red-tagged.
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Ensure the proper type and use of ladders is being followed. Training of employees about proper ladder use.
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Ensure that LOTO Procedures are written for all dual energy machines.
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Ensure that LOTO training is conducted for both authorized and affected employees.
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Ensure that all LOTO Procedures are audited on an annual basis.
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Ensure that all Point of Operation is guarded to protect employees from coming in contact with the Point of Operation.
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Ensure that PPE is proper for the hazards trying to protect against.
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Ensure that PPE is in good working order.
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Ensure that PPE is ANSI or ASME rated.
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Ensure that Forklifts are inspected daily.
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Ensure that Forklift Damage is reported and repaired.
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Ensure that Forklifts are parked and turned off when operator is greater than 25 feet away or out of site of the forklift.
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Ensure that Carbon Monoxide testing is completed & documented quarterly for environmental exposure, not just tail pipe testing.
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Ensure that all Respirators are cleaned, stored, and used in appropriate manner.
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Ensure that all employees have signed Appendix D when using voluntarily.
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Ensure all required users are trained, medically evaluated, and fit tested annually as required by the Respiratory Protection Standard.
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Ensure that Scaffolds are Tied/Secured >4:1 Base height
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Ensure that guardrail system is not missing or incomplete.
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Ensure that all pins are in place.
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Ensure that proper Foundation/Base is being used.
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Enter Recommendation here:
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Enter Recommendation Here:
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Potential OSHA Penalties
Corrective Action:
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Corrective Action Taken:
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Corrective Action completed:
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Verification of corrective action: