Monthly Safety Evaluation

• THIS SITE HAS BEEN RATED:

  Select A B C D

  • A
  • B
  • C
  • D

• Document No.

• Job #

• Job Name

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Incident and Injury Free (IIF)

• Is the IIF board posted and updated?

  Yes

  No

  N/A

• Is supervision participating in stretch and flex?

  Yes

  No

  N/A

• Is supervision participating in the MTA's

  Yes

  No

  N/A

• Percentage of co-workers gone through IIF orientation

  5

  4

  3

  2

  1

• Have this project reported any incident this month?

  5

  4

  3

  2

  1

OSHA and B | DC, General Requirements and Posting

• Is a well stocked first aid cabinet on site and inspected weekly?

  5

  4

  3

  2

  1

• Is the first aid log posted on the cabinet?

  5

  4

  3

  2

  1

• Is incident reporting procedure posted?

  5

  4

  3

  2

  1

• Is the 5-in-1 poster & emergency action plan posted?

  5

  4

  3

  2

  1

• Are toolbox meetings being conducted and documented?

  5

  4

  3

  2

  1

• Are MTA's conducted and documented?

  5

  4

  3

  2

  1

• Are First Aid / CPR trained co-worker on site?

  5

  4

  3

  2

  1

Personal Protective Equipment (PPE)

• Are all coworkers wearing hardhats, and eye protection?

  5

  4

  3

  2

  1

• Are coworkers wearing ear plugs where they are required?

  5

  4

  3

  2

  1

• Are co-workers wearing face-shield when shipping, blowing the deck or cutting steel?

  5

  4

  3

  2

  1

• Are co-workers wearing traffic vest where they are requirred?

  5

  4

  3

  2

  1

• Are co-workers wearing appropriate gloves for the task?

  5

  4

  3

  2

  1

• Are co-workers wearing respirators when graining or working on a dusty environment?

  5

  4

  3

  2

  1

• Are coworkers wearing proper clothing and work boots?

  5

  4

  3

  2

  1

• Do coworkers have tarsal guards on during required tasks?

  5

  4

  3

  2

  1

• Did coworkers inspect PPE prior to the start of their shift?

  5

  4

  3

  2

  1

Personal Fall Arrest System

• Are coworkers using these system when required?

  5

  4

  3

  2

  1

• Have the coworkers been trained in the use of these system and using system correctly?

  5

  4

  3

  2

  1

• Is the equipment installed correctly and in good condition?

  5

  4

  3

  2

  1

• Are proper tie-off points used?

  5

  4

  3

  2

  1

Sanitation

• Are toilet facilities adequate and reasonably clean?

  5

  4

  3

  2

  1

• Are drinking cups placed into the trash containers and the trash containers located next to all water cans?

  5

  4

  3

  2

  1

• Are water containers cleaned and clearly marked of the contents and dated?

  5

  4

  3

  2

  1

Fire Protection

• Have coworkers been trained in the use of fire extinguishers?

  5

  4

  3

  2

  1

• Are extinguishers inspections current and extinguishers are in good working order?

  5

  4

  3

  2

  1

• Is there a fire extinguisher within100 feet of all work areas?

  5

  4

  3

  2

  1

• Do fuel cans have flame-arrester screen and self closing lid?

  5

  4

  3

  2

  1

• Is a fire extinguisher located 25 to 75 feet from outside storage tanks and the storage tank(s) grounded?

  5

  4

  3

  2

  1

• Are adequate "NO SMOKING" signs provided in fuel storage areas?

  5

  4

  3

  2

  1

• Are portable storage containers properly marked?

  5

  4

  3

  2

  1

Signs and Barricades

• Are signs and barricades used to protect the public from job hazards?

  5

  4

  3

  2

  1

• Are stripping signage and barricades adequate?

  5

  4

  3

  2

  1

• Are leading edge signage in use when needed?

  5

  4

  3

  2

  1

• Are coworkers trained in the difference between caution and danger tape?

  5

  4

  3

  2

  1

• Is caution and danger tape being used properly and removed when not needed?

  5

  4

  3

  2

  1

House Keeping, Material Handling, and Rigging

• Are all aisle-ways and emergency routes clear of materials and debris?

  5

  4

  3

  2

  1

• Are storage material near guardrails or leading edge?

  5

  4

  3

  2

  1

• Are nails removed from scrap lumber?

  5

  4

  3

  2

  1

• Are materials on upper floors secured to prevent displacement?

  5

  4

  3

  2

  1

• Are non-compatible materials separated?

  5

  4

  3

  2

  1

• Is picking eye available and used on forklift?

  5

  4

  3

  2

  1

• Is rigging inspected daily and in good condition when in use?

  5

  4

  3

  2

  1

• Are nylon straps free from cuts, frayes, or damage?

  5

  4

  3

  2

  1

• Do wire ropes have legible tags and free from damage? (Not kinked, crushed or bird caged) ?

  5

  4

  3

  2

  1

• Are whistles being used when flying material overhead?

  5

  4

  3

  2

  1

Tools

• Are tools requiring guards equipped and in good working order?

  5

  4

  3

  2

  1

• Are accessory handles present on drills, grinders?

  5

  4

  3

  2

  1

• Are carpenters using two hands on saw?

  5

  4

  3

  2

  1

• Are electrical cords in good condition?

  5

  4

  3

  2

  1

• Are the data plate on tools legible?

  5

  4

  3

  2

  1

• Are tools being inspected and used properly for the task?

  5

  4

  3

  2

  1

• Are hoses on the air compressor secured?

  5

  4

  3

  2

  1

• Has the saw depth been checked prior to cutting?

  5

  4

  3

  2

  1

• Are coworkers trained to operate powder actuated tools?

  5

  4

  3

  2

  1

Electrical

• Are GFCIs being inspected on a weekly basis and in good working order?

  5

  4

  3

  2

  1

• Are temporary lights properly suspended?

  5

  4

  3

  2

  1

• Are all electrical boxes, cords, receptacles, breakers, etc. being used for their intended use per NFPA, NEC, OSHA and their UL rating?

  5

  4

  3

  2

  1

• Are cords running from boxes protected from cutting or pulling from box?

  5

  4

  3

  2

  1

• Are extension cords being inspected daily?

  5

  4

  3

  2

  1

• Are ground pin present on tools?

  5

  4

  3

  2

  1

Ladders

• Are the spreaders on the step ladders locked?

  5

  4

  3

  2

  1

• Are ladders inspected and in good condition with all required labels?

  5

  4

  3

  2

  1

• Do side rails extend 36 inches above landings or ladder extensions installed?

  5

  4

  3

  2

  1

• Are extension or job made ladders tied off or is an coworker holding the ladder?

  5

  4

  3

  2

  1

• Are doorways barricades when ladders are set in from of them and a clear access/egress to the ladder?

  5

  4

  3

  2

  1

• Are coworkers using ladders properly?

  5

  4

  3

  2

  1

• Are job made ladder built properly (no double-headed nails)?

  5

  4

  3

  2

  1

• Is the ladder placed at the proper angle (1-4)?

  5

  4

  3

  2

  1

• Are double ladder or 2nd ladder when 25 + co-workers on deck?

  5

  4

  3

  2

  1

• Are the manufacturer's labels affixed and legible?

  5

  4

  3

  2

  1

Excavations

• Are coworkers protected from falling into pier or similar holes?

  5

  4

  3

  2

  1

• Is the competent person present?

  5

  4

  3

  2

  1

• Are excavations that are 5 feet or deeper in depth properly sloped, benched or shored?

  5

  4

  3

  2

  1

• Have provisions been made to control water accumulation?

  5

  4

  3

  2

  1

• Have excavations of 20 feet or more in depth been designed by a PE?

  5

  4

  3

  2

  1

• Is heavy equipment kept a safe distance from the edge and the spoil pile a minimum of 2' from the excavation?

  5

  4

  3

  2

  1

• Has proper access and egress been provided? (1 ladder every 25 coworker or every 25')

  5

  4

  3

  2

  1

• Are the utility locates less then 10 days old and clearly marked?

  5

  4

  3

  2

  1

• Is excavation properly barricaded and signs posted?

  5

  4

  3

  2

  1

• Are utility locates clearly communicated with backhoe operator or were they pot-holed to the depth?

  5

  4

  3

  2

  1

• Are under ground utilities protected while excavation is open?

  5

  4

  3

  2

  1

Floor and Wall Openings, Stairways and Roofs

• Do all holes (2" or more) or perimeters that are 6 feet or more above a lower level have guardrails or hole covers?

  5

  4

  3

  2

  1

• Are hole covers secured, marked "hole" or "cover" and capable of supporting intended loads?

  5

  4

  3

  2

  1

• Are coworkers protected from falling objects?

  5

  4

  3

  2

  1

• Are stacked materials kept at a safe distance from the toe boards?

  5

  4

  3

  2

  1

• Do guardrails and stair nails meet OSHA requirements?

  5

  4

  3

  2

  1

• Are steel stair pan treads filled?

  5

  4

  3

  2

  1

• Is proper fall protection provided when needed?

  5

  4

  3

  2

  1

• Are stairs and ladders properly constructed (no double-headed nails)?

  5

  4

  3

  2

  1

• Are guardrail cables flagged every 6' with high visibility material?

  5

  4

  3

  2

  1

• Is there access/egress for changes in elevation greater than 19" for walking working surfaces?

  5

  4

  3

  2

  1

Structural

• Is there proper access/egress on elevated decks?

  5

  4

  3

  2

  1

• Is there proper fire extinguishing equipment available?

  5

  4

  3

  2

  1

• Are all protruding vertical and horizontal rebar capped?

  5

  4

  3

  2

  1

• Is shoring and scaffolding installed properly and inspected before pour?

  5

  4

  3

  2

  1

• Is housekeeping on elevated deck in order?

  5

  4

  3

  2

  1

Heavy Equipment

• Are seat belts being used by operators?

  5

  4

  3

  2

  1

• Are riders not allowed on the equipment?

  5

  4

  3

  2

  1

• Does equipment have a functional back-up alarm?

  5

  4

  3

  2

  1

• Are the operators driving equipment at safe speeds?

  5

  4

  3

  2

  1

• Is the operator trained?

  5

  4

  3

  2

  1

• Has the equipment been inspected and in good working order?

  5

  4

  3

  2

  1

• Are picking eyes readily available for lifts?

  5

  4

  3

  2

  1

• Is equipment attended to while running?

  5

  4

  3

  2

  1

• Is parking brake set and all forks and buckets lowered to ground when equipment is not in use?

  5

  4

  3

  2

  1

• Does equipment have fire extinguishers and required manufacturer labels?

  5

  4

  3

  2

  1

Welding and Cutting - Supplement A

• Are all cylinders secured in an upright position?

  5

  4

  3

  2

  1

• Is proper eye protection being used?

  5

  4

  3

  2

  1

• Is there at least one 10 lb. extinguisher within 50 feet of oxygen and acetylene storage areas?

  5

  4

  3

  2

  1

• Are oxygen and acetylene bottles stored 20 feet apart?

  5

  4

  3

  2

  1

• Is there a fire watch for welding or cutting above combustible materials

  5

  4

  3

  2

  1

• Is cutting torch in good working order?

  5

  4

  3

  2

  1

Scaffolds - Supplement B

• Is fall protection provided for coworkers erecting or dismantling scaffold?

  5

  4

  3

  2

  1

• Are scaffold set on firm, secure footings with base plates and mud sills?

  5

  4

  3

  2

  1

• Are scaffolding components inspected and in good condition?

  5

  4

  3

  2

  1

• Has the scaffold been tied off every 25 feet in height (ties must be installed when the height of the scaffold is more than 4 times than the minimum base width)

  5

  4

  3

  2

  1

• Are scaffold boards properly overlapped and secured? (12")

  5

  4

  3

  2

  1

• Are rolling scaffolds moved correctly? (Not being surfed from platform)

  5

  4

  3

  2

  1

• Is fall protection and falling object protection provided?

  5

  4

  3

  2

  1

• Have coworkers been trained in the hazards associated with scaffolds and scaffold work?

  5

  4

  3

  2

  1

• Is the area below the scaffolding barricaded or toe-boards erected?

  5

  4

  3

  2

  1

• Have the scaffolding been inspected and tagged?

  5

  4

  3

  2

  1

Cranes - Supplement C

• Is the annual inspection current?

  5

  4

  3

  2

  1

• Are the daily inspections being conducted?

  5

  4

  3

  2

  1

• Is the operator's manual and load chart in the crane?

  5

  4

  3

  2

  1

• Has the crane received the proper routine maintenance?

  5

  4

  3

  2

  1

• Are operator's record of maintenance & crane company work-orders kept?

  5

  4

  3

  2

  1

• Does the LMI and Anti-Two block work?

  5

  4

  3

  2

  1

• Is there a fire extinguisher on the crane?

  5

  4

  3

  2

  1

• Is the crane cab free from window crack?

  5

  4

  3

  2

  1

• Is all rigging in good condition and inspected before each use?

  5

  4

  3

  2

  1

• If outriggers are used, are they on a level surface?

  5

  4

  3

  2

  1

• Is proper cribbing or matting used?

  5

  4

  3

  2

  1

• Is the entire swing radius barricaded?

  5

  4

  3

  2

  1

• Can the crane operator see the signal-person?

  5

  4

  3

  2

  1

• Are the ANSI approved hand signals being used?

  5

  4

  3

  2

  1

• Are two way radios being used to communicate with the opperator?

  5

  4

  3

  2

  1

• Are cranes located a safe distance from power lines?

  5

  4

  3

  2

  1

• Are chain sling inspected and documented (Monthly)?

  5

  4

  3

  2

  1

• Is the rigging appropriate for the lift?

  5

  4

  3

  2

  1

• Are tag-lines being used to control the load?

  5

  4

  3

  2

  1

• Is weather conditions adequate for lifts?

  5

  4

  3

  2

  1

• Is the crane appropriately sized?

  5

  4

  3

  2

  1

• Is there a copy of the crane operator's qualification on file?

  5

  4

  3

  2

  1

Aerial Lifts - Supplement D

• Are coworkers using proper fall protection?

  5

  4

  3

  2

  1

• Are coworkers remaining on the platform at all times?

  5

  4

  3

  2

  1

• Is the gate or chain closed when occupied?

  5

  4

  3

  2

  1

• Are lifts set on level ground, per manufacturer's recommendations?

  5

  4

  3

  2

  1

• Is operator trained?

  5

  4

  3

  2

  1

• Are tools and materials secured from displacement?

  5

  4

  3

  2

  1

• Has the equipment been inspected prior to use?

  5

  4

  3

  2

  1

• Is the lifting capacity visible and appropriate for the task?

  5

  4

  3

  2

  1

• Are office trailer clean and organized?

  5

  4

  3

  2

  1

• Are electrical panels secured and safe?

  5

  4

  3

  2

  1

• Are lanyards / retractable attached to proper anchorage points?

  5

  4

  3

  2

  1

Hazard Communication

• Do the co-workers know the location of the master MSDS book?

  5

  4

  3

  2

  1

• Are MSDS sheets maintained on each product in use?

  5

  4

  3

  2

  1

• Are MSDS labels on each chemical container that is unmarked?

  5

  4

  3

  2

  1

• Are co-workers properly trained on hazardous chemical present?

  5

  4

  3

  2

  1

Office Trailer

• Are office trailer clean and organized?

  5

  4

  3

  2

  1

• Have all waste bins emptied?

  5

  4

  3

  2

  1

• Are electrical panels secured and safe?

  5

  4

  3

  2

  1

• Are electrical panels secured and safe?

  5

  4

  3

  2

  1

• If generator is used it is at a safe distance and have fire extinguisher within 25'?

  5

  4

  3

  2

  1

• Scoring:
  5 = Compliant or 95 - 100%, 4 = Positive Effort or 75 - 94%, 3 = Other or 50 - 74%, 2 = Serious or 25 - 49%,
  1 = Repeat Serious or 0 - 24%

• This inspection reflects the condition of the job-site at the time of inspection and is limited by the portion of the site that was inspected

• This audit should be done on a monthly basis by the Superintended, designated B | DC coworker and turned in to the Safety Department, Project Manager and a copy of the audit should be filed in the job office.

• Superintendent's Name

  Sign

• Select date

  Date

• Personnel Present

  Sign

• "COMMITTED TO CREATING A HEALTHY LIFE, FREE OF INJURY, FOR ALL CO-WORKERS"