Information
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Project/Job #
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Project/Job
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Conducted on
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Prepared by
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Location
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Personnel
BEHAVIOR
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A. Are JSA (Job Safety Analysis) reviewed and signed?
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B. Are WTSR (Work Task Safety Requirements) for each job?
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C. Is the Water Blast Checklist being completed and followed?
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D. Is the Wet/Dry Vacuuming Checklist being completed and followed?
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E. Is the EH&S checklist being completed and followed?
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F. Are crew leaders / supervisors identified with White Hard Hats?
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G. Are any incidents being discussed?
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H. Are meaningful observations being completed?
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I. Other
WORK AREAS
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A. General Housekeeping
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B. Walking - Working Surfaces
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C. Unprotected Sides or Holes
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D. Restrooms identified and available? Trash cans present?
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E. Material Storage/Lay Down
JOB SITE POSTERS
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A. OSHA Posters<br> 300A during Feb 1st thru April 30th
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B. Emergency Evacuations Plans / Maps / Muster points posted
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C. Emergency Contacts List
PERSONAL PROTECTIVE EQUIPMENT
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A. Hard Hats
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B. Safety Glasses with Side Shields
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C. Face Shield / Goggles (If Required)
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D. Respiratory Protection (If Required)
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E. Hearing Protection (If required)
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F. Clothing (FRC etc. if required)
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G. Gloves
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H. Foot Protection
FALL PROTECTION
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A. Trained Personnel (Competent Person)
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B. Worn Properly
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C. Suitable Anchorage Points
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D. Inspected/Color Coded
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E. Stored Properly
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F. Emergency High Angle Rescue Plan
LADDERS
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A. Base/Footing/Set Up
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B. Inspections/Color Coded
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C. Proper Type for Task
TOOLS AND EQUIPMENT
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A. In Good Condition
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B. Inspected/Color Coded
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C. Whip-Checks
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D. Water Blast Guns with shrouds?
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E. Are Foot Pedals with Carbon Steel fittings?
CONFINED SPACE
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A. Trained Personnel (Competent Person)
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B. Attendant Trained
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C. Entrants Trained
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D. Attendant has means to summon rescue
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E. Attendant completing the Sign In/Out Sheet
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F. Permit Required
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G. Permit Followed
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H. Air Monitoring
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I. Emergency Rescue Plan
ELECTRICAL
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A. G.F.C.I.'s
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B. Extension Cords
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C. Power Tools
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D. Lock Out/Tag Out
RIGGING AND HOISTING
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A. Capacity Tags
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B. Hooks and Latches
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C. Chain falls/Come-a-longs
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D. Tag Lines
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E. Inspected/Color Coded
SCAFFOLD
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A. Trained Personnel (Competent Person)
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B. Hand and Mid-rails, Toeboards
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C. Platform Decked/Secured
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D. Level Footing/Set up
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E. Access/Egress
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F. Away from Powerlines
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G. Barricades
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H. Inspection/Tagged Correctly
EQUIPMENT
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A. Equipment Inspections
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B. Operator Qualified and Certified
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C. Operator Manual
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D. Flagman with Vest
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E. Proper setup and use
HAZCOM
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A. MSDS on Site
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B. MSDS for all Chemicals on Site
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C. Proper Storage of Chemicals
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D. Proper PPE for Handling Chemicals
OTHER
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A.
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B.
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C.
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D.
Comments/Recommendations
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Suggested corrective actions
Sign Off
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Health and Safety Representative
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Account Manager
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Field Supervision / Supervisor
