M+W Safe Behavior Observation

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Date / Time of Observation

  Date

• Contractor Observed

  Select NA AC Dellovade BBL Coghlin Collett DMC DSI FCS Gross ICON JAF JR KM Kelly Kleeberg-Tougher Kone Lotus M+W M&L Mid State Steel PCI P+H P&J RCC Stonhard TFS Whiting-Turner Other

  • NA
  • AC Dellovade
  • BBL
  • Coghlin
  • Collett
  • DMC
  • DSI
  • FCS
  • Gross
  • ICON
  • JAF JR
  • KM Kelly
  • Kleeberg-Tougher
  • Kone
  • Lotus
  • M+W
  • M&L
  • Mid State Steel
  • PCI
  • P+H
  • P&J
  • RCC
  • Stonhard
  • TFS
  • Whiting-Turner
  • Other

• Specific Location

  Select NFX Sub Fab NFX Fab NFX Interstitial NFX Fan Deck NFX Penthouse NFX RCTO NFX Roof NFX Exterior CUB L1 CUB L2 CUB Roof CUBX L1 CUBX L2 CUBX Roof NFN Roof NFC Roof CUB Exterior NFN Bump NFX Link Other Not Applicable

  • NFX Sub Fab
  • NFX Fab
  • NFX Interstitial
  • NFX Fan Deck
  • NFX Penthouse
  • NFX RCTO
  • NFX Roof
  • NFX Exterior
  • CUB L1
  • CUB L2
  • CUB Roof
  • CUBX L1
  • CUBX L2
  • CUBX Roof
  • NFN Roof
  • NFC Roof
  • CUB Exterior
  • NFN Bump
  • NFX Link
  • Other
  • Not Applicable

• Insert column Location, a Picture or Other Comments Here

  Yes

  No

  N/A

• Number of Employees Observed

• Observer

  Select Gary Allain Jerry Akins Ron Bell Lisa Burniche Michael Braden Mitch Brown John Bryant Russell Cameron Scott Cashin Wendy DeNew Matthew Gac Gogi Gwardschaladse Kieran Heneghan Art Hommel Dan Jeski Amelia Jezierski James Kehoe Donny Littlejohn Derek Maiellaro Nick Maryanopolis David McLaughlin Cody Messier Jarrod Mills Lee Ogle Robert Petri Dennis Robbins Terry Shupe Martin Tremblay Marc Turgeon Chuck Vickers Ryan Washburn Eric Williams Brian White Other (insert name in "other comments" section)

  • Gary Allain
  • Jerry Akins
  • Ron Bell
  • Lisa Burniche
  • Michael Braden
  • Mitch Brown
  • John Bryant
  • Russell Cameron
  • Scott Cashin
  • Wendy DeNew
  • Matthew Gac
  • Gogi Gwardschaladse
  • Kieran Heneghan
  • Art Hommel
  • Dan Jeski
  • Amelia Jezierski
  • James Kehoe
  • Donny Littlejohn
  • Derek Maiellaro
  • Nick Maryanopolis
  • David McLaughlin
  • Cody Messier
  • Jarrod Mills
  • Lee Ogle
  • Robert Petri
  • Dennis Robbins
  • Terry Shupe
  • Martin Tremblay
  • Marc Turgeon
  • Chuck Vickers
  • Ryan Washburn
  • Eric Williams
  • Brian White
  • Other (insert name in "other comments" section)

Any Marked "At Risk" Must Include Details and a photo.

• Face / Eye PPE

  Safe

  At Risk

  N/A

• Foot PPE

  Safe

  At Risk

  N/A

• Hand / Arm PPE

  Safe

  At Risk

  N/A

• Head PPE

  Safe

  At Risk

  N/A

• Hearing PPE

  Safe

  At Risk

  N/A

• Respiratory PPE

  Safe

  At Risk

  N/A

• Fall Protection

  Safe

  At Risk

  N/A

• Mobile Equipment

  Safe

  At Risk

  N/A

• Electrical / GFCI

  Safe

  At Risk

  N/A

• Lockout / Tagout

  Safe

  At Risk

  N/A

• Work Permits

  Safe

  At Risk

  N/A

• Excavations

  Safe

  At Risk

  N/A

• Hot Work

  Safe

  At Risk

  N/A

• Storage Area

  Safe

  At Risk

  N/A

• Manual Lifting

  Safe

  At Risk

  N/A

• Ladders

  Safe

  At Risk

  N/A

• Scaffolds

  Safe

  At Risk

  N/A

• Access

  Safe

  At Risk

  N/A

• Aerial Lifts

  Safe

  At Risk

  N/A

• Barricades / Signs

  Safe

  At Risk

  N/A

• Slips / Trips / Falls

  Safe

  At Risk

  N/A

• Lifting / Rigging

  Safe

  At Risk

  N/A

• Confined Space

  Safe

  At Risk

  N/A

• Equipment / Tools

  Safe

  At Risk

  N/A

• Housekeeping

  Safe

  At Risk

  N/A

• Lighting

  Safe

  At Risk

  N/A

• Chemical

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

• Audit Conducted by:

  Sign