Non-Asbestos Site Visit Report - AAC

• Job Number

• Work in progress

• Inspection Date

  Date

• Inspector Name

  Select Doug Stamp Michel Medina

  • Doug Stamp
  • Michel Medina
• Location
  Address

• PROJECT

• Project Superintendant

• Foreman

• Is AAC a Subcontractor?

  YES

  NO

• Name of Contractor

Asbestos Paperwork

• Is this an asbestos abatement job?

  YES

  NO

• Current Company License Posted

  Yes

  No

• Size of Project

  Minor

  Small

  Large

• Building Posted

  Yes

  No

• Background Air Samples Complete

  Yes

  No

  N/A

• Regulated area(s) established

  YES

  NO

• Proper signage posted

  Yes

  No

• Entry / Exit Log

  Yes

  No

• Worker Certs Posted

  Yes

  No

  N/A

• Log Book

  Yes

  No

• All Entries Up to Date (including Job Number)

  Yes

  No

• NYS notification posted, amended and not expired

  Yes

  No

  N/A

• EPA notification posted, amended and not expired

  Yes

  No

  N/A

• All Federal / State Notices Posted

  Yes

  No

  N/A

• Asbestos Survey

  Yes

  No

  N/A

• Site Specific Variance Posted

  Yes

  No

  N/A

• Variance Number

• Applicable Variances posted

  Yes

  No

  N/A

• AV Number

• Personal Air samples taken as needed

  Yes

  No

  N/A

• Results Posted

  Yes

  No

  N/A

• COC completed properly

  Yes

  No

  N/A

• Exposure Assessment

  Yes

  No

  N/A

• Negative

  YES

  NO

• Change PPE

  YES

  NO

• Waste Shipment Records

  Yes

  No

  N/A

• Proper Owner Identified

  Yes

  No

• Signed and Dated

  Yes

  No

• Type of Project

• Is Silica Exposure a concern?

  YES

  NO

• Is proper PPE being used?

  Yes

  No

  N/A

• What PPE is inappropriate or missing?

• Are proper work practices being used?

  Yes

  No

  N/A

• Which work practice(s) is incorrect or not being followed?

• Are all Federal Postings displayed?

  Yes

  No

  N/A

Training Required

• Supervisor referred for training?

  Yes

  No

General Site Safety

• JHA's

  Yes

  No

• Are JHA's applicable to the work being completed?

  Yes

  No

• Have all tasks been identified with a JHA?

  Yes

  No

• What tasks, or hazards, are not addressed?

• Site emergency action plan

  Yes

  No

  N/A

• Daily job safety meeting documented

  Yes

  No

• Hazcomm/SDS on site

  YES

  NO

• Can Supervisor access SDS online

  Yes

  No

  N/A

• Forms book on site

  Yes

  No

  N/A

• Is a "Hot Work" Permit Required?

  YES

  NO

• Type of hot work to be performed

• Fire watch assigned?

  Yes

  No

• Other Safety Documents issues

  Yes

  No

• Description:

Personal Protective Equipment

• Head Protection — Hard Hats were worn by all personnel.

  Yes

  No

  N/A

• Eye and Face Protection — ANSI Approved Safety Glasses were being worn at all times.

  Yes

  No

  N/A

• Full Face Shield — Worn as required.

  Yes

  No

  N/A

• Hand Protection — Cut, tear-resistant gloves were worn by all personnel if required

  Yes

  No

  N/A

• Forearm Protection - Cut resistant sleeves were worn by all personnel as required

  Yes

  No

  N/A

• Protective Clothing — Pants, Shirts with sleeves, Hi-vis vest/shirt

  Yes

  No

  N/A

• Respiratory Protection -- Appropriate for the hazard (Asbestos, Chemical, Silica, etc.)

  Select Half face Full Face PAPR SAR Dust / Medical Mask N/A

  • Half face
  • Full Face
  • PAPR
  • SAR
  • Dust / Medical Mask
  • N/A

• Hearing Protection — Needed for TWA of 85+ decibels

  Yes

  No

  N/A

• Available at site

  Yes

  No

  N/A

• Foot Protection — Substantial work boots or ANSI Safety Boots.

  Yes

  No

  N/A

• Other- Specialized PPE, or otherwise unique to the situation

Housekeeping and Hazard Control

• Work area (outside) cleaned of excess trash and waste materials disposed of daily.

  Yes

  No

  N/A

• Waste free of cut/puncture hazards

  Yes

  No

  N/A

• Walkways & Work Areas - clear of debris, tripping hazards & sharp objects. Clean up in progress during demolition.

  Yes

  No

  N/A

• Fire Control — No fire hazards were present on site. Fire extinguishers were available on all occupied floors.

  Yes

  No

  N/A

• First aid kit available and adequate.

  Yes

  No

  N/A

• Location?

• Construction Materials & Supplies — Properly staged or stored

  Yes

  No

  N/A

• Emergency Access Routes - Doorways, Aisles, Fire Exits. EVAC plan gone over with crew by Supervisor in tool box talk.

  Yes

  No

  N/A

• Tools and Equipment — Properly staged and stored

  Yes

  No

  N/A

• Holes covered and marked

  Yes

  No

  N/A

• Hot Objects marked and / or turned off

  Yes

  No

  N/A

• Live Pipes marked

  Yes

  No

  N/A

• Ladders are properly used, stored, inspected and maintained

  Yes

  No

  N/A

• Other housekeeping issues

  Yes

  No

Electrical Hazards

• Lockout/tagout being used properly, work area de-energized

  Yes

  No

  N/A

• Ground Fault Circuit Interrupters in use on all wiring and tools or lighting - inspected and tested daily

  Yes

  No

  N/A

• Live Electric Properly Marked

  Yes

  No

  N/A

• Cords/Lights/Equipment - No damage to insulation. No electrical tape repairs. Cords were protected from damage from other equipment, doors, window sills, heat, etc.

  Yes

  No

  N/A

• Generators Grounded — External grounding per manufacturers specifications.

  Yes

  No

  N/A

• All multiple Power Outlets and Extensions Cords - UL approval, construction load rated. No job or home built cords with multiple outlets.

  Yes

  No

  N/A

• Power tools properly grounded or double insulated

  Yes

  No

  N/A

• Lighting - meets UL and National Electric codes and is GFCI Protected.

  Yes

  No

  N/A

Comments

• Overall impression of Site

  Outstanding

  Above Average

  Average

  Below Average

• State reason(s) for the impression

• Is this site in AAC compliance?

  Yes

  No

  N/A

• State reason(s) Site is not in Compliance

Review and Signatures

• Report Written by (Name and Signature)

  Sign

• Reviewed by Supervisor / Foreman (Name and Signature)

  Sign