Information

  • Site conducted

  • Document No.

  • Conducted on

  • Client / Site

  • Project Name

  • Responsible Party

  • Location

  • If "other" was selected provide location

  • General Contractor (If applicable)

  • Safety Evaluator

SITE EVALUATION

AERIAL and SCISSOR LIFTS

  • Does the crew maintain a JSA, properly filled out and within 15 feet (4.5 meters) of work being performed?

  • Workers have been trained in the use of equipment?

  • Lift occupants wearing harness correctly? Employees been trained in fall protection?

  • Workers tied off to boom or basket using the manufacturers anchor points?

  • Lift controls clearly marked and readable?

  • Both feet remain on the floor of the basket?

  • Operators are staying within the load limits of the basket / lift?

  • Lift is stationary when boom is elevated?

  • Operators / employees are refraining from transferring at height while in a scissor lift?

  • Mid-rail chain / gate used when in operation?

  • Operators maintaining safety compliance while operating lift?

  • Notes:

CONCRETE / MASONRY

  • Does the crew maintain a JSA, properly filled out and within 15 feet (4.5 meters) of work being performed?

  • Rebar / flat stakes guarded (covered) to eliminate impalement hazard?

  • Employees working in concrete wearing proper hand and foot protection?

  • Connectors, ties or whips used to secure pressurized air hoses?

  • Guard down on pump (pump truck)?

  • Masonry saw blades guarded?

  • Fugitive dust controlled while cutting block or conducting finish work?

  • Masons wearing face shields AND safety glasses while cutting block?

  • Formwork capable of supporting vertical / lateral loads?

  • Shoring equipment inspected?

  • Base plates secured to foundation / mud sill / formwork?

  • Jacks / supports do not exceed the rated capacity?

  • Limited access zone equal to the wall height plus 4 feet (1.2 meters)?

  • Limited access zone strictly enforced?

  • Walls over 8 feet (2.5 meters) braced to prevent collapse?

  • Masons maintaining safety compliance?

  • Notes:

CONFINED SPACE

  • Does the crew maintain a JSA, properly filled out and within 15 feet (4.5 meters) of work being performed?

  • JSA and rescue plan on-site and available? Employees been trained on the plan?

  • Entry permit completed and signed?

  • Air sampling completed and documented prior to entry?

  • Proper warning signage posted at entry to the permit space?

  • Forced air ventilation used for the duration of entry?

  • Proper lighting provided?

  • Rescue team trained and readily available?

  • Retrieval system (Tripod) available and utilized?

  • Entrants attached to the retrieval line?

  • Attendant on duty outside the permit space?

  • Attendant only performs monitoring duties?

  • Confined space team is maintaining safety compliance?

  • Notes:

CRANES / RIGGING

  • Does the crew maintain a JSA, properly filled out and within 15 feet (4.5 meters) of work being performed?

  • Crane(s) inspected and properly maintained?

  • Crane operator, rigger and signal person certified?

  • Crane load charts visible to the operator?

  • Hand signal charts posted or available?

  • Fire extinguisher located within the cab?

  • Pick (Lift) plan on-site, reviewed and the load is within load capacity?

  • Crane outriggers fully extended and on cribbing properly?

  • Crane swing radius identified and barricaded?

  • Workers remained clear of the in the swing radius and under suspended loads?

  • All power lines are a minimum 15 feet (4.5 meters) away from all lifting and boom swing radius?

  • Rigging equipment inspected and in good condition?

  • Rigging equipment maintain lift capacity markings?

  • Crane operations maintaining safety compliance?

  • Notes:

ELECTRICAL

  • Does the crew maintain a JSA, properly filled out and within 15 feet (4.5 meters) of work being performed?

  • Electrical cords maintain ground posts?

  • Electrical cords are free from damage / repair / alterations?

  • Electrical cords protected from damage (roll over)?

  • Doorways and windows are free from electrical cords?

  • Electrical cords kept clear of work areas and walk ways?

  • Electrical cords are rated for construction? Flat cords removed from site?

  • Spider box being inspected quarterly? (Assured Grounding Program)

  • Power strips and 3 way splitters construction rated?

  • Electrical equipment being used per the manufacturers specifications?

  • Are GFCI's (ELCB) being used, if not on an AGP? Is the GFCI being used closest to the operator?

  • All outlets have cover plates when outlets are energized?

  • Temp light cords are hung with non-metallic fastener, off the ground and does not cause a hazard?

  • Temp light bulbs maintain cages and all bulbs?

  • Electrical rooms maintain proper warnings and labels per NFPA 70e or equivalent?

  • Access to electrical room(s) restricted per NFPA 70e or equivalent?<br>

  • Electrical panels are covered, labeled and all breaker slots are covered?

  • 3 foot clearance around all electrical panels being maintained?

  • Employees are clear of all unprotected circuits / panels?

  • Employees are locking and tagging out equipment and panels? (NOT working on hot equipment)

  • Employees working with energy maintaining safety compliance?

  • Notes:

FALL PROTECTION

  • Does the crew maintain a JSA, properly filled out and within 15 feet (4.5 meters) of work being performed?

  • JSA and fall protection rescue plan has been established and all effected employees have been trained?

  • All employees have been trained in fall protection?

  • A fall protection system is provided for all employees working above 6 feet (1.8 meters)

  • PFA rigged to prevent contact with any surface? (Max fall distance allowed is 6 feet (1.8 meters))

  • Harnesses have been inspected prior to use?

  • Employee wearing harness correctly, wearing the appropriate lifeline (lanyard) and attached to an anchor?

  • Fall protection anchors are set up per specifications and all elements are rated to 5000 lbs (2268 kg)?

  • Guardrails are able to with stand 200 lbs (91 kg) outward and down force?

  • Guardrails (cable rails) do not exceed 2 inch (50 mm) deflection in any direction?

  • Guardrails and mid-rails are at the proper height?

  • Guardrail posts are not more than 8 foot (2.4 meters) On center?

  • Guardrails / mid-rails are constructed to be on the inside on the guardrail posts?

  • Guardrails and mid-rails have been placed around floor / roof openings?

  • Floor holes greater than 2 inches (50 mm) have been covered, properly labeled and secured from movement?

  • The fall protection selected is appropriate for the fall exposure?

  • Floor hole covers are capable of handling 2 times the intended load?

  • Warning line 6 feet (1.8 meters) back for roofing activities?

  • Warning line 15 feet (4.5 meters) for non-roofing activities?

  • Safety monitor performs only monitoring duties?

  • Safety monitor is at the same surface as the work with visual and verbal contact?

  • Warning line erected on all open sides?

  • Warning line flagged and suspended at proper height?

  • Access and hoisting areas guarded?

  • All materials stored more than 6 feet back from roof or deck edge?

  • Safety compliance being maintained?

  • Notes:

FIRE SAFETY

  • Does the crew maintain a JSA, properly filled out and within 15 feet of work being performed?

  • Employees trained in the use of fire extinguishers?

  • Fire extinguishers in good condition, fully charged and recently inspected?

  • Fire extinguishers replaced annually?

  • Fire extinguishers are within 75 feet (22 meters) of workers?

  • Fire extinguishers within 15 feet (4.5 meters) of hot work?

  • Minimum of 1 fire extinguisher per floor / level?

  • Fire extinguishers within 50 feet (15 meters) of flammable materials?

  • Flammables stored in an approved and closed containers?

  • No smoking signs posted near flammables?

  • Flammable liquids protected from ignition sources?

  • Flammables are clear from access and egress locations?

  • Scrap piles, debris and trash stored more than 10 feet (3 meters) from building or structure?

  • Maintaining fire safety compliance?

  • Notes:

FORKLIFTS

  • Does the crew maintain a JSA, properly filled out and within 15 feet (4.5 meters) of work being performed?

  • Forklift operators been trained for the specific forklift they are operating?

  • Forklift inspected prior to use?

  • Forklifts are free from modifications or alterations?

  • Outriggers being used on extended reach fork lift?

  • Forklift is operating within lift capacities?

  • Forklift slings have been inspected and maintain lift capacity tags?

  • Forklifts have lift, load and angle charts?

  • Forklift has fire extinguisher in the cab?

  • Forklift forks are down when not in operation?

  • Forklift operator wearing seat belt when in operation?

  • Forklift has an audible back up alarm that can be heard up to 200 feet (60 meters) away?

  • Spotters are used when forklift has to travel through barrier curtains or blind accesses?

  • Operator is traveling less than 15 MPH (24 kilometers) stopping at all intersections and stop signs?

  • Workers are clear of all lifted / suspended loads?

  • Lift basket secured to forklift?

  • Forklift maintains an operator when the lift basket has employees in it?

  • Forklift operators maintaining safety compliance?

  • Notes:

HOUSEKEEPING

  • Does the crew maintain a JSA, properly filled out and within 15 feet (4.5 meters) of work being performed?

  • Impalement hazards (flat stakes, rebar or other like material) maintain impalement protection?

  • Work site / location reasonably organized - Good housekeeping?

  • Lunch trash picked up and removed from site?

  • Trash removed at regular intervals?

  • Scrap, pipe cut offs, pipe and other slip / trip hazards removed?

  • Staging / lay down area in good condition / good housekeeping?

  • Gang boxes free from combustible / flammable materials?

  • All scrap lumbar / planks has nails removed or bent over?

  • Housekeeping is being maintained?

  • Notes:

LADDERS and STAIRS

  • Does the crew maintain a JSA, properly filled out and within 15 feet (4.5 meters) of work being performed?

  • Ladders inspected / no visible defects?

  • Ladders rated for construction (1 AA ladder) ?

  • Spreaders fully extended and locked into position on A frame ladders?

  • Top two steps of a step ladder not being used?

  • Ladders set up on firm stable base?

  • Ladders being used for the intended purpose?

  • Proper ladder selected for task?

  • Extension ladder extends 3 feet (.91 meters) above landing surface?

  • Extension ladder set up at 4:1 angle?

  • Extension ladders tied off at the top and secured at the bottom to prevent slip?

  • Stair/ladder/ramp used at elevation break of 18 inches (457 millimeters) or more?

  • Handrails on stairs with 4 or more risers?

  • 3 feet around the ladder at the top and bottom remain clear of all materials and debris?

  • Employee is maintaining 3 points of contact while climbing ladders?<br><br>

  • Treads / landings on pan stairways filled?

  • Ladder / steps used when access a flat bed trailer?

  • Ladder users maintaining safety compliance?

  • Notes:

MEDICAL / FIRST AID

  • Emergency numbers posted on site, visible to all employees?

  • Location of nearest medical facilities posted, visible to all employees?

  • Eye wash / body wash stations set up when required?

  • Every trade maintains their own first aid kit / supplies? First aid kit fully stocked?

  • A minimum of 1 CPR / FA / AED certified employee per crew?

  • Maintaining safety compliance with medical / first aid?

  • Notes:

PERSONAL PROTECTIVE EQUIPMENT

  • PPE provided to the employee / available as required?

  • PPE being maintained in good condition?

  • Replacement PPE readily available?

  • Hard hats being worn, properly and without alterations?

  • Eye protection used as required? Glasses rated as eye protection?

  • Hand protection used when required? (Digging, handling tag lines etc)

  • Safety boots (Steal toe) footwear worn when required (Compacting soil, jack hammering etc)?

  • Respirators provided / used as required?

  • Has the employee been trained in respiratory protection?

  • Does employer maintain a current written respirator program?

  • Has the employee been seen by a physician and been fit tested?

  • Employee using the proper filter for respirator?

  • Respirator being stored correctly?

  • Hearing protection used as required?

  • Face protection used as required?

  • High visibility clothing worn as required?

  • Maintaining safety compliance with personal protection equipment ?

  • Notes:

POSTINGS / SAFETY SIGNS

  • OSHA Workplace Poster displayed at all locations?

  • Emergency numbers / contacts posted?

  • OSHA 300 log posted Feb. 1st through April 30th?

  • Danger / warning signs posted? Each site maintains proper signage?

  • Danger - Keep out / Construction signs posted on security fencing?

  • All posting meet safety compliance?

  • Notes:

SANITATION

  • Adequate supply of potable water provided at no cost to the employee ( Minimum of 1 quart of water per hour per employee)?

  • Single use, disposable drinking cups provided? (Common cup and drinking directly from the container is prohibited)

  • Trash cans provided at all drinking locations?

  • NON-POTABLE water is clearly marked and identified?

  • 1 toilet per 20 workers at the job site? Females have a separate facilities?

  • Hand washing stations provided? 1 hand washing outlet per 20 workers?

  • Facilities (toilets and hand washing facilities) are being maintained in sanitary conditions?

  • Sanitation locations are being maintained in good conditions and maintaining safety compliance?

  • Notes:

SCAFFOLDS

  • Does the crew maintain a JSA, properly filled out and within 15 feet of work being performed?

  • Guard rails are installed and secured between 42 - 48 inches (1066 - 1219 millimeters) off of platform?

  • Mid-rails are installed and secured between 21 - 24 inches (533 - 609 millimeters) off of platform?

  • Perry Scaffolds has guard rails and mid rails when platform is at 6 feet (1.8 meters)?

  • Perry Scaffolds have outriggers when scaffold is 3 times the base?

  • Perry Scaffold is built per manufacturers specifications?

  • Employees are not "surfing" or scooting on Perry Scaffolds?

  • Employees have both feet on the platform at all times?

  • Trades maintaining good compliance with Scaffolds?

  • Scaffold(s) are free of materials for the employees to gain additional height?

  • All employees have been trained in Scaffold Awareness to work off of scaffolds?

  • Competent person inspecting scaffold before daily occupancy? From all trades working off of scaffolds?

  • Scaffold inspection tags are located at each scaffold ladder? Inspection tags filled out and maintains current inspections?

  • Scaffold was erected under the supervision of a Competent Person?

  • Working platforms fully planked?

  • Fall protection provided at 6feet (1.8 meters) and above?

  • Legs / frames bear on base plates / mud sills?

  • Mud sills free from undermining?

  • Base plates / mud sills clear from dirt, debris and obstructions? Able to inspect? Base plate secured to mud sill?

  • Planks in good condition? Scaffold grade planks? Free from splits, cuts and damage?

  • Planks / Working platform clean, free from excessive debris, trash and materials?

  • Ladder provided and used to access all scaffold platforms?

  • Scaffold plank overlap a minimum of 6 inches (152 millimeter) max. to 18 inches (457 millimeters) and overlap is over a frame?

  • Scaffold is tied into structure at 12 (3.6 meters) 26 (7.9 meters) and 30 feet 9.1 meters) (or top of structure)?

  • Toe-boards provided above all access / egress points and anywhere employees are working below?

  • All types of scaffold(s) maintaining safety compliance?

  • Notes:

STEEL ERECTION

  • Does the crew maintain a JSA, properly filled out and within 15 feet of work being performed?

  • Site erection plan available for review?

  • Lay down area graded, drained and adequate?

  • Decking secured upon placement?

  • Guardrails around stair / elevator / perimeters openings?

  • Floor opening covers properly marked and secured?

  • Tools secured against accidental displacement?

  • Perimeter cables installed when decking is completed?

  • Perimeter cables flagged at 6 foot (1.8 meters) intervals?

  • Perimeter cables maintain less than 2 inch (50 millimeter) deflection?

  • Iron workers / steel erection maintaining safety compliance?

  • Ramps and runways properly guarded?

  • Notes:

TOOLS (HAND and POWER)

  • Does the crew maintain a JSA, properly filled out and within 15 feet of work being performed?

  • Hand and power tools in safe operating condition?

  • Tool guards in place and functional on all power tools?

  • All tools stopped and turned off / unplugged during maintenance / refueling?

  • Power tools maintain a ground post or be double or triple insulated?

  • Tools are in like new condition with no alterations, repairs or damage?

  • Handles on tools free from splinters and cracks?

  • Safety spring(s) being maintained in all nail guns?

  • Grinders and cutting wheels maintain fully functioning guards?

  • All air delivery equipment maintain air pressure gauges and hose connection safety's (ties/whips/connection pins)?

  • Tools are properly hoisted / lowered?

  • All tools being maintained within safety compliance?

  • Notes:

TRAFFIC CONTROL

  • Does the crew maintain a JSA, properly filled out and within 15 feet (4.5 meters) of work being performed?

  • Personal trained in work zones traffic safety techniques?

  • Manual on Uniform Traffic Control Devices available?

  • Traffic Control Plan available and updated?

  • Work zone inspected? Documented?

  • Warning signs visible and spaced properly?

  • Warning signs alert drivers to upcoming road work?

  • Warning signs in good condition, legible, clean and working?

  • Delineation devices (cones, barrels, panels) positioned properly?

  • Delineation devices (cones, barrels, panels) in good condition?

  • Barricades provided / placed where required?

  • Barricades erected with correct directional stripes?

  • High visibility clothing is worn within the work zone? Proper rating (class 2 or class 3)?

  • Beacon lights activated on vehicles near active traffic lanes?

  • Contractors maintaining traffic control safety?

  • Notes:

TRENCHING / EXCAVATION

  • Does the crew maintain a JSA, properly filled out and within 15 feet (4.5 meters) of work being performed?

  • Competent person identified on the JSA and has completed daily inspections?

  • Competent person on-site and at location when trench is occupied?

  • Soil has been properly classified by manual tests and properly documented?

  • Competent person identified on the JSA and has completed daily inspections?

  • Atmospheric conditions tested prior to entry (where required) ?

  • Employees are protected from cave-in by protective systems?

  • Sloping / benching adequate for soil type?

  • Spoils / materials / equipment set back 2 feet (.6 meters) from edge? No material / equipment on the benches?

  • Travel distance to egress is no more than 25 feet (7.62 meters)?

  • Stability of adjacent structures ensured?

  • Pavements / structures not undermined unless supported?

  • Utilities located / identified prior to start of excavation? PM or Dig Alert contacted?

  • Signs / barricades provided on all open trenches? Barricades a minimum of 6 feet (1.8 meters) away from the trench?

  • Surface encumbrances removed or supported?

  • Water runoff controlled to prevent accumulation?

  • Access prohibited when water accumulation is uncontrolled?

  • Back filling occurs following removal of support system?

  • Trenches and excavations are within good safety compliance?

  • Excavation shield / trench box extend at least 18 inches (457 mm) above shelf or vertical slide?

  • Excavation contractor maintaining safety compliance?

  • Notes:

WELDING / CUTTING / HOT WORK

  • JSA and Hot work permit filled out completely and is accurate?

  • Welding screens provided and used when required?

  • Regulators / gauges / valves in proper working order?

  • Cylinders maintained in good condition?

  • Welding hoses in good condition?

  • Fire extinguisher within 20 feet (6.1 meters) of hot work?

  • Valve caps in place when stored / transported?

  • Area identified and employees protected from falling slag?

  • Combustibles removed / protected from heat / spark / slag?

  • Cylinders secured in upright position?

  • Fuel gas cylinders separated from oxygen cylinders (by 20 feet / 6.1 meters) when not in use, or has a firewall between tanks?

  • Fuel gas has a flash arrestor in-line or at the handle?

  • Cylinders in transportation are secured in a vertical position?

  • Fire watch is in place when required?

  • Welders are operating safely and maintaining safety compliance?

  • Notes:

OTHER

  • Construction areas properly illuminated?

  • Security fencing installed, maintained in good condition and is closed when site is not occupied?

  • Frequent / regular inspections by the contractor of the job site completed? Documented?

  • Defective equipment tagged or removed from job site?

  • Was the site free from any Immanent Danger to Life or Health (IDLH) exposures?

  • Notes:

MISC. INFORMATION

  • Notes:

  • This space is available for draw out.

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