Information
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Jobsite Name
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Job site Number
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Location
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Foremen
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Job description:
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Conducted on
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Prepared by
Kettle/Tanker
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Temperature
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Proper PPE (face shield, gloves, long sleeves, cuff less pants)
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Fire extinguisher
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Proper pipe setup
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Placard Present (Hot - 3257)
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Access / Egress
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Portable Ladders
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Ladder extends 3' over landing
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3 points of contact maintained while climbing
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In good safe working condition. Proper ladder for the job.
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Ladder set up at proper angle (4:1)
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Daily ladder inspection form completed?
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Ladder tied off securely
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Fixed Ladders
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Fall protection or cage available if 24' in height or greater
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If cage or well is used, landing platform is provided at maximum of 50'
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Minimum clearance between ladder and obstruction behind is 7"
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Inside of cage or well is free of obstructions
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Ladder in good repair, no visible damage
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Stepladders
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Stepladders in good repair. No visible damage to rails, rungs, or spreader
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Ladder used in an open a-frame position
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Proper ladder size used. Climbing on top of stepladder, or on first rung from the top, is prohibited
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Stairs / Scaffold Stairs
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Metal pan stairs are filled with with suitable material or barricaded to prevent access
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Stairways with four or more risers, or rising more than 30" in height (whichever is less) have stair rails provided on each unprotected edge
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Handrails are provided between 30" and 37", have at least 3" clearance between the handrail and structure behind, and are constructed so as to provide an adequate handhold
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All railings are free from projection hazards such as nails, surfaced to prevent injuries or snagging of clothing
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Other
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Electrical Safety
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GFCI utilized at all times
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Cords and tools in good condition. Damaged cords / tools tagged out of service or rendered inoperable
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All cords protected from damage (not exposed to vehicular traffic or crushing damage from doors or windows, etc.)
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All ladders and equipment at least 10' from electrical lines
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Other
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No fall from height exposures present. Ground work being performed, high parapet walls (greater then 39") or similar structure that prevents a fall.
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Total roof area enclosed with high parapet walls or other structure to prevent any possibility of falling
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Do the high walls surround the entire roof
Fall Protection
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Warning Line Systems
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Warning lines completely enclose the roof area
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Warning lines kept minimum of 6' from edge of roof, or minimum of 10' from edge of roofs with mechanical equipment in use
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Well maintained, a minimum of 34" off the working surface, a maximum of 39"
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Stanchions utilized are designed to resist, without tipping over, a force of at least 16 lbs applied horizontally 30" above the walking / working surface
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Employees adhering with requirement and remaining inside warning lines unless using a different fall protection system
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Points of access connected to work area by access path formed by two lines. When not in use, a warning line is run across the path to fully enclose the work area
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Guardrails System
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Proper height: Top rail 39-45 inches above the walking working surface. Cable deflects 3" or less and does not sag below 39" with 200lbs of force applied. Midrails installed midway between top rail and walking / working surface
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Guardrail system properly installed capable of withstanding 200lbs of force
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Standard toe boards installed if exposure below exists
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Guardrails surfaced to prevent injury. No protruding nails
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Safety Monitoring System
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Safety monitor in audible & visual distance, on same working level and performing monitoring duties only
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Safety monitor educated to recognize fall hazards and aware of items that he/she should be looking for
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Monitor used in conjunction with warning line, except for on roofs that are <50' in length or width
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Employees ensuring a safety monitor is present prior to going outside warning lines or working on an unprotected roof
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Personal Fall Arrest Systems
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Anchorage points of suitable strength to support fall or restraint (5,000lbs arrest, 1,000lbs restraint). Roof anchors properly installed.
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Equipment inspected prior to use
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Harness & lanyards worn and adjusted properly. Lifelines installed properly, slack removed, pendulum effect and free fall distance considered and controlled
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Anchorage connectors such as cross arm straps utilized to wrap units / structures. No wrapping of lifelines / lanyards and hooking them back to themselves
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Skylight and hole protection
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Skylight / holes protected by guardrail, cover, net, or personal fall arrest system is used
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Hole covers capable of withstanding twice the intended load. "Hole" or "Cover" painted atop the cover
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Hoist area fall protection
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Guardrails or PFAS utilized in hoisting areas (areas where material / debris / equipment is being brought up to or removed from roof)
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Employees using PFAS in hoist areas set them up for fall restraint
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Other
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Fire Prevention
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Extinguishers in place, charged and in work area. Clear of obstruction. No more than 100' from employees, no more than 50' from flammables
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No smoking near flammables
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Proper flammable safety cans in use
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Other
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General Safety
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First aid kits available onsite
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SDS available onsite for all chemicals, chemicals properly labelled
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Weekly tool box talks conducted
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General housekeeping efforts kept up
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All materials and debris secured daily. Public protected from falling / flying objects
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General precautions taken to protect property from damages
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Intakes covered or turned off when chemicals used
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Other
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Hand and Power Tools
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All hand and power tools in good repair. Damaged equipment tagged out of service or rendered inoperable
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All power tools have proper machine guards in place
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Hand tools used for the task they are designed for. No prying items with a utility knife
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Utility knife blades kept sharp, cuts made away from body. Retracted or fully sheathed when not in use
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Other
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Material Handling
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Proper lifting techniques observed. Team lifts or mechanical equipment used when lifting heavy objects
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Material handling equipment in good condition
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Debris removed of promptly and safely. Chute provided when over 20'.
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Crane Safety
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Operators licensed / certified
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Qualified rigger / signal person used
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Rigging in good condition. Capacities legible. Inspected prior to use with no visible damage.
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Outriggers fully deployed, pads/cribbing used on soft surfaces
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Daily inspection of crane performed. Must be documented at least once per month and available on crane
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Work zone established. Elevated visual aids in place to ensure crane maintains minimum approach distance from overhead power lines
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Forklift Safety
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Operator certified. License available and current (not more than 3 years old)
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Daily inspection completed. All critical safety elements in good repair (back up alarm, windows & mirrors, boom angle indicator, load chart available, tires in good repair, etc)
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Seatbelt worn at all times
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Safe speeds maintained
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Other
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Personal Protective Equipment
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Eye protection worn when hazard exits and per policy
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Hard hats worn when hazard exits and per policy
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Proper gloves worn when handling tear off debris, when handling sharp metal, and when handling chemicals requiring glove usage
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Proper work attire worn (boots, pants, sleeved shirts, long sleeve shirts if handling hot asphalt)
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Other
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Scaffolding
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Supported Scaffolding
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Competent person onsite - daily inspections conducted
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All components in good condition, properly assembled
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Safe access onto scaffold available
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Guardrails and toeboards on all open sides of work area
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Work platform fully decked with proper overhang / cleating of planks
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All employees using have user training
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Scaffold kept a safe distance (10' minimum) from overhead powerlines unless lines have been de-energized or other acceptable safeguards implemented
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Falling object protection adequate if exposure below exists. Toe boards in place, or netting used if material stacked higher than toe boards
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Aerial Lifts
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All employees using have received user training
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Inspections performed prior to operating. No dropoffs, depressions, holes, etc. surrounding the equipment that can be driven into
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Guardrails in proper working condition. Safety chains latched closed on scissor lifts. Swing gates shut on boom lifts
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Proper fall protection in place when working from boom lift. Retractable lanyard or other restraining device used. Harness worn properly
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Equipment kept a safe distance from overhead powerlines (minimum of 10' unless power lines are de-energized or other acceptable safeguard is implemented)
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Other
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Specific Roof Systems Hazards
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Modified Bitumen - Torch Applied System (if not checked than N/A)
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Torch set up properly, in good working order. Stand in place. Connections and fittings leak checked prior to use
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All sparks or open flame controlled and kept away from roof openings which could suck flame into structure
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No torching to combustible surfaces
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BUR - Kettle Safety (if not checked than N/A)
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Propane tanks upright, in good condition and kept 10' from kettle & building
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Kettle area flagged / barricaded
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Proper temperature maintained. Ground man present and aware of temperature and flashpoint
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Kettle lid closed when not being loaded
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Other
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Jobsite Grading
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Acceptable: Jobsites which have no serious violations of federal requirements, or safety policies and have recognizable hazards controlled at the time of the inspection.<br><br>Needs Improvement: Jobsites in which violations occurred which may be serious in nature but the inspector does not believe them to be done intentionally or egregiously.<br><br>Unacceptable: Jobs in which egregious safety violations exist and are to believe to have been known by those involved.
Follow-up
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Corrective Actions taken onsite to correct noted deficiencies:
Sign Off
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On site representative
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Auditor's signature
