OSHA rep checklist

• CLIENT:

• CONTACT AND PHONE #

• Job Number:

• Location
  Address

• Conducted on

  Date

PRE START OSHA REP. CHECKLIST

• DATE COMPLAINT WAS RECEIVED BY RUFOLO OFFICE

  Date

• COMPLAINT IS:

  INCIDENT

  ACCIDENT

  DANGEROUS CONDITION

  UNSAFE CONDITION

• LIST COMPLAINTS:

OSHA checklist

• DATE/ TIME OF INCIDENT / ACCIDENT

  Date

• is client

  Select general contractor construction manager sub contractor developer

  • general contractor
  • construction manager
  • sub contractor
  • developer

• contact is

  Select project manager super asst super operator laborer assr. project mgr. other

  • project manager
  • super
  • asst super
  • operator
  • laborer
  • assr. project mgr.
  • other

• incident was :

  Select general complaint letter osha visit random recall incident report accident report minor injury major injury

  • general complaint
  • letter
  • osha visit
  • random
  • recall
  • incident report
  • accident report
  • minor injury
  • major injury

• call to office from:

  client

  osha compliance officer

• does hazzard still exist

  YES

  NO

  NA

• Union ?

  YES

  NO

• injured overnight stay or other required report

• OSHA notified by

  Select rufolo client complaint police EMS other other employee

  • rufolo
  • client
  • complaint
  • police
  • EMS
  • other
  • other employee

• Date and time OSHA notified

  Date

• OSHA compliance officer assigned: [name and info]

• Notes on injury;

• injured is employee of?

  AJD

  subcontractor

  visitor to site

• Subcontractor info:

• Injured info:

• Witnesses:

• Witness [if any] Names, info & phone

CLIENT INFORMATION

• CLIENT INFORMATION

• # of clients employees at this site & at all sites

• ADDITIONAL INFORMATION NEEDED FROM CLIENT?

• ADDITIONAL INFORMATION NEEDED

• information received from client on site

Site Conditions

• Have you read the projects site specific safety plan, taking note of specific hazards?

  YES

  NO

  NA

• Is there safe access to work area?

  YES

  NO

• Have you inspected the site for hazards that could injure workers?

  YES

  NO

• Amenities available and in reasonable condition, first aid kit in vehicle and emergency information current?

  YES

  NO

• Stairwells including temporary stairs are in place and secure, stairs have clear access

  YES

  NO

  NA

Tools & Equipment

• Are all guards fitted and in good condition?

  YES

  NO

• Do workers have the right PPE and safety equipment?

  YES

  NO

• all electric tools and cords in good condition [no tape ,have ground prong etc.]

• Proper ladders and used & stored properly

• Access to work area is protected?

  YES

  NO

  NA