Information
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Location
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Conducted on
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Document No.
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Job-site
- A1- Main Plant
- A3- Main Plant
- Parking Lot- Main Plant
- DC Remodel- Main Plant
- Pre-Process - Firebaugh
- Other
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Other:
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Contractors working on site:
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Other:
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PFI JSA, Job-site Auditor?
- Lacey Trusty - Safety Coordinator
- Kelsey Audap
- Other
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Other:
PFI JSA Jobsite and Permit information
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Photo of JSA's
Job-site Info
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JSA available and posted on the Job-site board or at the site location?
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Responsible Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
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Does the JSA have the Specific Job Location & Brief Job Description?
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Contractor(s)
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Does the JSA identify the Equipment to be Worked on?
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Responsible Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
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Contract Company name and Supervisor filled out and is accurate?
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Responsible Contractor?
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Is PFI Production Manager filled out and accurate?
-
Responsible Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
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PFI Project Manger filled out and accurate?
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Responsible Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
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Is "Filled Out By" filled out accurate?
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Responsible Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Is "Today's Date" filled out accurate?
-
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
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Is "Project End Date" and "Form Expiration Date" filled out, accurate and is within the 7 day allotment period?
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Responsible Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
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Is "Form Expiration Date" filled out, accurate, and within 7 day period?
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Responsible Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Additional details and or notes for Job-site Info
Locations:
-
Dose the PFI JSA identify the location of the following…
- Medical Treatment Facility
- Evacuation Location
- MSDS, or SDS
- Eye Wash Station
- Fire Extinguisher
- First Aid Kit
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Additional details and or notes for Locations:
Personal Protective Equipment
-
Does the JSA identify any of the Following PPE required for the task being performed?
- Hardhat
- Eye Protection
- Hand Protection
- Foot Protection
- Fall Protection
- Face Protection
- Hearing Protection
- Respiratory Protection
- Other
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Details:
-
Additional details and or notes for Personal Protective Equipment:
Permits
-
Is the work being performed in a Production Area?
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Is the work being performed in close proximity to the production?
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Does the JSA outline the precautions being taken to assure no product contamination?
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Responsible Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
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Project Manager Notified?
-
Corrective Action Issued?
-
Will any used equipment be introduced into the Production Area?
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Does the JSA explain how the equipment is prepared not to cross contaminate?
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Responsible Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
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Project Manager notified?
-
Correction Action issued?
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Will the contractor be introducing any chemicals and / or paint into the production area?
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List chemical(s), listed on the JSA
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Has the SDS (MSDS) been submitted tot he project manager?
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Responsible Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Project Manager aware?
-
Details/Notes:
-
Has the JSA been signed by all workers working at the location?
-
Responsible Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
Job Steps
Preparation
-
Does the JSA outline Preparation Sequence Steps?
-
Contractors
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Is the Steps accurate?
-
Contractors
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Does the JSA outline Preparation Food and Human Safety Hazards?
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Contractors
- Yes
- No
- N/A
-
Are the Safety Hazards accurate?
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Does the JSA list the ways to eliminate and / or reduce food and/or Human Safety Hazards for Steps to Preparation
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Does the JSA identify Traffic Flow Sequence Steps?
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Does the JSA identify Steps to Traffic Flow Eliminate / Reduce Food and Human Safety Hazards?
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Does the JSA properly identify the Job Steps - Sequence of Steps?
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Does the JSA properly identify Job Steps - Food and Human Safety Hazards?
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Does the JSA properly identify Job Steps - Steps to Eliminate or Reduce Food and Human Safety Hazards?
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Has the JSA, Completion - Sequence of Steps been properly filled out and is complete?
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Has the JSA, Completion - Food and Human Safety Hazards been properly filled out and complete? Is the information accurate?
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Has the JSA, Completion - Steps to Eliminate or Reduce Food and Human Safety Hazards been filled out and complete? Is the information accurate?
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Site Audit
Aerials and Scissor Lifts
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Has Contractor been trained in the use of equipment?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Is the Contractor wearing harness correctly?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Is the Contractor trained in fall protection?
-
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Is the Contractor tied off to boom or basket? (Not required in scissor lifts unless the lift moves when lift is up)
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Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Are lift controls clearly marked and readable?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Is the Contractors tied off to adjacent structures?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Both feet remain on the floor of the basket?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Lift is stationary when boom is elevated?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Are Contractors transferring at height from scissor lift?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Contractor uses Mid-rail chain or gate when in operation?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Concrete & Masonry
-
Rebar / flat stakes guarded (covered) to eliminate impalement hazard?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Contractor working in concrete wearing proper hand and foot protection?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Masonry saw blades guarded?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Contractors wearing face shields AND safety glasses while cutting block?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Dust controlled while cutting block or conducting finish work?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Confined Space
-
JSA and rescue plan on-site and available?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Contractor has been trained on the plan?
-
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Entry permit completed and signed?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Air sampling completed and documented prior to entry?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Proper warning signage posted at entry to the permit space?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Forced air ventilation used for the duration of entry?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Proper lighting provided?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Rescue team trained and readily available?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Retrieval system (Tripod) available and utilized?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Entrants attached to the retrieval line?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Attendant on duty outside the permit space?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Attendant only performs monitoring duties?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Cranes & Rigging
-
Crane(s) inspected and properly maintained?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Crane operator, rigger and signal person certified?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Crane rigger certified?
-
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Crane signal person certified?
-
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Crane load charts visible to the operator?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Hand signal charts posted or available?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Pick (Lift) plan on-site, reviewed and the load is within load capacity?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Crane outriggers fully extended and on cribbing properly?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Swing radius identified and barricaded?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Workers remained clear of the in the swing radius and under suspended loads?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
All power lines are a minimum 15 feet away from all lifting and boom swing radius?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Rigging equipment inspected and in good condition?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Rigging equipment maintain lift capacity markings?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Electrical
-
Electrical cords maintain ground posts?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Electrical cords are free from damage / repair / alterations?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Electrical cords protected from damage and roll over?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Electrical cords kept clear of work areas and walk ways?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Electrical cords are rated for construction?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Power strips and 3 way splitters construction rated?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Electrical equipment being used per the manufacturers specifications?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
All outlets have cover plates when outlets are energized?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Electrical panels are covered, labeled and all breaker slots are covered?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Employees are locking and tagging out equipment and panels and NOT working on hot equipment?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Fall Protection
-
All employees have been trained in fall protection?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
A fall protection system is provided for all employees working above 7 1/2 feet? (Max Fall distance allowed is 6 feet)
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Harnesses have been inspected prior to use?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Contractor is wearing harness correctly, wearing the appropriate lifeline (lanyard) and attached to an anchor?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Fall protection anchors are set up per specifications and all elements are rated to 5000 lbs?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Guardrails are able to with stand 200 lbs outward and down force?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Guardrails do not exceed 2 inch deflection in any direction?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Guardrails and mid-rails are at the proper height?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Guardrails / mid-rails are constructed to be on the inside on the guardrail posts?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Guardrails and mid-rails have been placed around floor / roof openings?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Floor holes greater than 2 inches have been covered, properly labeled and secured from movement?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
The fall protection selected is appropriate for the fall exposure?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Floor hole covers are capable of handling 2 times the intended load?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Warning line 6 feet back for roofing activities?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Warning line 15 feet for non-roofing activities?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Warning line erected on all open sides?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Warning line flagged and suspended at proper height?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Access and hoisting areas guarded?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
All materials stored more than 6 feet back from roof or deck edge?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Fire Safety
-
Contractors trained in the use of fire extinguishers?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Fire extinguishers in good condition?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Fire extinguishers fully charged?
-
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Fire extinguishers recently inspected?
-
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Fire extinguishers replaced annually?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Fire extinguishers are within 75 feet of workers?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Minimum of 1 fire extinguisher per floor / level?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Fire extinguishers within 50 feet of flammable materials?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Flammables stored in an approved and closed containers?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
No smoking signs posted near flammables?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Flammable liquids protected from ignition sources?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Flammables not stored near access and egress locations?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Scrap piles, debris and trash stored more than 10 feet from building or structure?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Maintaining fire safety compliance?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Forklifts
-
Forklift operators been trained for the specific forklift they are operating?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Forklifts have not been modified or altered?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Outriggers being used on extended reach fork lift?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Forklift is operating within lift capacities?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Forklift slings have been inspected and maintain lift capacity tags?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Forklifts have lift, load and angle charts?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Forks are down when the Forklift is not in operation?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Forklift operator wearing seat belt when in operation?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Forklift has an audible back up alarm that can be heard up to 200 feet away?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Spotters are used when forklift has to travel through barrier curtains or blind accesses?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Forklift Operator is traveling less than 10 MPH, stopping at all intersections and stop signs?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Contractors are not under lifted or suspended loads.
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Lift basket secured to forklift?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Forklift maintains an operator when the lift basket has contractor in it?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Housekeeping & Sanitation
-
Work site / location reasonably organized - Good housekeeping?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Lunch trash picked up and removed from site?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Trash removed at regular intervals?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Scrap, pipe cut offs, pipe and other slip / trip hazards removed?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Staging / lay down area in good condition / good housekeeping?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
All scrap lumbar / planks has nails removed or bent over?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Adequate supply of potable water provided at no cost to the Contractors Employees? Reminder: Minimum of 1 quart, 2 avg. size drinking bottles, of water per hour per employee.
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
NON-POTABLE water is clearly marked and identified?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
1 toilet per 20 workers at the job site?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
If there are females working on the jobsite, do they have a separate facilities?
-
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Hand washing stations provided? 1 hand washing outlet per 20 workers?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Facilities (toilets and hand washing facilities) are being maintained in sanitary conditions?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Ladders & Stairs
-
Ladders inspected / no visible defects?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Ladders rated for construction (1 A ladder) ?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Spreaders fully extended and locked into position on A frame ladders?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Top two steps of a step ladder not being used?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Ladders set up on firm stable base?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Ladders being used for the intended purpose?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Proper ladder selected for task?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Extension ladder extends 3 feet above landing surface?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Extension ladder set up at 4:1 angle?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Extension ladders tied off at the top and secured at the bottom to prevent slip?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
3 feet around the ladder at the top and bottom remain clear of all materials and debris?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Contractor is maintaining 3 points of contact while climbing ladders?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Medical, First Aid, Safety Training
-
Eye wash / body wash stations set up when required?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Every trade maintains their own first aid kit / supplies?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
The first aid kit fully stocked?
-
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Job-specific safety training provided / documented?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Safety orientation training provided and verified?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
All employees have been trained in Heat Illness and Injury Prevention? (8CCR3395)
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Personal Protective Equipment
-
PPE provided to all Contractors or available as required by job or for replacement?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
PPE being maintained in good condition?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Hard hats being worn, properly and without alterations?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Eye protection, Z87 Stamped, used as required?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Hand protection used when required?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Safety boots (Steal toe) footwear worn when required?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
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?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Hearing protection used as required?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
High visibility clothing worn as required?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Face protection used as required?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Safety Signs
-
Location of nearest medical facilities posted, visible to all employees?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Emergency numbers posted on site, visible to all employees?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Emergency numbers / contacts posted?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Danger / warning signs posted? Each site maintains proper signage?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Danger - Keep out signs posted on security fencing?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Scaffolds & Steel Erection
-
Guard rails are installed between 42 - 48 inches off of platform?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Mid-rails are installed between 21 - 24 inches off of platform?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Perry Scaffold is built per manufacturers specifications?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Employees are not "surfing" or scooting on Perry Scaffolds?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Employees have both feet on the platform at all times?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Scaffold(s) are free of materials for the employees to gain additional height?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
All employees have been trained in Scaffold Awareness to work off of scaffolds?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Competent person inspecting scaffold before daily occupancy? From all trades working off of scaffolds?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Scaffold was erected under the supervision of a Competent Person?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Scaffold inspection tags are located at each scaffold ladder? Inspection tags filled out and maintains current inspections?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Working platforms fully planked?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Fall protection provided at 7 1/2 feet and above?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Base plates / mud sills clear from dirt, debris and obstructions? Able to inspect? Base plate secured to mud sill?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Mud sills free from undermining?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Planks in good condition? Free from splits, cuts and damage?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Ladder provided and used to access all scaffold platforms?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Scaffold plank overlap a minimum of 6 inches max. 18 inches, and overlap is over a frame?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Scaffold is tied into structure at 12, 26 and 30 feet (or top of structure)?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Toe-boards provided above all access / egress points and anywhere Persons are working below?
-
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Site erection plan available for review?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Lay down area graded, drained and adequate?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Decking secured upon placement?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Guardrails around stair / elevator / perimeters openings?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Floor opening covers properly marked and secured?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Structure members secured with two bolts per connection?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Diagonal bracing secured with one bolt per connection?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Tools secured against accidental displacement?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Perimeter cables installed when decking is completed?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Perimeter cables flagged at 6 foot intervals?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Perimeter cables maintain less than 2 inch deflection?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Ramps and runways properly guarded?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Hand & Power Tools
-
Hand and power tools in safe operating condition?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Tool guards in place and functional on all power tools?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
All tools stopped and turned off during refueling and maintenance?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Power tools maintain a ground post or be double or triple insulated?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Tools are in like new condition with no alterations, repairs or damage?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Handles on tools free from splinters and cracks?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Safety spring(s) being maintained in all nail guns?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Grinders and cutting wheels maintain fully functioning guards?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
All air delivery equipment maintain air pressure gauges and hose connection safety's (ties/whips/connection pins)?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Tools are properly hoisted / lowered?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Traffic Controls
-
Personal trained in work zones traffic safety techniques?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Manual on Uniform Traffic Control Devices available?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Traffic Control Plan available and updated?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Work zone inspected? Documented?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Warning signs alert drivers to upcoming road work?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Warning signs visible and spaced properly?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Warning signs in good condition, legible, clean and working?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Delineation devices (cones, barrels, panels) positioned properly?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Delineation devices (cones, barrels, panels) in good condition?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Barricades provided / placed where required?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Barricades erected with correct directional stripes?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
High visibility clothing is worn within the work zone? Proper rating (class 2 or class 3)?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Beacon lights activated on vehicles near active traffic lanes?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Trenching & Excavation
-
Excavations not more than 2 feet below protective systems?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Pavements / structures not undermined unless supported?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Excavation contractor maintaining safety compliance?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Utilities located / identified prior to start of excavation? PM or Dig Alert contacted?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Competent person identified on the JSA and has completed daily inspections?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Competent person on-site and at location when trench is occupied?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Soil has been properly classified by manual tests and properly documented?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Atmospheric conditions tested prior to entry (where required) ?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Signs / barricades provided on all open trenches? Barricades a minimum of 6 feet away from the trench?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Employees are protected from cave-in by protective systems?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Sloping / benching adequate for soil type?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Spoils / materials / equipment set back 2 feet from edge? No material / equipment on the benches?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Travel distance to egress is no more than 25 feet?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Surface encumbrances removed or supported?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Stability of adjacent structures ensured?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Water runoff controlled to prevent accumulation?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Access prohibited when water accumulation is uncontrolled?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Back filling occurs following removal of support system?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Trenches and excavations are within good safety compliance?
-
Notes:
Welding Cutting & Hotwork
-
Welding screens provided and used when required?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
JSA and Hot work permit filled out completely and is accurate?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Welders are operating safely and maintaining safety compliance?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Regulators / gauges / valves in proper working order?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Cylinders maintained in good condition?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Welding hoses in good condition?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Fire extinguisher within 20 feet of hot work?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Valve caps in place when stored / transported?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Combustibles removed / protected from heat / spark / slag?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Cylinders secured in upright position?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Fuel gas cylinders separated from oxygen cylinders (by 20 feet) when not in use, or has a firewall between tanks?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Fuel gas has a flash arrestor in-line or at the handle?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Cylinders in transportation are secured in a vertical position?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Fire watch is in place when required?
-
Exposing Contractor
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
Notes:
Corrective Actions
-
Is the JSA accurate? No corrective actions required?
-
What are the corrective actions?
-
has the Project Manager been notified of the corrective actions needed?
-
Are the contractor aware of any corrective actions that need to be completed?
-
What Contractors were notified of corrective actions?
- Baghouse
- Blue Mtn Const.
- Central California Const.
- JTI Electric
- Precision Grading & Paving
- Ross & Sons Const.
- Ross Fab
- Superior
- Ross & Sons Const. Sub-Contract.
- Valadon Plumbing
- Valley Tree
- Walker Concrete
- Other
-
list any Sub-Contractors
-
How was the contractor's notified?
-
Date and time the contractor was informed of the corrective action
