Phalcon Project Safety Survey

• Project

• Foreman

• Tap to enter information

  Date

• Conducted on

  Date

• Prepared by

• Location
  Address

• Weather

  Sunny

  Partly cloudy

  Overcast

  Raining

  Snowing

• Temperature

Administrative

• Was previous survey reviewed?

  Yes

  No

  N/A

• Are there any outstanding items?

  Yes

  No

  N/A

• Review daily tailboard talk

  Yes

  No

  N/A

• Project JHA signed and clinic directions posted

  Yes

  No

  N/A

Personal Protective Equipment

• Hard Hat<br>

  Safe

  At Risk

  N/A

• Safety Glasses

  Safe

  At Risk

  N/A

• Gloves

  Safe

  At Risk

  N/A

• High-Visibility Vest

  Safe

  At Risk

  N/A

• Avg noise level (dBa)

Material Handling & Ergonomics

• Material Handling Aids

  Safe

  At Risk

  N/A

Electrical

• GFCI Inspections Current

  Yes

  No

  N/A

• Enclosures Intact

  Yes

  No

  N/A

• Cord & Cable Condition

  Safe

  At Risk

  N/A

• Temporary Lighting

  Safe

  At Risk

  N/A

• LOTO & Electrical Safe Work Practices

  Safe

  At Risk

  N/A

Walking & Working Surfaces

• Housekeeping

  Safe

  At Risk

  N/A

Ladder Use

• Stepladders- inspect, spreaders locked

  Safe

  At Risk

  N/A

• Extension Ladders - inspect, proper angle, tied off

  Safe

  At Risk

  N/A

Fall Protection

• Guardrails

  Safe

  At Risk

  N/A

• Holes Covered

  Yes

  No

  N/A

• Personal Fall Arrest System

  Safe

  At Risk

  N/A

Fire Protection

• Fire Extinguishers

  Safe

  At Risk

  N/A

• Hot Work Procedures

  Safe

  At Risk

  N/A

Employee Health

• Dust Control

  Safe

  At Risk

  N/A

• Sanitation

  Safe

  At Risk

  N/A

Scaffolding

• Inspected by Competent Person and tagged

  Yes

  No

  N/A

• Guardrails

  Safe

  At Risk

  N/A

• Working Level Completely Decked

  Yes

  No

  N/A

• Proper Access (Ladders & Stairs)

  Yes

  No

  N/A

Excavations

• Proper Slope, Shore or Bench

  Yes

  No

  N/A

• Spoil piles >2' from the edge

  Yes

  No

  N/A

• Egress within 25 Feet

  Yes

  No

  N/A

Cranes & Rigging

• Equipment grounds installed, where applicable

  Yes

  No

  N/A

• No work under loads

  Safe

  At Risk

  N/A

• Outriggers - extended, cribbing

  Yes

  No

  N/A

• Tag lines used on all loads

  Yes

  No

  N/A

• Sling Condition

  Safe

  At Risk

  N/A

• Protection setup for equipment below work area

  Yes

  No

  N/A

Employee Interactions

• Employee name:

  Positive Feedback

  Coaching

  Employee Safety Violation

Aerial Lifts

• 100% Fall protection

  Yes

  No

  N/A

• Equipment grounds installed, where applicable

  Yes

  No

  N/A

• Comments:

• Pictures

  Media

• I have reviewed the results of this Safety survey.

  Sign