Phalcon Project Safety Survey

• Audit Title

• Project

• Foreman

• Conducted on

  Date

• Prepared by

• Location
  Address

• Weather

  Sunny

  Partly cloudy

  Overcast

  Raining

  Snowing

• Temperature

Administrative

• Describe any outstanding items from the previous survey?

• Review daily tailboard talk

  Yes

  No

  N/A

• Project JHA signed and clinic directions posted

  Yes

  No

  N/A

Personal Protective Equipment

• 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 Utilized (forklifts, carts, etc)

  Safe

  At Risk

  N/A

Electrical

• GFCI Inspections Current

  Yes

  No

  N/A

• Enclosures Intact

  Yes

  No

  N/A

• Cord & Cable Condition - ground prong intact, no cuts in the outer jacket, cords not pulling free from the plug ends.

  Safe

  At Risk

  N/A

• Temporary Lighting - lights are lit, cages closed/installed, adequate light

  Safe

  At Risk

  N/A

• LOTO & Electrical Safe Work Practices

  Safe

  At Risk

  N/A

Walking & Working Surfaces

• Housekeeping

  Safe

  At Risk

  N/A

• Access/Egress - pathways clear and uncluttered. No tripping hazards.

  Safe

  At Risk

  N/A

• Holes Covered

  Yes

  Yes - Corrected

  No

  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

• Personal Fall Arrest System

  Safe

  At Risk

  N/A

Fire Protection

• Fire Extinguishers - present and inspected

  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

• First Aid Kit (Available, correct size, stocked)

  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

Summary / Comments / Pictures

• Comments:

• Additional Information

• Other Project Hazards (caused by others)

• Follow Up Actions

• Overall Grade: Excellent - no deficiencies noted, Good up to 3 minor deficiencies, Needs Improvement more than 3 minor or one major deficiencies

  Excellent

  Good

  Needs Improvement

• Pictures

  Media

• I have reviewed the results of this Safety survey.

  Sign