Title Page

  • Document No.

  • PROJECT SAFETY AND HEALTH SURVEY

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Project Name/Job # .....

  • Date and Time

  • Description

  • Project Manager

  • Supervisor

  • McCarl's employees (Trade/#)

  • Subcontractors (by Trade #)

Requirements (Check if verified)

  • McCarl's Safety & Health Program onsite/ online

  • Safety & Health Posting Requirements

  • First Aid Kit

  • OSHA 300 Log

  • Emergency Procedures/Phone Numbers

  • Orientation performed for all employees

  • Physician Panel (if required)

  • Fire Extinguisher in office

Overview

  • PPE

  • Housekeeping

  • Confined Space Entry

  • Assure Grounding of Tools/Cords

  • Scaffolding

  • Trenching/Excavation

  • Ladders/Stairways

  • Wall & Floor Openings

  • Perimeter/Fall Openings

  • Fire Protection

  • Mechanical Lock-out/Tag-out

  • Welding/Cutting

  • Gas Cylinders

  • Cranes/JLG's/Manlifts

  • Rigging-Slings/Cables

  • Material Storage

  • Subcontractor Safety

Safety Preplanning (2 week look ahead)

  • Please enter response below.

Hazard Corrections

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

  • Hazard #

  • Check if hazard is created by others

  • Observations/Location

  • Immediately Abated?

  • Steps taken to correct condition

  • Goal Date

  • Responsible Person

  • Date Completed

  • Initials

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