Information
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Project Name:
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Foreman Name:
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Conducted on
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Location
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Subcontractor Job?
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Subcontractor Name?
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Prepared by
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Scope of Work
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Project Description
- Deck Replacement
- Go-over Existing
- New Construction Install
- Rip/Replace
- Repair / Maintenance
- Other
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Roof Slope
- Steep > 4:12
- Low Slope =/< 4:12
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Work Description
- Standing seam / metal
- Shingle / slate / tile / shakes
- Other
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Work Description
- Bur
- Shingle / Slate / Tile
- Single Ply
- Spray Foam
- Standing Seam / Metal Panels
- Torch Applied
- Other
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Project Description
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Location
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Project Description
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Sub Category
Access / Egress
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Portable Ladders (if not checked then N/A)
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Ladder extends 3' over landing
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3 points of contact maintained while climbing
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In good safe working condition. Proper ladder for the job.
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Ladder set up at proper angle (4:1)
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Ladder tied off securely
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Other
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Fixed Ladders (if not checked then N/A)
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Fall protection or cage available if 24' in height or greater
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Minimum clearance between ladder and obstruction behind is 7"
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Ladder in good repair, no visible damage
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3 points of contact maintained while climbing
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Other
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Stepladders (if not checked then N/A)
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Stepladders in good repair. No visible damage to rails, rungs, or spreader
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Ladder used in accordance with manufacturers specifications
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Proper ladder size used. Climbing on top of stepladder, or on first rung from the top, is prohibited
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Other
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Stairs (if not checked then N/A)
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Metal pan stairs are filled with with suitable material or barricaded to prevent access
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Stairways with four or more risers, or rising more than 30" in height (whichever is less) have stair rails provided on each unprotected edge
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Handrails are provided between 30" and 37", have at least 3" clearance between the handrail and structure behind, and are constructed so as to provide an adequate handhold
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All railings are free from projection hazards such as nails, surfaced to prevent injuries or snagging of clothing
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Other
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Other
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Electrical Safety
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GFCI utilized at all times
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Cords and tools in good condition. Damaged cords / tools tagged out of service or rendered inoperable
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All ladders and equipment at least 10' from electrical lines
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All cords protected from damage
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Other
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Fall Protection
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No Fall Hazards Present (if not checked then N/A)
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Employees are performing work at ground level.
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Parapet walls greater than 39" enclose the entire the roof.
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Employees are performing interior work, no fall hazards present.
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No Fall Protection Utilized (if not checked then N/A)
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No fall protection was being utilized by employees, with fall hazards present.
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Warning Line Systems (if not checked then N/A)
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Warning lines completely enclose the roof area
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Warning lines kept minimum of 6' from edge of roof, or minimum of 10' from edge of roofs with mechanical equipment in use
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Well maintained, a minimum of 34" off the working surface, a maximum of 39"
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Stanchions utilized are designed to resist, without tipping over, a force of at least 16 lbs applied horizontally 30" above the walking / working surface
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Employees adhering with requirement and remaining inside warning lines unless using a different fall protection system
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Points of access connected to work area by access path formed by two lines. When not in use, a warning line is run across the path to fully enclose the work area
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Guardrails System (if not checked then N/A)
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Top rail 39-45 inches above the walking working surface. Cable deflects 3" or less and does not sag below 39" with 200lbs of force applied. Midrails installed midway between top rail and walking / working surface
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Guardrail system properly installed capable of withstanding 200lbs of force
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Standard toe boards installed if exposure below exists
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Guardrails surfaced to prevent injury. No protruding nails
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Safety Monitoring System (if not checked then N/A)
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Safety monitor in audible & visual distance, on same working level and performing monitoring duties only
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Safety monitor educated to recognize fall hazards and aware of items that he/she should be looking for
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Monitor used in conjunction with warning line, except for on roofs that are <50' in length or width
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Employees ensuring a safety monitor is present prior to going outside warning lines or working on an unprotected roof
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Employees have received management authorization to use a monitor.
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Personal Fall Arrest Systems (if not checked then N/A)
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Anchorage points of suitable strength to support fall or restraint (5,000lbs arrest, 3,000lbs restraint)
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Equipment inspected prior to use
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Harness & lanyards worn and adjusted properly. Lifelines installed properly, slack removed, pendulum effect and free fall distance considered and controlled
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Anchorage connectors such as cross arm straps utilized to wrap units / structures. No wrapping of lifelines / lanyards and hooking them back to themselves
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Skylight and hole protection (if not checked then N/A)
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Skylight / holes protected by guardrail, cover, net, or personal fall arrest system is used
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Hole covers capable of withstanding twice the intended load. "Hole" or "Cover" painted atop the cover
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Other
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Fire Prevention
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Extinguishers in place, charged and in work area. Clear of obstruction. No more than 100' from employees, no more than 50' from flammables
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No smoking near flammables
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Proper flammable safety cans in use
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Other
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General Safety
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First aid kits available onsite
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SDS available onsite for all chemicals.
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All chemical containers are properly labeled.
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General housekeeping efforts kept up
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All materials and debris secured daily. Public protected from falling / flying objects
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General precautions taken to protect property from damages
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Intakes covered or turned off when chemicals used
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Employees are protected from silica exposure. Proper controls are being utilized as outlined in Table 1.
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Employees are protected from radio frequencies created by RF antennas on the roof.
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Other
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Hand and Power Tools
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All hand and power tools in good repair. Damaged equipment tagged out of service or rendered inoperable
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All power tools have proper machine guards in place
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Hand tools used for the task they are designed for. No prying items with a utility knife
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Utility knife blades kept sharp, cuts made away from body. Retracted or fully sheathed when not in use
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Other
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Material Handling
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Proper lifting techniques observed. Team lifts or mechanical equipment used when lifting heavy objects
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Material handling equipment in good condition
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Debris removed of promptly and safely. Chute provided when over 20'.
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Crane Safety (if not checked then N/A)
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Operators licensed / certified
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Rigging in good condition. Capacities legible. Inspected prior to use with no visible damage.
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Qualified rigger / signal person used
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Outriggers fully deployed, pads/cribbing used on soft surfaces
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Daily inspection of crane performed. Must be documented at least once per month and available on crane
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Work zone established. Elevated visual aids in place to ensure crane maintains minimum approach distance from overhead power lines
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Forklift Safety (if not checked then N/A)
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Operator certified. License available and current (not more than 3 years old)
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Daily inspection completed. All critical safety elements in good repair (back up alarm, windows & mirrors, boom angle indicator, load chart available, tires in good repair, etc)
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Seatbelt worn at all times
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Safe speeds maintained
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Other
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Personal Protective Equipment
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Eye protection worn when hazard exits and per policy
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Hard hats worn when hazard exits and per policy
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Proper gloves worn when handling tear off debris, when handling sharp metal, and when handling chemicals requiring glove usage
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Proper work attire worn (boots, pants, sleeved shirts, long sleeve shirts if handling hot asphalt)
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Other
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Scaffolding
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Supported Scaffolding (if not checked then N/A)
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Competent person onsite - daily inspections conducted
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All components in good condition, properly assembled
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Safe access onto scaffold available
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Guardrails and toeboards on all open sides of work area
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Work platform fully decked with proper overhang / cleating of planks
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All employees using have user training
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Scaffold kept a safe distance (10' minimum) from overhead powerlines unless lines have been de-energized or other acceptable safeguards implemented
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Falling object protection adequate if exposure below exists. Toe boards in place, or netting used if material stacked higher than toe boards
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Aerial Lifts (if not checked than N/A)
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All employees using have received user training
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Inspections performed prior to operating. No dropoffs, depressions, holes, etc. surrounding the equipment that can be driven into
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Guardrails in proper working condition. Safety chains latched closed on scissor lifts. Swing gates shut on boom lifts
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Proper fall protection in place when working from boom lift. Retractable lanyard or other restraining device used. Harness worn properly
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Equipment kept a safe distance from overhead powerlines (minimum of 10' unless power lines are de-energized or other acceptable safeguard is implemented)
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Other
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Specialty Roof Systems
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Modified Bitumen - Torch Applied System (if not checked than N/A)
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Torch set up properly, in good working order. Stand in place. Connections and fittings leak checked prior to use
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All sparks or open flame controlled and kept away from roof openings which could suck flame into structure
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No torching to combustible surfaces
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BUR - Kettle Safety (if not checked than N/A)
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Propane tanks upright, in good condition and kept 10' from kettle & building
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Kettle area flagged / barricaded
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Proper temperature maintained. Ground man present and aware of temperature and flashpoint
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Kettle lid closed when not being loaded
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Other
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Jobsite Grading
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Acceptable: Jobsites which have perceived no serious violations of federal regulations or safety practices and have recognizable hazards controlled at the time of the inspection. <br><br>Needs Improvement: Jobsites in which violations were found that may be serious in nature but the inspector does not believe them to be intentionally performed in an egregious manner. <br><br>Unacceptable: Jobs in which egregious safety violations exist and were believed to have been done with disregard for safety policy and known, or should have been known, by those involved with authority to correct.
Sign Off
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On site representative
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Auditor's signature
