RJM Construction Safety Assessment

• Conducted on

  Date

• Job Name / Job Number

• Superintendent

GENERAL SAFETY

• Safety Planning (pre-con meetings, safety plan, JSA, morning huddles, pre-task plans)

  Yes

  No

  N/A

• Postings (State, Federal, Emergency #'s, Incident Reporting & Crisis Management)

  Yes

  No

  N/A

• Material Safety Data Sheets (3E MSDS on Demand Posting & Subcontractor MSDS's)

  Yes

  No

  N/A

• First Aid Kit / Eyewash Replenished

  Yes

  No

  N/A

• Sanitation (1 toilet per 20 workers)

  Yes

  No

  N/A

• Housekeeping (trash & debris removed, proper material storage)

  Yes

  No

  N/A

• Date Corrected:

  Date

Personal Protective Equipment

• Proper Attire (shirts 4" sleeves, pants, boots, hard hat)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Eyes (glasses, goggles, face shield)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Other (hearing, gloves, respirators, chemical protection, metatarsal guards)

  Yes

  No

  N/A

• Date Corrected:

  Date

Fall Protection System

• Guardrails (200#, 42" +/- 3", toeboards, wire rope flagged every 6')

  Yes

  No

  N/A

• Date Corrected:

  Date

• Holes (guarded, covered, secured, labeled)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Protection @ 6' (anchor point, harness, lanyard, retractable, rope grab, positioner)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Other (falling object protection, safety nets, warning lines minimum of 15' from edge)

  Yes

  No

  N/A

• Date Corrected:

  Date

Fire Protection/Prevention

• Fire Extinguishers (accessible, identified, charged, w/in 100' of travel, @ stairways)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Fuel Storage (location, container, extinguisher, traffic protection)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Hot Work (fire watch, fire blankets, permit, extinguisher present, debris clear)

  Yes

  No

  N/A

• Date Corrected:

  Date

Cranes

• Daily Lift Plan (Qualified Operator, Signal Person, Rigger, Daily, Periodic and Annual Inspections)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Set-Up (barricaded, level, powerlines 20' minimum clearance)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Outriggers (extended, pads adequate & level per Daily Lift Plan)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Operation (load path, taglines, signal person)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Capacity (charts available, critical lift plan, object weights identified)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Sling Condition (wire rope, synthetic, hardware)

  Yes

  No

  N/A

• Date Corrected:

  Date

Access Equipment

• Extension Ladders (4V:1H, secured at top and base, 3' above landing, 3 points of contact)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Step Ladders (stable, proper use, inspected, non-conductive)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Stairs (metal pan treads filled, uniform w/in 1/4", rails @ 36", unobstucted, illuminated)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Aerial & Scissor Lifts (proper use, fall protection, condition, rails, operator training)

  Yes

  No

  N/A

• Date Corrected:

  Date

Electricity

• Panels (covers in place, circuits identified, weatherproof, secured, breakers/holes filled)

  Yes

  No

  N/A

• Date Corrected:

  Date

• GFCI (@ breakers, outlets, pigtails, electrician weekly testing log)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Electrical Cords (ground, strain relieve, condition, protected from traffic, proper use)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Romex (protected to 8', proper splices taped, fastened every 10' with non-conductive fastener, protected from physical damage)

  Yes

  No

  N/A

• Lighting (adequate- 5 ft candles, protected, secured, sockets filled, separate circuit)

  Yes

  No

  N/A

• Date Corrected:

  Date

Excavation

• Daily Dig Permit (Competent Person Inspection, utilities located, cracks, spalling, water accumulation, changed conditions)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Access/Egress @ 4' (ladder, ramp, stairs within 25' of travel)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Protection @ 5' (slope, bench, shield, shore)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Other (spoils 2' back, vibration, hazardous atmosphere potential)

  Yes

  No

  N/A

• Date Corrected:

  Date

Scaffolding

• Base (sills/plates/jacks/casters, secured, level, locked)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Braces (installed, secured, condition)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Frames (compatible, pinned, condition)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Platform (fully planked, overhang 6"-12" or cleated, plank condition)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Access (integral frame - 16 3/4" rung spacing, ladder w/ gate, stairtower)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Other (secured @ 4V:1H, level, tagged, competent person inspected, tarp/debris net engineer approval)

  Yes

  No

  N/A

• Date Corrected:

  Date

Other

• Concrete (pump 20' from power lines, impalement protection - flat rebar caps)

  Yes

  No

  N/A

• Date Corrected:

  Date

• Motorized Equipment (qualified operator identified, backup alarms, seat belts, equipment condition acceptable)

  Yes

  No

  N/A

• Date Corrected:

  Date

General Observations (items not referenced in inspection form and / or add positive comments)

• Yes

  No

  N/A

• Date Corrected:

  Date

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Inspection a Completed By:

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