Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Select date
WORK ACTIVITY STEPS
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* Work Area - inspected for hazardous exposures, e.g. trip/slip/fall hazards, exposure to work from above, hazards from other trades, site traffic.<br> - work perimeter controls, e.g. CAZs, permits, warning signs, monitors, attendants
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1. FALL PROTECTION - WORK FROM ABOVE GROUND LEVEL
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2. LADDERS - USE OF PERMANENT, TEMPORARY, EXTENSION, STEP, OR ROLLING LADDERS TO ACCESS OR DO THE WORK ACTIVITY.
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3. SCAFFOLDS - THE USE AND TYPE OF SCAFFOLD TO DO THE WORK ACTIVITY
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4. STAIRWAYS - WILL STAIRWAYS BE USED TO ACCESS/EGRESS OR ACCOMPLISH THE WORK ACTIVITY?
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5. EXCAVATION - INCLUDING WORK ACTIVITIES e.g. CLEARING/GRUBBING, GRADING, TRENCHING, ETC.
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6. ELECTRICAL - CONTROL OF HAZARDOUS ENERGY (LOCKOUT/TAGOUT)
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7. ELECTRICAL - TEMPORARY OR PERMANENT POWER TRANSMISSION<br>
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8. GAS LINES - e.g. UNDERGROUND NATURAL GAS PIPES, PROPANE DISTRIBUTION, ETC. (IDENTIFY ALL)
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9. SEWER LINES - IDENTIFY INSTALL, REPAIR, OR WORK IN HAZARD PROXIMITY.
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10. WATER LINES - INSTALL, REPAIR, ETC.
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11. STORM WATER - WORK ACTIVITY INVOLVES OR INFLUENCES POLLUTION PREVENTION, INSTALLATION, OR REPAIR.
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12. HOISTING/RIGGING - ANY ACTIVITY REQUIRED ON ANY EQUIPMENT.
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13. CONFINED SPACE - OSHA; A CONFINED SPACE MEETS THREE CRITERIA<br> 1. IT IS NOT DESIGNED FOR CONTINUOUS EMPLOYEE OCCUPANCY.<br> 2. IT IS LARGE ENOUGH AND SO CONFIGURED FOR AN EMPLOYEE TO BODILY ENTER AND PERFORM ASSIGNED WORK.<br> 3. IT HAS LIMITED OR RESTRICTED MEANS OF ENTRY OR EXIT.
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14. DEMOLITION - IDENTIFY TYPE OF SPACE/MATERIALS TO BE DEMOLISHED<br>
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15. CONSTRUCTION HEAVY EQUIPMENT - IDENTIFY TYPES/USES.
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16. CONSTRUCTION VEHICLES (INCLUDING WORKER AND COMPANY VEHICLES).
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17. MECHANIZED AND OR SPECIALIZED EQUIPMENT- e.g. conveyors, mortar mixers, drilling equipment, etc.
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18. FIRE PROTECTION/PREVENTION - e.g. fire extinguishers, fire watch, hot work permit, etc. required for work actitty/scope.
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19. HOT WORK - INCLUDING WELDING, CUTTING, BRAZING AND OTHER SPARK GENERATING WORK ACTIVITIES/EXPOSURES.
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20. Material Handling/Storage/Use/ Disposal - Reference Hazardous Materials Management Plan
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21. Concrete Work - identify task/location, e.g. foundation, floor slab, sidewalk, curb &gutter, etc.
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22. Masonry - Identify type of material, e.g. CMU, brick, stone, etc. - task, e.g. wall, retaining wall, veneer, etc. - location.
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23. Drywall/Plastering - Identify installation, location, tools, equipment.
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24. Mechanical Trades - Identify space worked (including confined space) - installation/specific task - location - tools - equipment.
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25. Painting - Identify paint/material used - location - equipment (including lifts, ladders, compressors, heaters, fans, lights) proximity to other trades, tools, etc.
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26. Plumbers/Pipe Fitters - identify space worked (including confined spaces), equipment, tools (including power tools), materials used (e.g. solvents, joint compounds, cleaners, etc.), locations, inclusive activities (e.g. trenching, hot work, grinding, etc.), type of work (e.g. installing water line, etc.)
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27. Steel Erection/Iron Worker/Millwright - Identify the broad scope of work included - heights of work over 6 feet - if steel erection checklist is completed - equipment/tools used, proximity of other trades, location.
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28. Cranes,Hoists/etc. - Identify type, loads, capacity, location, schedule, certified operators/riggers/signalers, scope of operations, type of lifts performed, project site coordination required, etc.
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29. Carpentry - Identify scope of work tasks, location, equipment (e.g. power saws, scissor lifts, fork lifts, power sanders, etc.), location, proximity to other trades, work above exposures, leading edge work, etc.
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30. Glass Work - identify work activities e.g. cutting, window installation, cleaning, work above, etc. Identify locations, materials, equipment, tools, proximity to other trades, etc.
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31. Landscaping - Identify work activities included (e.g. grading, sprinkler installation, mulching, seeding (type), planting trees, installing SWPPP BMPs,) locations, proximity to other trades, equipment, tools, etc.
POTENTIAL HAZARDOUS EXPOSURES
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* Potential Work area hazards:<br><br>1. Slip/Trip/Fall hazards from ________________ (e.g. trash, materials, debris, metal strips, water, snow, ice, lose dirt, saw dust, etc.)<br>2. Falling objects from work above<br>3. Vehicular/heavy equipment traffic<br>4. Site environmental Exposures (e.g. unstable hill sides, creek beds, dead trees,etc.) weather conditions, heat/cold stress, site conditions (e.g. landfills, building conditions asbestos, lead, structural, etc.) <br>5. Toxic vapor/mist atmosphere (e.g. carbon monoxide, oxygen deficient, VOCs, LELs, etc.)<br>6. Hazardous exposures generated by other trades.<br>7. Other trades exposed to hazards generated from your work activity.<br>8. Severe weather hazardous exposures (e.g. storms, tornado, wind, dust,etc.) <br>9. Eye Hazards<br>10. Hearing Hazards (hazardous noise level exposures)<br>11. Fall Hazards<br>12. Struck by Hazards<br>13. Caught Between<br>14. Electrical<br>15. Worker behavior hazards, including lack of knowledge, lack of focus, etc.) <br>
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1. Falling hazardous exposure: including leading edge work, heights 6 feet and over, excavations deeper than 6 feet.
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2. Fall from ladders - As caused by worker behavior/use, condition of ladder, capability of the ladder, stability of the ladder, ladder being exposed to being moved or falling, etc.
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3. Scaffold hazardous exposures - Including access/egress, scaffold condition, work platform, structural integrity, secured, stable, damaged/missing components, overloading, missing fall protection, worker behaviors, improper use of scaffold, weather hazards (e.g. wind, etc.), other trades exposed, work above exposures, falling objects exposure, etc.
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4. Stairways - access/egress hazards, e.g. slip/trip/fall hazards due to incomplete step surface, materials, debris, tools, or equipment. falling hazard due to unprotected/not fully protected edges, falling object exposures, staging hazards, etc.
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5. Excavation - Cave-in hazard, soil repose hazard, access/egress injury hazard, unknown exposure hazard, slip/trip/fall hazard, fall over 6 feet hazard, work path/area instability, water hazard, hazardous vapor atmosphere, electrical hazards (including buried power lines, proximity to live power, etc), heavy equipment operation (behaviors), work surface hazards, unknown soil condition hazards, other trades/public exposed to excavation hazards, excavation workers exposed to other trades/public generated hazards, etc.
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6. & 7. - live electrical power exposure, wiring/equipment damaged or in poor condition exposure, worker behaviors, arc flash hazardous exposures, electrical hazardous exposures to other trades, water hazards, unknown live power locations, non-GFCI power distribution, inadequate lighting hazards, etc.
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8. Gas Lines/ distribution - unknown location of gas lines/distribution/hazardous exposure, fire hazards, toxic vapors (e.g. propane - carbon monoxide exposure), etc.
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9. Sewer Lines - Confined space hazards, hazardous atmospheres (e.g.hydrogen sulfide, oxygen deficiency, etc), lighting hazards, cave-in hazards, equipment/tools hazards, access/egress hazards, emergency response hazards, unsafe or unexpected worker behaviors/work condition hazardous exposures, etc.
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10. Water Lines hazards - Includes excavation hazards (e.g. cave in hazards, unknown exposures to utility lines/distribution hazards, unsafe or unexpected work behavior/conditions exposures, confined space hazards, damaged equipment/tools hazards, etc.
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11. Storm Water - Potential erosion, sediment release, contaminated ground water, contaminated water, etc.
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12. Hoisting/Rigging Hazards - using unsafe/improper method, damaged/defective rigging, unsafe/improper work base,falling object hazardous exposure, ` proximity of other trades, work below live loads, equipment failure, surpassing load capacity, unknown hazards in work areas/load travel path, etc.
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13. Confined Space Hazards - Workers, public not knowing the space is a confined space/hazardous area. Identify potential hazardous atmospheres, e.g. oxygen deficiency, carbon monoxide, hydrogen sulfide, Lower Explosive Limit vapors/mist, Volatile Organic Compounds, flammable, electrified, asbestos, lead, etc.
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14. Demolition Hazards - Workers/public not knowing the area is exposed to demolition hazards. - unknown live power exposures, unknown gas/utility hazardous exposures, falling/flying material or debris (eye, stuck by, falling object hazards), slip/trip/fall hazards, potentially hazardous atmospheres (e.g. asbestos,carbon monoxide, lead, oxygen deficient, LEL, VOC, flammable, etc.), hazardous noise levels, etc.
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15. Construction Heavy Equipment Hazards - Equipment operation failures, inaudible back up alarms, unstable base, over load, falling loads, proximity of workers/other trades/public, struck by, noise level (hearing), heat/cold, unknown work area hazards (e.g. work area topography, traffic, etc.).
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16. Construction Vehicle (including worker and company vehicles) Hazards - Worker Exposed Traffic, Struck By Hazards, Hazard Recognition, Driver/Worker Pre-Hazard Recognition, Driver/Worker Reaction Time, Work Path Exposures, Driver/Worker Focus, Path of Travel, etc.
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17. Mechanized and/or Specialized Equipment Hazards - worker exposure to live power or moving parts, hazardous proximity of other workers /trades,<br> eye hazards, noise level hazards, caught between hazards, struck by hazards, other workers/trades generating unknown hazardous exposures, etc.
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18. Fire (Protection/Prevention) hazards - Flammables, work area exposures, hot work worker/materials protection, worker/fire watch lack of knowledge or focus, proximity of other workers to hot work or fire hazard exposures, properly sized and operable fire extinguisher (method) readily available, safe egress from fire exposure, worker behavior, etc.
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19. Hot Work (including Welding) Hazards - Fire (protection/prevention) hazards, escaping gas from cylinders (propelled cylinders, flammable/explosive vapors), eye hazardous exposure, struck by hazardous exposure, spark hazards, ignition hazards, etc.
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20. Material Handling/Storage/Use/Disposal Hazards - Worker/other trade/site personnel fire/health/reactive/specialized hazardous exposures, storage/transport/disposal hazardous exposures, environmental damage hazards, improper use risk hazards, workers not understanding of how to safely store/use/dispose of the material, improper tool/equipment use, improper ergonomics by workers/material handlers, etc.
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21. Concrete Work Hazards - eye hazardous exposure, hazardous exposures to the skin, unknowledgeable/unfocused workers, ergonomic risk exposures, impalement hazards, struck by hazards, work above hazards (including falling object hazards, structural design hazards (load bearing), proximity to hazardous exposures by other trades/workers, equipment hazards, traffic hazards, tool utilization hazards, etc.
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22. Masonry Hazards - Material Handling, Concrete (mortar) Work, Scaffold Hazardous Exposures, slip/trip/fall hazardous exposures, electrical hazardous exposures, FallHazards, Impalement Hazards, Mechanized/Specialized Equipment Hazards, , Falling Object Hazards, proximity of other trades/workers risk, eye hazards, hearing hazards, weather hazards, heat/cold exposures, Fire Hazards, Equipment (fork lifts/aerial lifts/scissor lifts) Hazards Unsafe Worker Behavior, Hazard Recognition Risk, etc.
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23. Drywall/Plastering Hazards - Mechanized/Specialized Equipment Hazards, Struck By Hazards, Caught Between Hazards, Electrical Hazards, tool use Hazards, ladder hazards, proximity of other workers/trades to work exposures, Powder actuated Tools, Worker Unsafe Behaviors, etc.
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24. Mechanical Trades Hazards - Confined Space Hazards (limited egress, potentially hazardous atmospheres (e.g. carbon monoxide, oxygen deficient, etc.) struck by hazards, falling object hazards, ladder hazards, fall hazards, electrical hazards, caught between hazards, fire hazards, welding hazards, equipment hazards, tool hazards, aerial lift hazards, scaffold hazards, worker unsafe behaviors, lack of worker understanding of procedures/hazards,etc
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25. Painting Hazards - Hazardous Atmosphere (vapors, particulates, etc.), aerial and scissor lift hazards, scaffold hazardous exposures, ladder usage hazards, eye hazards, falling object hazards, fall hazards, electrical hazards, material usage/storage/disposal hazards, access/egress hazards, environmental (including SWPPP Hazards), work/other trades proximity hazards, fire (protection/prevention) hazards, slip/trip/fall hazards, ergonomic hazards, worker behavior hazards, etc.
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26. Plumbers/Pipe Fitters Hazards - Confined Space Hazards, Struck By Hazards, Ergonomic Related Hazards, Hazardous Materials Usage/Exposure Hazards, Specialized Equipment Usage Hazards (including electrical, exposed moving/spinning/cutting parts, eye injury, accumulated trauma, face injury), Fire Hazards, Hearing Hazards, Other Workers/Trades Exposed to Hazards, Ladder Hazards, AerialLifts/Scissor Lift hazards, Scaffold Hazards, Falling Object Hazards, Fall Hazards, Worker Behavior/Knowledge Hazards, Power Tools Hazards, Tool Hazards, etc.
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27. Steel Erection/Iron Worker/Millwright Hazards - Falling, Falling Objects, Ladders, Aerial Lifts, Fork Lifts, Welding, Slip/Trip/Fall, Unidentified Hazardous Work Areas, Fire (Protection/Prevention), Leading Edge, Deficient PPE, Worker Behavior/Focus/Knowledge, Impalement, Equipment, Tools, Electrical, Struck By, Slip/Trip/Fall, Other Workers/Trades Exposed to Hazards, Cranes, Material Handling, Structural Loading, Rigging, Emergency Rescue, Access/Egress, etc.
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28. Crane Hazards - Travel path stability, deficient set-up (crane falling), worker/other trades exposed during set up, Operator error (including lack of knowledge or focus), deficient crane operation (e.g. loss of hydraulics, etc.), load extended beyond stability triangle, improperly secured/ unsafe load (rigging error), worker other trade struck by hazardous exposure, work or travel below live load, hazardous proximity to live power, traffic, stability and load capacity of work base, etc.
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29. Carpentry Hazards - Struck By, Tools, Power Tools, Electrical, Ergonomic Related, Slip/Trip/Fall, Falling Objects, Fall Hazards, Ladder Hazards, Other Workers/Trades generated exposures, Electrical, Caught Between, Equipment Moving Parts Exposure, Aerial Lifts/Scissor Lifts, Material Handling, Specialized Equipment, Worker Behavior/Focus/Knowledge, Weather, Heat/Cold, Fire, Environmental, Hazardous Atmospheres (including Carbon Monoxide), Confined Space, etc.
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30. Glass Work Hazards - Struck By (including cut/puncture injuries), tool usage hazards (including worker behavior and tool condition), Other Worker/Trades proximity to glass work area hazards, ladders, equipment, electrical, slip/trip/fall, etc.
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31. Landscaping Work Hazards - Construction Heavy Equipment Hazards, Ergonomic, Struck By, Caught Between, Traffic, Falling Objects, Slip/TRip/Fall, Eye, Hearing, Environmental, SWPPP, Tools (Hand and Power), Foot Injury,Heat/Cold, Worker Behavior (knowledge/focus), etc.
Integrated Safety and Health Action Plan (Procedures)
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All Workers/Employees are site specific safety oriented as approved by Roche Constructors prior to starting work. Documented.
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Competent Person Inspection
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SWPPP BMPs per work activity are installed, maintained prior to and throughout the work activity.
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Workers/Employees trained in specific activity safety plan (Pre-Work Hazard Analysis)
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Drinking Water (disposable cups and/or properly labeled personal drinking containers) are readily accessible.
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Work Area/Work Paths are kept free of trip/slip/fall hazards,i.e. trash, debris, materials, etc.
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Controlled Access Zone (CAZ): Danger
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Controlled Access Zone (CAZ): Caution
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Safety Cones/Delineators - Hazard Identification
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Fencing installed - Restricted, controlled access to area, opening, etc.
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Barricades used to restrict/control access to hazard exposure.
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Guardrails
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Safety Cables (flagged at least every 6 feet) - deflecting not more than 3 inches checked and maintained.
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Toeboards
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Scaffold inspected by Competent Person prior to beginning work. Scaffold tag shall be initialed/signed and dated as safe to use for the specific work activity. If it is not safe to use, the scaffold shall be tagged Danger - Do Not Use..
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Scaffold workers trained and are knowledgeable to recognize scaffold hazards and not work on an unsafe scaffold.
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Scaffold erection/dismantle fall protection plan approved by Roche Constructors.
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Fall Protection Plan specific to the work activity approved by Roche Constructors and all activity workers trained regarding the plan prior to starting work.
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Scaffolds: Baseplates/Mud sills secured with nails or other Roche Constructors approved method. Fully planked with scaffold grade planking in good condition Guyed, tied, braced, or equivalent to prevent tipping.
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Hazardous Materials specific to the worker's potential exposure on this site have been inventoried. MSDSs readily available on site and the workers/employees trained in the material's use prior to starting work. All containers properly labeled. Site specific Hazardous Waste/Universal Waste plan (procedures) is trained and implemented.
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Power Lock Out/ Tag Out
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GFCI checked (documented) and used at power outlet.
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Electrical flex cords (aka. extension cords) are visually inspected: construction grade, minimum gage of 14 (only minimum gage of 12 may be repaired), and in good condition.
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Weather conditions monitored and work shall be suspended with severe weather conditions causing hazardous work conditions, e.g. high winds, ice/snow slipping not resolved, etc.
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Construction Heavy Equipment safety practices including pre-operation equipment inspections, clearly audible back up alarms, work areas identified and controlled, operators with documented training and/or certification, workers/other trades wearing safety vests, etc.
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Excavation; Slope or bench soil as required for type of soil.
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Excavation: Competent Person not only prior to work inspection, but also frequent soil inspections during the working shift to identify newly generated hazardous conditions and the reclassification of the working area soil.
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Excavation: Trench Box installation
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Excavation: Shoring or shielding installed.
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Excavation: Clearly identified with spoils, signage, CAZs, etc.
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Signs, Signage specific to hazard, conditions, requirement (e.g. Danger - Work Above, Danger - Laser in Use, Danger - Do Not Enter, FIRE EXTINGUISHER with an arrow, EXIT, etc.
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Environmental Testing, e.g. Carbon Monoxide gas monitoring, Oxygen Deficiency, decibel meter (noise), Silica monitoring, etc.
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Hardhats
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Safety Glasses
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Face Shield
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Ear plugs, Ear Muffs, etc.
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Personal Fall Arrest - harness and (shock absorbing) lanyard.
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Steel Toe Boots
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Metatarsal Guards
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Dust Masks (including employee training requirements per 29 CFR 1910.134 Appendix D -Information for Employees Using Respirators When Not Required Under The Standard (Mandatory).
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Negative Air Half Face Respirator
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Emergency Exit/Egress, Plan/Map, Workers Trained
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Emergency Rescue Equipment: Tripod/Winch, special lifts,etc.
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Disposable (paper suits/pants/shirts/etc). Arc Flash Suits.
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Gloves. Disposable Gloves. Insulated Gloves. Cut Resistant Gloves. Chemical Resistant Gloves.
SIGNATURES
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