Safety Assessment Wireless - duplicate

• Document No.

• Crew Leader / Foreman

• Client / Site

• Weather Conditions

• Conducted on

  Date
• Location
  Address

• Prepared by

• Personnel

A. Personal Protective Equipment

• Hard Hats in use by all personnel (1= auto fail)<br>

  3

  2

  1

  0

• Eye protectin in use by all personnel

  3

  2

  1

  0

• Reflective vest worn by all personnel

  3

  2

  1

  0

• Hearing protection in use when required

  3

  2

  1

  0

• Proper Foot Wear ?

  3

  2

  1

  0

• Proper clothing ( FR if applicable )

  3

  2

  1

  0

• RF monitor onsite for tower and/or civil crews.

  3

  2

  1

  0

B. Fall protection

• PFAS inspected daily prior to use and documented?

  3

  2

  1

  0

• 100% fall protection over 6 feet?(1= Auto fail)

  3

  2

  1

  0

• Is fall protection equipment working properly?

  3

  2

  1

  0

• Employees tied to adequate anchorage point? (1= auto fail)

  3

  2

  1

  0

• PFAS consist of a full body harness and a double hook shock absorbing lanyard

  3

  2

  1

  0

• Tower rescue kit available at the bottom of the tower.

  3

  2

  1

  0

• At a minimum one professional on the ground trained in tower rescue.

  3

  2

  1

  0

• does the team have a suitable rescue plain? (ask all the team members)

  3

  2

  1

  0

C. Rigging

• Rigging inspections completed and recorded. (1= Auto fail)

  3

  2

  1

  0

• Rigging plain has been discussed.

  3

  2

  1

  0

• All tag lines are being used.

  3

  2

  1

  0

• All capacity tags attached to the slings are legible.

  3

  2

  1

  0

D. Work site

• Warning devices (ADB wireless sign)

  3

  2

  1

  0

• Safety cones in good condition and placed correctly

  3

  2

  1

  0

• Traffic taper correctly positioned

  3

  2

  1

  0

• Brakes set on truck / Chock on unhitched trailers

  3

  2

  1

  0

• Equipment properly secured on truck / trailer

  3

  2

  1

  0

E. General

• Cathead is mounted properly and secured to a sufficient anchorage point.

  3

  2

  1

  0

• Cat head operator controls in good working order.

  3

  2

  1

  0

• A rope locking bar or device is in place on the cathead

  3

  2

  1

  0

• First aid kit / Eye wash available

  3

  2

  1

  0

• Good housekeeping and material storage

  3

  2

  1

  0

• Extension cords in good condition (must have a ground) (not a trip hazard)

  3

  2

  1

  0

• All power and electrical tools are in good condition (must have a ground if not double insulated)

  3

  2

  1

  0

• JSA completed and reviewed by all employees (1= Auto fail)

  3

  2

  1

  0

• Fire extinguisher: good condition; current inspection tag; within 50 ft

  3

  2

  1

  0

F. Ladders

• proper ladder usage

  3

  2

  1

  0

• Ladders are in good condition

  3

  2

  1

  0

• Side rails extend 36 inches above landing.

  3

  2

  1

  0

• Step ladders are used in the fully opened position.

  3

  2

  1

  0

• Is The top of the ladder secured.

  3

  2

  1

  0

• Are ladders at the proper slope (4 to 1)

  3

  2

  1

  0

G. D.O.T.

• Lights / reflectors / beacons operational

  3

  2

  1

  0

• Truck inspection completed

  3

  2

  1

  0

• Truck cab neat / vehicle clean

  3

  2

  1

  0

• Trailer properly mounted and free of debris

  3

  2

  1

  0

• Tires with in acceptable tread depth

  3

  2

  1

  0

ANY other Hazards/Need to know info

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