Safety Audit / Inspection - RADCO

• Location
  Address

• Entity:

  DNI

  KURS

  Nevada

• Conducted On:

  Date

• Prepared By:

• Project Manager

• Superintendent

• Foremen

• Personnel Present:

Documentation & Health Requirements

• Copy of the Site Specific Safety Plan On-site?

  Yes

  No

• Medical Provider Information Included?

  Yes

  No

• 29 CFR § 1926.50 CCR T8 CSO § 1512

• Current Copy of the Kodiak IIPP & Code of Safe Practices On-site?

  Yes

  No

• The IIPP & Code of Safe Practices was last revised into one file for craft workers
  CCR T8 CSO § 1509

• Applicable Safety Data Sheets (SDS) On-Site for All Chemical Hazards Present?

  Yes

  No

  N/A

• 29 CFR § 1910.1200(b)(3)(ii) CCR T8 CSO 5194(i)(2)

• 29 CFR § 1926.20(b)(1) CCR T8 CSO § 1510(c) (CFR - Code of Federal Regulations, CCR - California Code of Regulations, T8 - Title 8, CSO - Construction Safety Orders)

• Job Hazard Analysis JHA Completed Daily & Signed By Personnel Present

  Yes

  No

• 29 CFR § 1926.20(b)(1) CCR T8 CSO § 1510(c)

• Tailgate Safety Meeting Completed The Current Week?

  Yes

  No

• 29 CFR § 1926. 21(b)(2) CCR T8 CSO § 1509(e)

• Fall Prevention Plan is Completed and Specific to This Site?

  Yes

  No

  N/A

• 29 CFR §1926.21(b)(2) CCR T8 CSO §1671.1

• Fall Rescue Plan Specific to This Site, Completed and Signed by Crew Members?

  Yes

  No

  N/A

• 29 CFR § 1926.502(d)(20) CCR T8 CSO § 1670(b)(14)

• What Type of Equipment Will Be Used to Rescue a Fallen Coworker?

• Kodiak Silica Exposure Prevention Plan Required for this Project?

  YES

  NO

• Is it Complete and Specific to this Project

  Yes

  No

• 29 CFR § 1926.1153 CCR T8 CSO § 1530.1

• Kodiak Heat Illness Prevention Plan Checklist Included?

  Yes

  No

  N/A

• Is it Completed and Specific to This Project?

  Yes

  No

  N/A

• 29 USC § 654(a)(1) CCR T8 CSO § 3395, (USC - United States Code)

• What is the Current Temperature On-site?

  Less than 70 Degrees F

  Between 70 - 80 Degrees F

  Between 80 - 90 Degrees F

  Between 90 - 100 Degrees F

  Over 100 Degrees F

• Adequate Supply of Water Available Onsite?

  Yes

  No

• Drinking Water Provided By:

  Select Water Bottles Purchased by Company Individual Supplied Water Water Not Available N/A

  • Water Bottles Purchased by Company
  • Individual Supplied Water
  • Water Not Available
  • N/A

• Is The Water Supply Being Maintained & Is Water Suitably Cool?

  Yes

  No

• Do Water Bottles Have Identifiable Markings?

  Yes

  No

• Water must not be too cold or warm. Coolers should be arranged so that water bottles are not submerged in icy water.

• Waste Container for Used Drinking Cups/Bottles Available?

  Yes

  No

• Trained and Certified CPR/First Aid Person On-site?

  Yes

  No

• Name of First Aid/CPR Trained Worker and Expiration Date of Certification:

• 29 CFR § 1926.50(c) CCR T8 CSO § 1512(b)

• First Aid Kit Readily Available?

  Yes

  No

• First Aid Contents in Good Condition, Stocked and Sterile?

  Yes

  No

• 29 CFR § 1926.50(d)(2) CCR T8 CSO § 1512(c)

• Is Work Performed or Equipment in Use That Requires a Fire Extinguisher to be Present? (Hot, Single Ply, Generator, Spark or Heat Producing Equipment)

  YES

  NO

• Does the Foremen Have an Available Fire Extinguisher Onsite?

  Yes

  No

• Fire Extinguisher(s) Charged and Free From Damage?

  Yes

  No

• Fire Extinguisher(s) Inspected & Inspection Tag Complete & Current?

  Yes

  No

• Fire Extinguisher(s) Available & Within 50 Feet of Where Hot Work is Performed?

  Yes

  No

  N/A

• Hot Work Permit Required?

  YES

  NO

• Is Hot Work Permit Complete?

  Yes

  No

• Has a Fire Watch Been Assigned?

  Yes

  No

• 29 CFR § 1926.504 CCR T8 CSO § 6777(e)

• 29 CFR § 1926.150(a) CCR T8 CSO § 6151(c)

• Eye Wash Station Required On-site?

  YES

  NO

• Container or Appropriate Means for Draining Used Eyewash Solution Available?

  Yes

  No

• Eyewash Station Clean and Accessible?

  Yes

  No

• Weekly Inspections & Operational Checks Completed?

  Yes

  No

• 29 CFR § 1910.151(c) CCR T8 CSO § 5162

• Site Weather or Other Conditions Present

  Select Clear Sunny Partly Sunny Partly Cloudy Cloudy Rain Humid Foggy Icy Snowing Smokey Windy

  • Clear
  • Sunny
  • Partly Sunny
  • Partly Cloudy
  • Cloudy
  • Rain
  • Humid
  • Foggy
  • Icy
  • Snowing
  • Smokey
  • Windy

• Notes:

Personal Protective Equipment (PPE)

• Employees Compliant with Kodiak / OSHA Dress Standards (Pants, Work Boots, Shirt with at least 4" sleeves)?

  Yes

  No

• 29 CFR § 1926.28(a) CCR T8 CSO § 1522(a)

• Hard Hats in Use by All Kodiak Personnel?

  Yes

  No

• 29 CFR § 1926.100 CCR T8 CSO § 1514(e)

• Safety Glasses in Use by All Kodiak Personnel?

  Yes

  No

• 29 CFR § 1926.102 CCR T8 CSO § 1514(e)

• Are the Correct Type of Safety Glasses Utilized for Conditions (Clear, Shaded etc.)?

  Yes

  No

• 29 CFR § 1926.102 CCR T8 CSO § 1514(e)

• Does the Foreman Have Spare Safety Glasses On-site?

  Yes

  No

• Kodiak Personnel Exposed to Vehicle Traffic Wearing Class II Hi-Visible Vests or Work-Wear?

  Yes

  No

  N/A

• 29 CFR § 1926.28(a) CCR T8 CSO § 1598(c)

• Hearing Protection Required?

  Select Not Required Yes & In Use Yes, But Not Utilized Foreman Does Not Have Available For Personnel

  • Not Required
  • Yes & In Use
  • Yes, But Not Utilized
  • Foreman Does Not Have Available For Personnel

• If You are Unable Carry-on a Normal Conversation with Another Person 3-4 Feet Away Without Raising Your Voice, Hearing Protection is Required. (≥85 dB 8 hour TWA-Time Weighted Average) 29 CFR § 1926. 101 CCR T8 CSO § 1521

• Hand Protection Required?

  Select Not Required Yes & In Use Yes, But Not Utilized Foreman Does Not Have Available For Personnel

  • Not Required
  • Yes & In Use
  • Yes, But Not Utilized
  • Foreman Does Not Have Available For Personnel

• Type of Hand Protection Required?

  Select Leather/Canvas/Cotton Rubber/Vinyl Dipped Cut Resistant Chemical Resistant Other Type Specific

  • Leather/Canvas/Cotton
  • Rubber/Vinyl Dipped
  • Cut Resistant
  • Chemical Resistant
  • Other Type Specific

• 29 CFR § 1926.Subpart E CCR T8 CSO § 1514(e)

• Face Shield Required for Work Performed?

  Select Not Required Yes & In Use Yes, But Not Utilized Foreman Does Not Have Available For Personnel

  • Not Required
  • Yes & In Use
  • Yes, But Not Utilized
  • Foreman Does Not Have Available For Personnel

• Face Shield Utilized in Addition to Safety Glasses?

  Yes

  No

  N/A

• 29 CFR § 1926.102 CCR T8 CSO § 1514(e)

• Safety Goggles Required for Work Performed?

  YES

  NO

• Safety Goggles in Use as Required?

  Yes

  No

• 29 CFR § 1926.102 CCR T8 CSO § 1514(e)

• Silica Dust Abated per the Kodiak Silica Exposure Control Plan?

  Select Yes No Control Measures Not Compliant/Effective N/A

  • Yes
  • No
  • Control Measures Not Compliant/Effective
  • N/A

• Workers Exposed to Silica Dust Operations Trained on the Proper Use of Tools, Methods?

  Yes

  No

  N/A

• Tools and Equipment Utilized Properly to Control Silica Dust Exposure?

  Yes

  No

• 29 CFR § 1926.1153 CCR T8 CSO § 1530.1

• Torch Applied/Hot Asphalt/Rubber Project?

  YES

  NO

• Name of Applicator(s)

• Are Applicators Certified?

  Yes

  No

• Torch Specific Training and Certification is Required by Kodiak's General Liability Insurance Policy.

• Shirts With Long Sleeves, Buttoned at the Wrist, Worn Personnel Working with Hot?

  Yes

  No

  N/A

• Pants Without Cuffs Worn by Personnel Working with Hot?

  Yes

  No

  N/A

• Type of Gloves in Use?

  Select Cotton/Kevlar/Leather Rubber/Vinyl Dipped Not Used N/A

  • Cotton/Kevlar/Leather
  • Rubber/Vinyl Dipped
  • Not Used
  • N/A

• Personnel Transporting Hot "Alerting" Co-workers When They are Approaching?

  Yes

  No

  N/A

• Kettle Man Wearing a ANSI Class II Hi-Visible Vest?

  Yes

  No

  N/A

• Face Shield Utilized in Addition to Safety Glasses by the Kettle Man as Well as the Person Filling Mop Carts, Buckets etc. With Hot?

  Yes

  No

  N/A

• Kettle Man been Trained in the Safe Operation of the Kettle?

  Yes

  No

  N/A

• Arc or Gas Welding Performed by Kodiak Personnel?

  YES

  NO

• Welder Wearing Leather Apron, Gloves and Appropriate Welding Helmet/Eye Protection?

  Yes

  No

• Welding Area Well Ventilated?

  Yes

  No

• 29 CFR § 1926 Subpart E CCR T8 CSO § 1514(e)

• Notes:

Fall Protection

• Roof Slope?

  Select Low Slope < or= 4:12 Steep Slope > 4:12 N/A

  • Low Slope < or= 4:12
  • Steep Slope > 4:12
  • N/A

• Scope of Work

  Select Single Ply Metal ACM HOT/BUR Cold Applied Tile/Shingle Other

  • Single Ply
  • Metal
  • ACM
  • HOT/BUR
  • Cold Applied
  • Tile/Shingle
  • Other

• Fall Protection Required on This Project?

  YES

  NO

• Personal Fall Arrest System (PFAS) Required?

  YES

  NO

• PFAS Utilized Per Kodiak Policy & OSHA Standards? <br>(Are Employees Tied Off or Not?)

  Yes

  No

• PFAS Components in Good Condition?

  Yes

  No

• Anchors Attached to Structural Members with Approved Screws and/or Hardware?

  Yes

  No

  N/A

• 29 CFR § 1926.502(d)(16) CCR T8 CSO § 1670(b)(10)

• Kodiak Personnel Utilizing PFAS in Fall Restraint Rather Than Fall Arrest or Excess Slack in Lifelines Minimized?

  Yes

  No

• 29 CFR § 1926.502 LOI -Letter of Interpretation "November 2, 1995, CCR T8 CSO § 1670(d)

• Kodiak Personnel Observing Swing Fall Conditions (< or = to 30 Degrees to Either Side of Anchorage)?

  Yes

  No

• 29 CFR § 1926 Subpart M Appendix C (m) CCR T8 CSO § 1670

• 29 CFR § 1926.502(a)(2) CCR T8 CSO § 1670(a)(3)

• Specialty Anchors in Use (Beam Straps, Standing Seam, Sky Mast, Fall Cart, Horizontal Lifeline etc.)?

  YES

  NO

• Are Horizontal Lifeline Components Installed Correctly (Posts, Cable, Cable Clamps etc.)?

  Yes

  No

  N/A

• 29 CFR § 1926.502(d)(8) CCR T8 CSO § 1670(b)(2)

• Standing Seam Anchors Attached Properly and Torqued (Over Panel Clips and Torqued to 50 ft lbs)?

  Yes

  No

  N/A

• Manufacturer Installation & Use Instructions

• Fall Protection Cart Set-up Properly and Inspected Daily?

  Yes

  No

  N/A

• Manufacturer Installation & Use Instructions

• SkyMast Post & Outriggers Installed Properly With Correct Fasteners?

  Yes

  No

  N/A

• Manufacturer Installation and Use Instructions

• Specialty Anchors Attached to Approved Locations/Elements on Roof/Structure?

  Yes

  No

  N/A

• 29 CFR § 1926.502(d) CCR T8 CSO § 1670(b)(10)

• Self Retracting Lifelines in Use?

  YES

  NO

• Condition of Self Retracting Lifeline

  Select Good/Acceptable Good but Labels/Decals Not Legible Needs Repair or Re-Certification

  • Good/Acceptable
  • Good but Labels/Decals Not Legible
  • Needs Repair or Re-Certification

• 29 CFR § 1926.502(d)(12) CCR T8 CSO § 1670(b)(7)

• 29 CFR § 1926.501(b)(1) CCR T8 CSO § 1670(a)

• Warning Line Required?

  YES

  NO

• Warning Line: System Condition

  Compliant

  Not Compliant

  No Warning Line Set-up

• Non-Compliant Conditions

  Select Too Much Sag in 2 or More Sections Height too High Flagging Set-Back From Edge Incomplete Path of Travel From Access Section(s) Tipped Over Other

  • Too Much Sag in 2 or More Sections
  • Height too High
  • Flagging
  • Set-Back From Edge
  • Incomplete
  • Path of Travel From Access
  • Section(s) Tipped Over
  • Other

• 29 CFR § 1926.502(f) CCR T8 CSO § 1730(b)(2)(B)

• Safety Monitor Approved for This Project?

  YES

  NO

• Safety Monitor Identified by Blue Hard Hat and Blue Vest?

  Yes

  No

• Safety Monitor Trained & Certified by Kodiak?

  Yes

  No

• Safety Monitor on Same Level as Personnel Being Monitored?

  Yes

  No

• 29 CFR § 1926.502(h) CCR T8 CSO § 1671.2(b)

• Guardrails in Use?

  YES

  NO

• Guardrail Type

  Select Job Made Wood/Metal Manufactured Portable Fiberglass, Metal Parapet Clamp Style Portable Permanent Fixed Other

  • Job Made Wood/Metal
  • Manufactured Portable Fiberglass, Metal
  • Parapet Clamp Style Portable
  • Permanent Fixed
  • Other

• Guardrails Compliant (Top, Mid Rails & Toe Boards)?

  Yes

  No

• 29 CFR § 1926.502(b) Top Rail 42" ±3" CCR T8 CSO § 1620(a)(1) Top Rail 42" - 45"

• Parapet Walls Used for Fall Protection at Least 39" high ?

  Yes

  No

  N/A

• 29 CFR § 1926.502(b) CCR T8 CSO §1730(c)(1)

• Safety Nets Utilized on This Project?

  YES

  NO

• Kodiak Personnel Familiar Working with Safety Nets?

  Yes

  No

• Note (Who is Responsible for Maintenance, Inspections & Name of Installer, etc.):

• 29 CFR § 1926.502(c) CCR T8 CSO § 1671(a)

• Skylights, Holes & Roof/Floor Openings Covered or Barricaded, secured and Identified?

  Yes

  No

  N/A

• 29 CFR § 1926.502(i) CCR T8 CSO § 1632

• Wall Openings Barricaded?

  Yes

  No

  N/A

• 29 CFR § 1926.501(b)(14) "Outside Edge to Lower Level ≥6' Inside Edge ≤39" High x ≥18" Wide", CCR T8 CSO § 1632(j) "Outside Edge ≥4' Inside Edge ≤36" High x ≥18" Wide"

• Roof Access Hatches Guarded or Barricaded?

  Yes

  No

  N/A

• 29 CFR § 1926.501(b)(4) CCR T8 CSO § 1632(c)

• Notes:

Ladders / Access

• Ladder type(s) in use?

  Select Extension Ladder Step Ladder Job Made Other N/A

  • Extension Ladder
  • Step Ladder
  • Job Made
  • Other
  • N/A

• Access Ladder(s) Tied-off to Prevent Displacement?

  Yes

  No

  N/A

• 29 CFR § 1926.1053(b)(7) CCR T8 CSO § 3276(e)(9)

• Ladder(s) Set-up Outside of Traffic Areas (Foot, Vehicle)?

  Yes

  No

  N/A

• 29 CFR § 1926.1053(b)(8) CCR T8 CSO § 3276(e)(14)

• Top of Ladder 3' (36") Above Landing Surface?

  Yes

  No

  N/A

• 29 CFR § 1926.1053(b)(8) CCR T8 CSO § 3276(c)(11)

• Step Ladders Used Properly (Not Leaning Against Wall or Vertical Surface etc.) ?

  Yes

  No

  N/A

• 29 CFR § 1926.1053(b)(4) CCR T8 CSO § 3276(e)(15)(C)

• Spreaders or Extension Locks Engaged Fully?

  Yes

  No

  N/A

• 29 CFR § 1926.1053(b)(4) CCR T8 CSO § 3276(e)(13)

• Non-conductive Ladders Used Around Electrical Elements (Power Lines, Panes etc.) ?

  Yes

  No

  N/A

• 29 CFR § 1926.1053(b)(12) CCR T8 CSO § 3276(e)(18)

• Ladder Condition

  Safe, No Defects or Damage

  Not Safe

• Unsafe Ladder Conditions:

  Select Rungs Spreader / Locks Side Rails Decals / Labels Feet Other

  • Rungs
  • Spreader / Locks
  • Side Rails
  • Decals / Labels
  • Feet
  • Other

• 29 CFR § 1926.1053(b)(16) CCR T8 CSO § 3276(e)(1)

• Elevation Changes from One Working / Walking Surface to Another Greater than 19"?

  Yes

  No

  N/A

• Safe Access Provided at Elevation Changes of 19" (Fed-OSHA) 18" (Cal-OSHA) or More?

  Yes

  No

• Type of Access:

  Select Stair Tower Extension Ladder Step Ladder Ramp/Stairs Platform with Proper access Step Bucket / Material Other

  • Stair Tower
  • Extension Ladder
  • Step Ladder
  • Ramp/Stairs
  • Platform with Proper access
  • Step
  • Bucket / Material
  • Other

• Note Other Access:

• 29 CFR § 1926.1051(a) CCR T8 CSO § 1629(a)(3)

• Notes:

Scaffolds

• Are Scaffolds Utilized by Kodiak Personnel?

  YES

  NO

• Who Is Supplying The Scaffolding?

  Kodiak

  General Contractor

  Other

• Type of Scaffold in Use?

  Select Self supported Mobile Swing Stage Utility Mobile Work Platform (Baker Style) Stair Tower

  • Self supported
  • Mobile
  • Swing Stage
  • Utility Mobile Work Platform (Baker Style)
  • Stair Tower

• Inspected & Tagged for Use? (green=safe, red=unsafe)?

  Yes

  No

• 29 CFR § 1926.451(f)(3) CCR T8 CSO § 1637

• Safe access provided?

  Yes

  No

  N/A

• 29 CFR § 1926.451(e) CCR T8 CSO § 1637(n)(1)

• Scaffold Legs Resting on Jacks or Base Plates and Mud Sills (2x10x10)?

  Yes

  No

  N/A

• 29 CFR § 1926.451(c)(2) CCR T8 CSO § 1644(a)(3)

• Cross-bracing, Guardrails, Mid Rails, End Rails in Place?

  Yes

  No

• 29 CFR § 1926.451(g)(4) CCR T8 CSO § 1644(a)(6)

• Scaffold Fully Planked?

  Yes

  No

• 29 CFR § 1926.451(b)(1) CCR T8 CSO § 1644(a)(7)

• Inside Edge Within 14" of Structure or 16" (Cal-OSHA), 18" (Fed-OSHA) When Utilized by Stucco Contractors?

  Yes

  No

  N/A

• 29 CFR § 1926.451(b)(3) CCR T8 CSO § 1644(a)(7)

• Toe Boards in Place Above Areas Where Personnel are Exposed to Falling Debris/Objects?

  Yes

  No

  N/A

• 29 CFR § 1926.451(h)(2) CCR T8 CSO § 1637

• Tie Backs in Place When Scaffold Exceeds 3:1 (California) or 4:1 (Federal) Base to Height Ratio?

  Yes

  No

  N/A

• 29 CFR § 1926.451(c)(1) CCR T8 CSO § 1646(a)

• Notes:

Electrical

• Are Fixed Electrical Panel(s)/Disconnect Box(es) Present in Work Area?

  YES

  NO

• Are Electrical Panel(s)/Disconnect Box(es) Required to be Moved During Work Activities?

  YES

  NO

• Has Electrical Power to Panel(s)/Disconnect Box(es) Been Shut Down?

  Yes

  No

• 29 CFR § 1926.416(a)(1) CCR T8 CSO § 1518(d)

• Has the Electrical Power Been Locked and Tagged Out to Prevent Unintended Start-Up?

  Yes

  No

• 29 CFR § 1926.417 CCR T8 CSO § 2940.3

• Has This Been Verified By Foreman?

  Yes

  No

• 29 CFR § 1926.417 CCR T8 CSO § 2940.13(h)

• Are Corded Electrical Tools or Extension Cords in Use on this Project?

  YES

  NO

• Extension/Power Cords

  Safe, No Defects or Damage

  Not Safe

• Unsafe Extension Cord / Power Cord Conditions:

  Select Torn/Cut/Burnt Outer Insulation Plug Ends Ground Prong Missing Exposed Conductors Electrical Tape Covering Damaged Cord Damaged/Defective Switch Other

  • Torn/Cut/Burnt Outer Insulation
  • Plug Ends
  • Ground Prong Missing
  • Exposed Conductors
  • Electrical Tape Covering Damaged Cord
  • Damaged/Defective Switch
  • Other

• 29 CFR § 1926.416(a) CCR T8 CSO § 2500.7(a)

• Proper Size Extension Cords Used?

  Yes

  No

  N/A

• 29 CFR § 1926.416(a) CCR T8 CSO § 2500.7(a)

• Extension Cords Routed Safely to Avoid Hazards (Vehicle Traffic, Sharp Edges, Wet Surfaces etc.) ?

  Yes

  No

  N/A

• 29 CFR § 1926.405(a)(2)(ii)(I) CCR T8 CSO § 2500.8

• Extension Cords Used Properly? (no Daisy-Chaining, Suspending Power Tools)

  Yes

  No

• 29 CFR § 1910.303(b)(2) CCR T8 CSO § 1518

• Power Strips Plugged Directly into Electrical Outlets & Not Extension Cords?

  Yes

  No

  N/A

• 29 CFR § 1926.403(b) CCR T8 CSO § 1518

• Electrical Power Feed Cable (from Generator on Truck/Ground) Secured to Prevent it From Falling From Roof?

  Yes

  No

  N/A

• 29 CFR § 1926.403(b)(2) CCR T8 CSO § 2803

• Spider box in use?

  YES

  NO

• Condition of Spider Box?

  Safe

  At Risk

  N/A

• Ground Fault Circuit Interrupters (GFCI) Utilized?

  Yes

  No

  N/A

• 29 CFR § 1926.404(b)(1) CCR T8 CSO § 2405.4

• Generator Electrical Control Panel & Outlets in Good Repair

  Yes

  No

  N/A

• 29 CFR § 1926.403 CCR T8 CSO § 1518

• Notes:

Hand / Power Tools

• Hand Tool Condition

  Safe

  At Risk

  N/A

• 29 CFR § 1926.301(a) CCR T8 CSO § 3556(a)

• Hand Tools Used Properly?

  Yes

  No

  N/A

• 29 CFR § 1926.Subpart H CCR T8 CSO § 3556(b)

• Utility Knives Account for a Large Number of Injuries Each Year. Hook Blades should only be used by workers when they are cutting long pieces of Single Ply Membrane, Ice and Water or Other Types of Underlayment. Hook Blades are not Allowed to be Used for Detail Work!!!

• Utilization of Utility Knives

  Select Safely Used and Stored Unsafe Use, Storage N/A

  • Safely Used and Stored
  • Unsafe Use, Storage
  • N/A

• Unsafe Use

  Select Non-Retractable Blades in Use Blades not Retracted When Not in Use Hook Blades Used for Detail Work Workers Cutting Toward Body / Body Parts Other

  • Non-Retractable Blades in Use
  • Blades not Retracted When Not in Use
  • Hook Blades Used for Detail Work
  • Workers Cutting Toward Body / Body Parts
  • Other

• Nail Guns in Use on This Project?

  YES

  NO

• Nail Gun Condition

  Safe Condition

  Needs Repair

• 29 CFR § 1926.302(b)(3) CCR T8 CSO § 1704

• Nail Gun Use

  Select Operator Using Tool Properly Nail guns Operators not Wearing Proper PPE Nail Guns Reloaded or Jams Cleared While Connected to Air Source Operator Holding Trigger When not Nailing Nail Guns left Unattended

  • Operator Using Tool Properly
  • Nail guns Operators not Wearing Proper PPE
  • Nail Guns Reloaded or Jams Cleared While Connected to Air Source
  • Operator Holding Trigger When not Nailing
  • Nail Guns left Unattended

• 29 CFR § 1926.302(b)(3) CCR T8 CSO § 1704

• Powder Actuated Tools in Use?

  YES

  NO

• Powder Actuated Tool Condition

  Safe Condition

  Needs Repair

• Users of Powder Actuated Tools Certified?

  Yes

  No

• 29 CFR § 1926.302(e)(1) CCR T8 CSO § 1685(a)(1)

• Powder cartridges should be stored in a secure location on the job site, such as a locked knack box. Eye and ear protection is required when using powder actuated tools.

• Powder Actuated Tools Utilized Safely?

  Yes

  No

• Unsafe Actions

  Select Operator not Wearing PPE Shooting into Walls w/Workers on Other Side Powder Charges Not Stored In a Separate Container From Tool Tool and/or Powder Charges left Unattended Other

  • Operator not Wearing PPE
  • Shooting into Walls w/Workers on Other Side
  • Powder Charges Not Stored In a Separate Container From Tool
  • Tool and/or Powder Charges left Unattended
  • Other

• 29 CFR § 1926.302(e) CCR T8 CSO § 1691

• Are The Powder Actuated Cartridges Stored In a Secure Location?

  Yes

  No

• Powder cartridges should be completely used before being disposed of. Empty cartridges should be placed in an empty bucket and emptied into the trash at the end of the day. Partially used cartridges should be fired and then disposed of. Unfired cartridges that have been hit but not fired need to be disposed of at a hazardous waste facility. 29 CFR § 1926.302(e)(12) CCR T8 CSO § 1689

• Are The Powder Actuated Cartridges Being Properly Disposed Of?

  Yes

  No

• 29 CFR § 1926.302(e)(12) CCR T8 CSO § 1689

• Notes:

Housekeeping

• 29 CFR § 1926.25 CCR T8 CSO § 1513

• Material Storage Areas Free From Trip/Slip Hazards?

  Yes

  No

  N/A

• Materials/Debris Stored on Roof or Elevated Surfaces at Least 6 Feet From Roof Edge?

  Yes

  No

  N/A

• Materials/Debris Secured to Prevent Displacement by Wind?

  Yes

  No

  N/A

• Work Areas Free From Excess Debris/Garbage?

  Yes

  No

• Slip/Trip Hazards Identified & Barricaded or Mitigated?

  Yes

  No

  N/A

• Flammable Materials/Chemicals Stored/Used Away From Heat/Flame/Spark Producing Activities?

  Yes

  No

  N/A

• 29 CFR § 1926.352(c) CCR T8 CSO § 1513

• Chemical Containers Appropriately Labeled With Contents & Warnings?

  Yes

  No

  N/A

• 29 CFR § 1926.1200(f)(6) CCR T8 CSO § 5194(f)(1)

• Alternate Chemical Containers Are Appropriate for Content and Labeled? (excludes immediate use containers)

  Yes

  No

  N/A

• Product Name/Identifier. This should match the product identifier on the safety data sheet.
  General Hazard Statement. This can be communicated with words, pictures symbols, or any combination thereof that provides at least general physical and health hazards associated with the chemical. 29 CFR § 1926.1200(f) CCR T8 CSO § 5194(f)

• Chemical Containers and/ or Lids Are Free From Punctures?

  Yes

  No

  N/A

• 29 CFR § 1926.1200 CCR T8 CSO § 5194

• New or Existing Construction?

  New

  Existing

  New & Existing

• Material Storage Area Barricaded to Prevent Unauthorized Personnel Access?

  Yes

  No

  N/A

• CCR T8 CSO § 3273(l)

• Are Fall Zones Barricaded to Prevent Exposure to Unauthorized Personnel?

  Yes

  No

  N/A

• 29 CFR § 1926.759(a) CCR T8 CSO § 3272(e)

• Paths of Travel Provided to Allow Unauthorized Personnel Safe Passage Around Potential Danger Zones?

  Yes

  No

  N/A

• 29 CFR § 1910.145 CCR T8 CSO § 1671.2

• Warning and/or Directional Signs Posted on Barricades & Paths of Travel?

  Yes

  No

  N/A

• 29 CFR § 1910.145 CCR T8 CSO § 1671.2

• Loading/Unloading Areas Barricaded During Loading/Unloading Activities?

  Yes

  No

  N/A

• 29 CFR § 1926.1424(a)(2)(ii) CCR T8 CSO § 4993.1

• General Public/Other Trades Protected from Potential Hazards Created by Kodiak Activities?

  Yes

  No

• ANSI/ASSP A10.34-2021 (ANSI - American National Standards Institute, ASSP - American Society of Safety Professionals)

• Are Intake Vents and A/C Units Covered to Prevent Fumes from Entering into Building/Work Spaces?

  Yes

  No

  N/A

• ANSI/ASSP A10.34-2021

• Notes:

Lifts / Cranes

• Fork Lifts or Aerial Lifts Currently in Use by Kodiak Personnel ?

  YES

  NO

• Type of Lift In Use?

  Select Forklift Aerial Boom Aerial Scissor

  • Forklift
  • Aerial Boom
  • Aerial Scissor

• Name of the Forklift Operator

• Name of the Aerial Boom Operator

  Select

• Name of the Aerial Scissor Lift Operator

  Select

• Operator(s) Certified?

  Yes

  No

• 29 CFR § 1926.453 & 1910.178 CCR T8 CSO § 3668

• Equipment & Site Inspections Completed Today?

  Yes

  No

• 29 CFR § 1926.453 & 1910.178 CCR T8 CSO § 3668

• Riggers / Spotters Wearing ANSI Class II Vests ot Shirts?

  Yes

  No

  N/A

• 29 USC § 64(a)(1) CCR T8 CSO §1598(c), 1599(d), & 1590(a)(5)

• Lifts Operated in Safe Manner (Speed, Observing Clearances, Looking Behind before Backing etc.)

  Yes

  No

• 29 CFR § 1910.178 CCR T8 CSO § 3650

• Crane Currently in Use by Kodiak on this Project?

  YES

  NO

• Is the Area Around the Crane Barricaded (Delineators & Caution / Danger Tape)?

  Yes

  No

  N/A

• 29 CFR § 1926.1424(a)(2)(ii) CCR T8 CSO § 4993.1

• Is the Fall Zone Identified & Barricaded/Other Protective Measures in Place

  Yes

  No

  N/A

• 29 CFR § 1926.1424(a)(2)(ii) CCR T8 CSO § 4993.1

• Rigger Person Trained and Certified?

  Yes

  No

• Name of Trained Certified Rigger?

• 29 CFR § 1926.753(c)(2) CCR T8 CSO § 4999(a)

• Signal Person(s) Trained & Certified?

  Yes

  No

• Name Signal Person(s):

• 29 CFR § 1926.1428 CCR T8 CSO § 5001(b)

• Signal Persons & Riggers Have Identified & Discussed Hazards ( Overhead, Fall Zones, Barricading ) With the Crane Operator?

  Yes

  No

• Operators, Signal Persons and Riggers Wearing an ANSI Class II Vests or Work Wear?

  Yes

  No

• Notes:

Miscellaneous

• Fuel Storage Containers OSHA Compliant?

  Yes

  No

  N/A

• 29 CFR § 1926.152(a)(1) CCR T8 CSO § 1930(a)(1)

• Propane Cylinders Stored Upright & Secured in Company Vehicle or On-Site?

  Yes

  No

  N/A

• DOT Regulation (DOT-Department of Transportation) 49 CFR § 173.315(j)(iii)

• Hot Work Performed (Spark, Heat or Flame Producing Work)?

  YES

  NO

• Type of Hot Work?

  Select Arc or Gas Welding Grinding Hot Asphalt/Rubber Metal Cutting or Routing Soldering Torch Down Operation Other

  • Arc or Gas Welding
  • Grinding
  • Hot Asphalt/Rubber
  • Metal Cutting or Routing
  • Soldering
  • Torch Down Operation
  • Other

• 29 CFR § 1910.252(a)(2)(iii) CCR T8 CSO § 6777(e)

• Notes:

• Kodiak Personnel Observed Lifting Material / Objects etc.?

  YES

  NO

• Observed Worker Lifting Properly?

  Yes

  No

  N/A

• Approximate Weight of the Material/Object Lifted?

  Select < 10 lbs 10 - 20 lbs 20 - 30 lbs 30 - 40 lbs 40 - 50 lbs 50 - 60 lbs > 60 lbs N/A

  • < 10 lbs
  • 10 - 20 lbs
  • 20 - 30 lbs
  • 30 - 40 lbs
  • 40 - 50 lbs
  • 50 - 60 lbs
  • > 60 lbs
  • N/A

• How Were They Lifting?

  Select Using Mechanical Equipment Using Proper Lifting Techniques Buddy Lift Unsafe Lifting Techniques Other

  • Using Mechanical Equipment
  • Using Proper Lifting Techniques
  • Buddy Lift
  • Unsafe Lifting Techniques
  • Other

• Kodiak Personnel Observed Moving Materials or Objects by Pushing and/or Pulling?

  YES

  NO

• Observed Worker Pushing/ Pulling Properly?

  Yes

  No

• What was the Approximate Weight of the Material or Objects Lifted or Moved?

  Select < 10 lbs 10 - 20 lbs 20 - 30 lbs 30 - 40 lbs 40 - 50 lbs 50 - 60 lbs > 60 lbs N/A

  • < 10 lbs
  • 10 - 20 lbs
  • 20 - 30 lbs
  • 30 - 40 lbs
  • 40 - 50 lbs
  • 50 - 60 lbs
  • > 60 lbs
  • N/A

• Unsafe Behaviors Observed During Inspections?

  YES

  NO

• Unsafe Behaviors Observed

  Select N/A Awkward Positions Repetitive Motions Forceful Exertion Contact Stress (Working on Knees, Striking /Kicking Object) Prolonged Vibration Slip/Trip/Fall Caught In/Between Hazard Struck By Hazard Using Tools Improperly Other

  • N/A
  • Awkward Positions
  • Repetitive Motions
  • Forceful Exertion
  • Contact Stress (Working on Knees, Striking /Kicking Object)
  • Prolonged Vibration
  • Slip/Trip/Fall
  • Caught In/Between Hazard
  • Struck By Hazard
  • Using Tools Improperly
  • Other

• How Was the Unsafe Behavior Addressed?

  Select Demonstrated/Explained Safe Behavior Stopped the Unsafe Behavior Verbal Warning Written Warning Informed the Foreman/Supervisor Other

  • Demonstrated/Explained Safe Behavior
  • Stopped the Unsafe Behavior
  • Verbal Warning
  • Written Warning
  • Informed the Foreman/Supervisor
  • Other

• Every employee is expected to work in a safe manner as they go throughout the day performing their tasks. Occasionally employees may go above and beyond what is expected of them. When this behavior is observed, we want to reward them in some way that recognizes this. If you don't directly observe this, ask the foreman in charge if he has observed this and who it is so that we can recognize this with a reward or recognition of some kind. The following questions should be answered after an observation by you or the foreman.

• Safe Behavior Observed that is above and beyond normal expectations?

  YES

  NO

• Describe What Was Observed

• Note Other Safe / Unsafe Behaviors (i.e. Climbing or Descending Ladder While Carrying Objects, Throwing Objects from Roof, Carrying Too Many Items etc.) :

Employee Training

• Did Employee Training Occur During This Visit?

  YES

  NO

• Who Was The Training With?

• Training Topic

  Select Documentation Safety Glasses/ Eye & Face Protection Hard Hat ANSI Class II Vest or Hi-Viz Shirt Other PPE PFAS Fall Protection Warning Line/Guardrails Skylight/Hole Protection Ladders Scaffold Fire Prevention Equipment Certification / Inspections Other

  • Documentation
  • Safety Glasses/ Eye & Face Protection
  • Hard Hat
  • ANSI Class II Vest or Hi-Viz Shirt
  • Other PPE
  • PFAS Fall Protection
  • Warning Line/Guardrails
  • Skylight/Hole Protection
  • Ladders
  • Scaffold
  • Fire Prevention
  • Equipment Certification / Inspections
  • Other
Employee Signature

• Employee Signature

  Sign
Employee Coaching

• Did Employee Coaching Occur During This Visit?

  YES

  NO

• Who Was The Coaching With?

• Coaching Topic?

  Select Documentation Safety Glasses/ Eye & Face Protection Hard Hat ANSI Class II Vest or Hi-Viz Shirt Other PPE PFAS Fall Protection Warning Line/Guardrails Skylight/Hole Protection Ladders Scaffold Fire Prevention Equipment Certification / Inspections Other

  • Documentation
  • Safety Glasses/ Eye & Face Protection
  • Hard Hat
  • ANSI Class II Vest or Hi-Viz Shirt
  • Other PPE
  • PFAS Fall Protection
  • Warning Line/Guardrails
  • Skylight/Hole Protection
  • Ladders
  • Scaffold
  • Fire Prevention
  • Equipment Certification / Inspections
  • Other
Employee Signature

• Employee Signature

  Sign

Review

• I Have Reviewed This Inspection With the Kodiak Safety Director (or Assistant) & I Will Take the Necessary Actions Needed To Correct and/or Mitigate Any Deficiencies Noted Here-in.

  Sign