Safety Compliance Confirmation

• Project Name

  Select
• Location
  Address

• Date

  Date

• Safety Manager

• Superintendent

• Weather Conditions

• Trade Partners Onsite

• Legal Disclaimer

Office Site Safety

• All workers currently on site have attended the required orientation?

• Emergency Response, Evacuation Plans and rescue procedure in place, muster points posted in field.

  Yes

  No

  N/A

• Safety bulletin board with safe workdays posted and current safety information

  Yes

  No

  N/A

• Toolbox safety meetings held weekly?

  Yes

  No

  N/A

• Trade Partner "competent person" identified

  Yes

  No

  N/A

• What trade partners have competent persons onsite?

• Weekly safety meetings held with Trade Partner's Competent Person

  Yes

  No

  N/A

• SDSs provided and maintained in field office

  Yes

  No

  N/A

• JHA's are completed as needed/required

  Yes

  No

  N/A

• All PTSPs completed as needed/required.

  Yes

  No

  N/A

• Emergency phone numbers posted in office areas and field.

  Yes

  No

  N/A

• Drinking water available

  Yes

  No

  N/A

• Toilet facilities available, accessible, and clean

  Yes

  No

  N/A

House Keeping

• Trade Partners inspect and clean work areas daily. (Clean as you work)

  Yes

  No

  N/A

• Walking surfaces clear, clean, trip hazard eliminated. Emergency routes through the construction area free of obstacles and marked in the field

  Yes

  No

  N/A

• Trash/construction debris emptied regularly, disposal area neat, receptacles available

  Yes

  No

  N/A

• Nails, scrap metal/wood, water bottles/cans picked up from previous days

  Yes

  No

  N/A

• Materials storage, proper segregation, stacked properly, chocked, no danger of falling

  Yes

  No

  N/A

PPE

• Hard hats, safety glasses, high visibility vests / clothing and safety footwear worn by craft / management

  Yes

  No

  N/A

• Safety glasses with secure side shields being worn if needed.

  Yes

  No

  N/A

• Face shields/goggles worn where appropriate

  Yes

  No

  N/A

• Hearing protection used where appropriate

  Yes

  No

  N/A

• Glove Program in effect and worn where needed

  Yes

  No

  N/A

• Respirators/dust masks worn where appropriate, program in place, fit test, etc. (Fit tests must be completed by Trade Partner)

  Yes

  No

  N/A

Fall Protection

• Are fall hazards present on the project?

  Select Yes No

  • Yes
  • No

• Are falls 6 feet and greater being protected?

  Yes

  No

  N/A

• Are personal fall arrest/ restrain systems being used?

  Yes

  No

• Adequate full body harnesses are being worn?

  Yes

  No

  N/A

• Are the full body harnesses being worn correctly?

  Yes

  No

  N/A

• All fall protection equipment is in good shape and being inspected prior to every use?

  Yes

  No

  N/A

• Anchorage points for fall arrest meet required ratings

  Yes

  No

  N/A

• Lanyards with correct shock absorbers and or retractable device and double locking clips - Ensure Fall risk and distance has been established

  Yes

  No

  N/A

• Perimeter guarding provided, perimeter cables or wire rope properly installed

  Yes

  No

  N/A

• Are controlled access zones adequately barricaded/signage to identify fall protection hazard. i.e. debris chutes

  Yes

  No

  N/A

• Are all Holes greater than 2" adequately protected?

  Yes

  No

  N/A

Site Safety

• Flaggers for mobile equipment movements

  Yes

  No

  N/A

• Containers, Chemical materials labeled (labels legible)

  Yes

  No

  N/A

• Fuels, flammable materials stored properly

  Yes

  No

  N/A

• Evacuation routes are foreseen of (temporary) emergency signage and orientation lighting (min. 5 Lux). Adequate task lighting provided as appropriate

  Yes

  No

  N/A

• Equipment/tools in good working condition and guards in place where needed

  Yes

  No

  N/A

• "Auto kill switch" at handle on grinders

  Yes

  No

  N/A

• Are all impalement Hazards protected? Impalement caps installed

  Yes

  No

  N/A

Ladders / Stairs

• Proper type of ladder being used

  Yes

  No

  N/A

• Ladders are inspected daily?

  Yes

  No

  N/A

• Are ladders being stored properly?

  Yes

  No

  N/A

• Conductive (metal) ladders not in use near electrical panels/rooms.

  Yes

  No

  N/A

• Extension ladders tied off, and/or footed and secure, extended 36" above landing, 4/1 slope maintained

  Yes

  No

  N/A

• Workers not using top two steps on ladders

  Yes

  No

  N/A

• Stairs provided where needed >19", secured

  Yes

  No

  N/A

• Stairs greater than 4 risers are equipped with a handrail?

  Yes

  No

  N/A

• Safe access/egress for the stairs, material being stored on the stairs?

  Yes

  No

  N/A

• Have the pan stairs been poured/filled to prevent a tripping hazard?

  Yes

  No

  N/A

Scaffolding

• Scaffolding being used onsite?

  Yes

  No

• All workers have been trained?

  Yes

  No

  N/A

• What type of scaffolding system is being used on the project?

• Is the scaffolding built correctly, safe, and secured?

  Yes

  No

  N/A

• Scaffold planking overlaps 12"

  Yes

  No

  N/A

• Safe access/egress for scaffolds

  Yes

  No

  N/A

• Working platforms at least 2 feet wide?

  Yes

  No

  N/A

• All workers are protected from falls from scaffold by guardrail?

  Yes

  No

  N/A

• Are workers below protected from falling hazards?

  Yes

  No

  N/A

• Are materials being dispersed immediately after being loaded?

  Yes

  No

  N/A

• Is the working surface clear of redundant materials?

  Yes

  No

  N/A

• Is the scaffolding being tagged properly and inspected daily?

  Yes

  No

  N/A

• All workers, working from the scaffolding have been trained by a qualified person?

  Yes

  No

  N/A

• All workers erecting, disassembling, moving, operating, repairing, maintaining, or inspecting a scaffold have been trained by a competent person?

  Yes

  No

  N/A

Welding and Cutting

• Hot Work taking place onsite?

  Yes

  No

• Hot work permit in use, hot work watch established?

  Yes

  No

  N/A

• Compressed gas cylinders secured with chain or wire?

  Yes

  No

  N/A

• Cylinders capped when not in use?

  Yes

  No

  N/A

• Oxygen and flammable gas cylinders kept 20 feet apart or approved 1/2 hour fire wall separation

  Yes

  No

  N/A

• Torch, hoses, gauges, regulators and cables in good condition. Torch equipped with flashback regula

  Yes

  No

  N/A

• No combustible material in vicinity of hot work

  Yes

  No

  N/A

• Welding screens used where needed

  Yes

  No

  N/A

• Fire Extinguisher within 25 feet of hot work?

  Yes

  No

  N/A

Lifting and Rigging

• Lifting and Rigging operations onsite?

  Yes

  No

• PTSP approved?

  Yes

  No

  N/A

• PTSP conference held onsite?

  Yes

  No

  N/A

• Swing radius protected at all time?

  Yes

  No

  N/A

• Daily and annual crane inspection documented?

  Yes

  No

  N/A

• Operator certification on hand?

  Yes

  No

  N/A

• Certified Rigger?

  Yes

  No

  N/A

• Qualified Signal Person?

  Yes

  No

  N/A

• What communication methods are being utilized?

• Pre-lift checklist completed?

  Yes

  No

  N/A

• Rigging equipment inspected prior to use, used properly,

  Yes

  No

  N/A

• Tag lines used to control loads

  Yes

  No

  N/A

• Is the ground stable?

  Yes

  No

  N/A

• Mud mats required?

  Yes

  No

  N/A

Excavation and Confined Space

• Trenches and excavations onsite?

  Yes

  No

• Soil classification identified

  Yes

  No

  N/A

• What is the soil classification?

• Describe the methods used to classify the soil?

• Trenches/excavations sloped properly or shored and barricaded

  Yes

  No

  N/A

• Adequate access in/out of excavations (max. 25')

  Yes

  No

  N/A

• Spoils, tools, paving materials etc. kept 3 feet back from excavation edge

  Yes

  No

  N/A

• Confined spaces work present onsite at time of the inspection?

  Yes

  No

• Confined Space: Air monitoring (including continuous) performed

  Yes

  No

  N/A

• Permit Required Confined Space: Testing/monitoring results noted on the permit.

  Yes

  No

  N/A

• Ventilation being utilized?

  Yes

  No

  N/A

• What testing / air monitoring system is being utilized?

• Permit Required Confined Space: Personnel properly trained

  Yes

  No

  N/A

• Permit Required Confined Space: Retrieval equipment available and used appropriately

  Yes

  No

  N/A

• Permit Required Confined Space: Standby attendant(s) present, communication means available

  Yes

  No

  N/A

Motorized Equipment

• Motorized equipment being used onsite?

  Yes

  No

• Operators are trained to operate?

  Yes

  No

  N/A

• Proper inspections performed/documented?

  Yes

  No

  N/A

• Rollover protection in place and maintained?

  Yes

  No

  N/A

• Equipment used safely?

  Yes

  No

  N/A

• Backup alarms, horns are in working order?

  Yes

  No

  N/A

• Seatbelts used by all operators?

  Yes

  No

  N/A

Electrical Safety

• All extension cords have been inspected prior to the start of work?

  Yes

  No

  N/A

• Cords in good condition, no cuts or repairs w/ tape Cables secured (through doorways etc.), and off floor as much as possible to minimize trip hazard

  Yes

  No

  N/A

• Power cords protected where routing through chases, doorways, floor openings, etc. All extension cords shall be elevated and not on the floor.

  Yes

  No

  N/A

• GFCIs used for lead cords, GFCIs tested monthly

  Yes

  No

  N/A

• Grounding in working order on power tools, equipment

  Yes

  No

  N/A

• Temp electrical panels labeled, grounded and secured.

  Yes

  No

  N/A

• Conduit tightly connected to junction/outlet box, all breakers labeled and field outlets w/ circuit #

  Yes

  No

  N/A

• Adequate illumination 5' candles

  Yes

  No

  N/A

• Temporary wiring; power/lighting isolated from building structure and not presenting trip hazard

  Yes

  No

  N/A

• Precautions taken where overhead lines are present, No Work within min 20' clear

  Yes

  No

  N/A

• Date and time of approval

  Date

• Approver's signature

  Sign