Safety Documentation Checklist

• Compass Safety Documentation Checklist

• Job

• Company

• Conducted on

  Date

• Tracey Kallunki

WAC 296-155-110 Program Elements Required in SSSP

• Company Safety Plan Signed by Safety Representative

  Yes

  No

  N/A

• Job Hazard Analysis completed and site-specific?

  Yes

  No

  N/A

• Employee signed to confirm review of SSSP

  Yes

  No

  N/A

• Fall Protection Work Plan completed for tasks >10 feet?

  Yes

  No

  N/A

• Designated Site Safety Representative - includes on the job training for new employees

  Yes

  No

  N/A

• Procedures to Report Injuries (How, Where, When) Accident Investigation

  Yes

  No

  N/A

• Procedures to Report Unsafe Conditions and Practices

  Yes

  No

  N/A

• Procedures for First Aid & Emergency Procedures

  Yes

  No

  N/A

• Personal Protective Equipment

  Yes

  No

  N/A

• Fall Protection Program

  Yes

  No

  N/A

• Disciplinary Action Policy

  Yes

  No

  N/A

• Fire Prevention and Protection

  Yes

  No

  N/A

• Heat Stress Program

  Yes

  No

  N/A

• Safety Data Sheets

  Yes

  No

  N/A

• Outlined Accident Prevention Program in Written Format

  Yes

  No

  N/A

• Hazardous Communication Program

  Yes

  No

  N/A

Documents Kept On Site

• Orientations (Compass and subcontractor)

  Yes

  No

  N/A

• Safety Meetings

  Yes

  No

  N/A

• Weekly Safety Audits

  Yes

  No

  N/A

• Equipment Inspections (Forklift, Scissor and Aerial Lifts, Crane)

  Yes

  No

  N/A

• Scaffold Inspections

  Yes

  No

  N/A

Required Program Elements if Part of Scope

• Work From Ladders

  Yes

  No

  N/A

• Trenching and Excavating (WAC 296-155 Part N)

  Yes

  No

  N/A

• Cranes and Rigging (WAC 296-155 Part L & F)

  Yes

  No

  N/A

• Welding and Cutting (WAC 296-155 Part H)

  Yes

  No

  N/A

• Exposure to Respirator Hazards - Respiratory Program (WAC 296-220)

  Yes

  No

  N/A

• Noise Exposure above 85 dBA's - Hearing Conservation Program (WAC 296-155-210)

  Yes

  No

  N/A

• Confined Spaces (WAC 296-155-203)

  Yes

  No

  N/A

• Asbestos Abatement (WAC 296-65)

  Yes

  No

  N/A

• Powder Actuated Tools (WAC 296-155-363)

  Yes

  No

  N/A

• Traffic Control (WAC 296-155 Part E)

  Yes

  No

  N/A

• Steel Erection (WAC 296-155 Part P)

  Yes

  No

  N/A

• Demolition (WAC 296-155 Part S)

  Yes

  No

  N/A

• Concrete, Concrete Forms, Shoring, Masonry (WAC 296-155-Part O)

  Yes

  No

  N/A

• Use of Electrical Equipment (including cord and plug tools) (WAC 296-155-280)

  Yes

  No

  N/A

• Work on Energized Conductors (WAC 296-155 Part I)

  Yes

  No

  N/A

• Comments

• Assistant Superintendent

  Sign

• Safety Representative

  Sign