Safety Observation Report

• Project Number/Name

  Select

• Conducted on

  Date

Please Select Add To Input Findings

Negative Findings

• What category did you have a negative finding?

  Select Body Use & Positioning Confined Space Equipment Operation Trenching/Excavation Electrical Fall Protection Hand & Power Tools Housekeeping/Working Surfaces Ladders Person Protection Equipment Rigging & Lifting Other

  • Body Use & Positioning
  • Confined Space
  • Equipment Operation
  • Trenching/Excavation
  • Electrical
  • Fall Protection
  • Hand & Power Tools
  • Housekeeping/Working Surfaces
  • Ladders
  • Person Protection Equipment
  • Rigging & Lifting
  • Other

• Body Use & Positioning findings:

  Select Body in line of fire Hand in line of fire Poor body mechanics

  • Body in line of fire
  • Hand in line of fire
  • Poor body mechanics

• Confined Space findings:

  Select No entry permit being used Continuous monitoring not performed No confined space attendant present No communication with entrants available Inadequate ventilation Gas monitor is due for calibration No retrieval equipment Did not eliminate or control hazards

  • No entry permit being used
  • Continuous monitoring not performed
  • No confined space attendant present
  • No communication with entrants available
  • Inadequate ventilation
  • Gas monitor is due for calibration
  • No retrieval equipment
  • Did not eliminate or control hazards

• Equipment Operation findings:

  Select Not wearing seat belt No daily equipment inspection Improper mounting/dismounting Operating erratically Operating at excessive speeds Operating too close to power lines Did not verify quick connect attachment Left machine unattended while running Left attachment in the air Backup alarm not functioning properly Operating rubber tired machine on slope Operator failed to recognize blind spot Operator exceeded load limit of machine Employee working underneath bucket

  • Not wearing seat belt
  • No daily equipment inspection
  • Improper mounting/dismounting
  • Operating erratically
  • Operating at excessive speeds
  • Operating too close to power lines
  • Did not verify quick connect attachment
  • Left machine unattended while running
  • Left attachment in the air
  • Backup alarm not functioning properly
  • Operating rubber tired machine on slope
  • Operator failed to recognize blind spot
  • Operator exceeded load limit of machine
  • Employee working underneath bucket

• Trenching/Excavation findings:

  Select Inadequate access/egress Improper sloping for soil type (1.5:1 for C & 1:1 for B) Inadequate shielding or shoring Tabulated data for trench box not readily available Daily inspection of excavation/trench not completed Spreader bar(s) are bent or damaged Pins are missing in spreader bar(s) Keepers are missing from pin(s) Spoils, materials and equipment placed within 2 feet from edge of trench Ladder not extended 3 feet above the box or grade Trench box set higher than the required 2 feet from the bottom of trench Trench box not backfilled on sides of box to prevent lateral movement Utilities not located or marks are faded Atmosphere not checked with air monitor @ 4 feet when a suspected hazardous atmosphere present Water accumulation present while workers inside trench box Probe rod not made of non-conductive materials

  • Inadequate access/egress
  • Improper sloping for soil type (1.5:1 for C & 1:1 for B)
  • Inadequate shielding or shoring
  • Tabulated data for trench box not readily available
  • Daily inspection of excavation/trench not completed
  • Spreader bar(s) are bent or damaged
  • Pins are missing in spreader bar(s)
  • Keepers are missing from pin(s)
  • Spoils, materials and equipment placed within 2 feet from edge of trench
  • Ladder not extended 3 feet above the box or grade
  • Trench box set higher than the required 2 feet from the bottom of trench
  • Trench box not backfilled on sides of box to prevent lateral movement
  • Utilities not located or marks are faded
  • Atmosphere not checked with air monitor @ 4 feet when a suspected hazardous atmosphere present
  • Water accumulation present while workers inside trench box
  • Probe rod not made of non-conductive materials

• Electrical findings:

  Select Extension cord not inspected Damaged extension cords Ground pin missing from extension cord Improper grounding (No GFCI or GFCI not working) Working with live circuits Skipping lockout/tagout procedures Forgetting required PPE

  • Extension cord not inspected
  • Damaged extension cords
  • Ground pin missing from extension cord
  • Improper grounding (No GFCI or GFCI not working)
  • Working with live circuits
  • Skipping lockout/tagout procedures
  • Forgetting required PPE

• Fall Protection findings:

  Select No inspection of PFAS or lifelines Incorrect fit of harness Not tied off when greater than 6 feet Not utilizing fall protection where required Incorrect anchor or tie off point Anchoring below dorsal D-ring Using damaged or recalled equipment Misuse of leading edge self-retracting devices Not meeting warning line system requirements Poorly designed horizontal lifelines Top rail not at 42" plus or minus 3" from working surface Top rail not capable of withstanding 200 pounds of force Mid rail not at least 21" high Mid rail not capable of withstanding 150 pounds of force No toe-board installed when using guard rails End of guard rail system not closed off

  • No inspection of PFAS or lifelines
  • Incorrect fit of harness
  • Not tied off when greater than 6 feet
  • Not utilizing fall protection where required
  • Incorrect anchor or tie off point
  • Anchoring below dorsal D-ring
  • Using damaged or recalled equipment
  • Misuse of leading edge self-retracting devices
  • Not meeting warning line system requirements
  • Poorly designed horizontal lifelines
  • Top rail not at 42" plus or minus 3" from working surface
  • Top rail not capable of withstanding 200 pounds of force
  • Mid rail not at least 21" high
  • Mid rail not capable of withstanding 150 pounds of force
  • No toe-board installed when using guard rails
  • End of guard rail system not closed off

• Hand and Power Tool findings:

  Select Poor condition Not inspected prior to use Using "modified" tool Missing handle or guard Loose or damaged blade in use No GFCI present on corded tool Bypassing safety device

  • Poor condition
  • Not inspected prior to use
  • Using "modified" tool
  • Missing handle or guard
  • Loose or damaged blade in use
  • No GFCI present on corded tool
  • Bypassing safety device

• Housekeeping/Working Surfaces findings:

  Select Walkways not clear and/or obstructed Work surfaces not clear and/or obstructed Insufficient lighting Sides or holes not guarded/covered where required Impalement hazards not mitigated

  • Walkways not clear and/or obstructed
  • Work surfaces not clear and/or obstructed
  • Insufficient lighting
  • Sides or holes not guarded/covered where required
  • Impalement hazards not mitigated

• Ladder findings:

  Select Ladder doesn't extend 3ft above landing Ladder is damaged Improper ladder use Ladder not at right angle (4-1 Lean Ratio) Ladder not inspected prior to use

  • Ladder doesn't extend 3ft above landing
  • Ladder is damaged
  • Improper ladder use
  • Ladder not at right angle (4-1 Lean Ratio)
  • Ladder not inspected prior to use

• PPE findings:

  Select Hardhat not worn Safety glasses not worn Dark glasses worn in dark environment Proper gloves not worn Face shield not worn Safety glasses not worn under face shield Respiratory protection not worn Incorrect respiratory protection Hearing protection not worn

  • Hardhat not worn
  • Safety glasses not worn
  • Dark glasses worn in dark environment
  • Proper gloves not worn
  • Face shield not worn
  • Safety glasses not worn under face shield
  • Respiratory protection not worn
  • Incorrect respiratory protection
  • Hearing protection not worn

• Rigging and Lifting findings:

  Select Rigging not inspected prior to use Rigging damaged and in use No tag lines Lifting too close to power lines Rigging overloaded Operator cannot see/communicate with spotter Improper rigging techniques Operator does know know the weight of the load Slings being used that show excessive wear Tags not legible

  • Rigging not inspected prior to use
  • Rigging damaged and in use
  • No tag lines
  • Lifting too close to power lines
  • Rigging overloaded
  • Operator cannot see/communicate with spotter
  • Improper rigging techniques
  • Operator does know know the weight of the load
  • Slings being used that show excessive wear
  • Tags not legible

• Other findings:

• Type of Violation

  OSHA Violation

  MSHA Violation

  Company Policy Violation

  Environmental Violation

  No Violation

• Specific OSHA Violation

• Specific MSHA Violation

• Specific Policy Violation

• Hazard Severity

  Select Catastrophic - A hazard, which may cause death, complete system loss, or severe equipment, property or environmental damage. Critical - A hazard, which may cause severe injury or occupational illness, major system loss, equipment, property or environmental damage. Marginal - A hazard, which may cause minor injury or minor occupational illness , marginal system loss, equipment, property or environmental damage. Negligible - A hazard, which does not cause injury or illness, system loss, equipment, property or environmental damage.

  • Catastrophic - A hazard, which may cause death, complete system loss, or severe equipment, property or environmental damage.
  • Critical - A hazard, which may cause severe injury or occupational illness, major system loss, equipment, property or environmental damage.
  • Marginal - A hazard, which may cause minor injury or minor occupational illness , marginal system loss, equipment, property or environmental damage.
  • Negligible - A hazard, which does not cause injury or illness, system loss, equipment, property or environmental damage.

• Photo

  Media

• Was the issue corrected?

  Yes

  No

  N/A

• What is the recommended corrective action?

• Who is responsible for the corrective action?

• When is the corrective action due?

  Date

• What was done to correct the issue? (who, what, when, where)

Positive Safety Findings

• What category did you have a positive finding:

  Select Body Use & Positioning Confined Space Equipment Operation Trenching/Excavation Electrical Fall Protection Hand & Power Tools Housekeeping Ladders Personal Protection Equipment (PPE) Rigging & Lifting Other

  • Body Use & Positioning
  • Confined Space
  • Equipment Operation
  • Trenching/Excavation
  • Electrical
  • Fall Protection
  • Hand & Power Tools
  • Housekeeping
  • Ladders
  • Personal Protection Equipment (PPE)
  • Rigging & Lifting
  • Other

• Comments:

• Inspected By

  Sign