Safety Report Copy

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Administration

• Project site orientations up to date

  Yes

  No

  N/A

• Subcontractors submitting JHA forms daily

  Yes

  No

  N/A

• Subcontractor meetings being held weekly

  Yes

  No

  N/A

• Pre Construction meeting being held with documentation

  Yes

  No

  N/A

• Northstar Safety program manual on site

  Yes

  No

  N/A

• Northstar SDS book on site

  Yes

  No

  N/A

• Northstar eye wash station on site and useable

  Yes

  No

  N/A

• Northstar first aid kit on site and stocked

  Yes

  No

  N/A

• Northstar project team has valid CPR and first aid training

  Yes

  No

  N/A

Project Postings

• Project team phone numbers posted

  Yes

  No

  N/A

• Emergency phone numbers posted

  Yes

  No

  N/A

• Directions to hospital and minor emergency care facility posted

  Yes

  No

  N/A

• OSHA posters posted

  Yes

  No

  N/A

• OSHA 300 log posted

  Yes

  No

  N/A

• GHS information posted

  Yes

  No

  N/A

• Right to know station created

  Yes

  No

  N/A

• Site logistics plan created and posted

  Yes

  No

  N/A

• Emergency action plan created and posted

  Yes

  No

  N/A

General Housekeeping

• Housekeeping being done by subs

  Yes

  No

  N/A

• Clean up being performed by composite crew

  Yes

  No

  N/A

• Project site clean and organized

  Yes

  No

  N/A

• Trip hazards being identified and corrected

  Yes

  No

  N/A

• Lay down yard organized

  Yes

  No

  N/A

• Worker parking organized and adequate

  Yes

  No

  N/A

• Proper access to work area

  Yes

  No

  N/A

Public protection

• Security system / Site security implemented

  Yes

  No

  N/A

• Barricades installed properly

  Yes

  No

  N/A

• Street closures identified

  Yes

  No

  N/A

• Excavations protected

  Yes

  No

  N/A

• Perimeter project fencing and signage package installed

  Yes

  No

  N/A

• Danger high voltage signs posted '

  Yes

  No

  N/A

• Equipment windshields are free of defects

  Yes

  No

  N/A

• Traffic control plan created/submitted

  Yes

  No

  N/A

Motorized equipment

• Operators using seat belt

  Yes

  No

  N/A

• Operator appears to be qualified

  Yes

  No

  N/A

• Operator training documentation onsite

  Yes

  No

  N/A

• Fire extinguishers inspected and present

  Yes

  No

  N/A

• Back-up alarm properly functioning

  Yes

  No

  N/A

Earthwork

• Fuel on site been permitted

  Yes

  No

  N/A

• All hoses free of leaks and defects

  Yes

  No

  N/A

• Fuel on site properly stored and containment measures installed

  Yes

  No

  N/A

• Does equipment have fire extinguishers

  Yes

  No

  N/A

• Dust control being maintained

  Yes

  No

  N/A

• Equipment and ground worker separation being maintained

  Yes

  No

  N/A

• Fire Lanes/road being cleaned/no mud on streets

  Yes

  No

  N/A

• Housekeeping being done

  Yes

  No

  N/A

• Proper equipment to comply with Silica

  Yes

  No

  N/A

Utilities/trench safety inspection

• Spill kits on site and readily available

  Yes

  No

  N/A

• Daily inspections being performed

  Yes

  No

  N/A

• Perimeter protection at excavations installed properly

  Yes

  No

  N/A

• Excavations shored/sloped or benched properly

  Yes

  No

  N/A

• Access within 25' of workers

  Yes

  No

  N/A

• Spoils at a minimum 2' from excavation

  Yes

  No

  N/A

• Surface encumbrances removed

  Yes

  No

  N/A

• Excavation free of water

  Yes

  No

  N/A

• Excavation exceeding 20', shoring must be engineered

  Yes

  No

  N/A

• Surface traffic exposure identified and removed

  Yes

  No

  N/A

• One call system being used

  Yes

  No

  N/A

• Housekeeping being done

  Yes

  No

  N/A

Concrete

• Eye protection being used, when appropriate

  Yes

  No

  N/A

• Ear protection being used, when appropriate

  Yes

  No

  N/A

• Is proper protection being used for silica exposure

  Yes

  No

  N/A

• No free rigging being used on project

  Yes

  No

  N/A

• Safety glasses and face shields being used when cutting rebar

  Yes

  No

  N/A

• Safe access to grade beams created

  Yes

  No

  N/A

• Fire extinguishers on equipment

  Yes

  No

  N/A

• No dry cutting

  Yes

  No

  N/A

• Curing compounds properly stored and used

  Yes

  No

  N/A

• Housekeeping begin done

  Yes

  No

  N/A

• Proper equipment to comply for Silica

  Yes

  No

  N/A

Cranes and Hoisting

• Annual 3rd party crane inspection performed

  Yes

  No

  N/A

• Operator NCCCO trained and current

  Yes

  No

  N/A

• Boom angle indicator visible

  Yes

  No

  N/A

• Anti two block device working properly

  Yes

  No

  N/A

• Crane leveled properly on firm footings / Outrigger pads

  Yes

  No

  N/A

• Fire extinguisher in cab present

  Yes

  No

  N/A

• Daily inspections current

  Yes

  No

  N/A

• Flag man identified

  Yes

  No

  N/A

• Load chart/owners manual present

  Yes

  No

  N/A

• Riggers been identified

  Yes

  No

  N/A

• Rigging being inspected

  Yes

  No

  N/A

• Housekeeping being done

  Yes

  No

  N/A

Steel Erection

• Steel erection plan submitted and approved <br>

  Yes

  No

  N/A

• Steel erection plan being followed

  Yes

  No

  N/A

• Back up alarms working on all equipment

  Yes

  No

  N/A

• Gauges on torches working properly

  Yes

  No

  N/A

• Flashback arrestors installed on torches

  Yes

  No

  N/A

• Harness's being worn correctly

  Yes

  No

  N/A

• No free rigging being performed

  Yes

  No

  N/A

• Lifts being used on level surfaces

  Yes

  No

  N/A

• Bottles upright/properly separated

  Yes

  No

  N/A

• Acytelene/oxygen caps installed when not in use

  Yes

  No

  N/A

• Fire blankets on site,used when needed

  Yes

  No

  N/A

• Annual 3rd party crane inspection performed

  Yes

  No

  N/A

• Fall protection system in place

  Yes

  No

  N/A

• Is dunnage being removed

  Yes

  No

  N/A

• Housekeeping being done

  Media

• Gates/chains on lifts being used

  Yes

  No

  N/A

• Welding leads in proper condition

  Yes

  No

  N/A

Drywall/Framing

• Standing surfaces on lifts,clean,no debris

  Yes

  No

  N/A

• Acytlene and oxygen gauges in proper working condition

  Yes

  No

  N/A

• "Laser in use" signs being posted

  Yes

  No

  N/A

• Back up alarms working properly

  Yes

  No

  N/A

• Fire extinguishers on equipment

  Yes

  No

  N/A

• Proper use of ladder

  Yes

  No

  N/A

• Ladder inspected

  Yes

  No

  N/A

• Scaffold bracing and pins installed

  Yes

  No

  N/A

• Scaffold inspected and tagged

  Yes

  No

  N/A

• Fall protection being used

  Yes

  No

  N/A

• Hilti gun in proper working order

  Yes

  No

  N/A

• Extension cords & screw guns/chop saws being inspected daily

  Yes

  No

  N/A

• Housekeeping being done

  Yes

  No

  N/A

• Safety glasses and face shields being used when required

  Yes

  No

  N/A

Masonry

• Toe boards properly installed

  Yes

  No

  N/A

• Walk boards properly installed

  Yes

  No

  N/A

• Footing boards properly installed and footings leveled

  Yes

  No

  N/A

• Scaffold tied off to structure if required

  Yes

  No

  N/A

• Safety railing installed at each end of walk boards inspection

  Yes

  No

  N/A

• Fire extinguisher on equipment

  Yes

  No

  N/A

• Is the proper equipment being used for silica exposure

  Yes

  No

  N/A

• Nuisance masks being used, when required

  Yes

  No

  N/A

• Masonry wall bracing plan submitted

  Yes

  No

  N/A

• Dry sawing not being performed

  Yes

  No

  N/A

• Masonry walls braced properly

  Yes

  No

  N/A

• Proper access provided to mixing station

  Yes

  No

  N/A

• All equipment guards in proper condition to manufacturing guidelines

  Yes

  No

  N/A

• Hand tools in good condition

  Yes

  No

  N/A

• Face shield been used while using porta saw

  Yes

  No

  N/A

• Housekeeping being done?

  Yes

  No

  N/A

• Proper equipment to comply with Silica

  Yes

  No

  N/A

Electrical

• Proper access on scaffold provided

  Yes

  No

  N/A

• Temporary electrical in proper condition

  Yes

  No

  N/A

• Eye protection being used, when required

  Yes

  No

  N/A

• Building minimum 8 foot candles

  Yes

  No

  N/A

• Electrical rooms locked when not in use

  Yes

  No

  N/A

• Ladders inspected daily

  Yes

  No

  N/A

• Fire extinguishers on equipment

  Yes

  No

  N/A

• Qualified electrician in electrical room when in use

  Yes

  No

  N/A

• Back up alarms working on equipment

  Yes

  No

  N/A

• No hot work being performed

  Yes

  No

  N/A

• Gates/chains being used on scissor lifts

  Yes

  No

  N/A

• Eye protection worn when required

  Yes

  No

  N/A

• LOTO being implemented

  Yes

  No

  N/A

• Fall protection being used?

  Yes

  No

  N/A

• Housekeeping being done

  Yes

  No

  N/A

• Proper equipment to comply with Silica

  Yes

  No

  N/A

Mechanical/Plumbing

• Ladders inspected daily

  Yes

  No

  N/A

• Is ladder being used correctly

  Yes

  No

  N/A

• Extension cords grounded,no cuts

  Yes

  No

  N/A

• Task fire extinguishers being used

  Yes

  No

  N/A

• Flash back arrestors on torch bottles

  Yes

  No

  N/A

• Back up alarms working on equipment

  Yes

  No

  N/A

• Fire extinguishers on equipment

  Yes

  No

  N/A

• LOTO being implemented

  Yes

  No

  N/A

• Fall protection system in place

  Yes

  No

  N/A

• Proper equipment to comply with Silica

  Yes

  No

  N/A

• Housekeeping being done

  Yes

  No

  N/A

Glazing

• Fire extinguishers on equipment

  Yes

  No

  N/A

• Laser in use signs posted

  Yes

  No

  N/A

• Ladders being used properly

  Yes

  No

  N/A

• Ladders inspected

  Yes

  No

  N/A

• Back up alarms working on equipment

  Yes

  No

  N/A

• Housekeeping being done

  Media

• Proper work platforms being utilized

  Yes

  No

  N/A

Roofing

• Parapet heights identified on plans

  Yes

  No

  N/A

• Kettle 15' away from building and fencing installed

  Yes

  No

  N/A

• Kettle operator has proper clothing and eye protection

  Yes

  No

  N/A

• Controlled access zone implemented under (Hot Tar) work areas

  Yes

  No

  N/A

• P.P.E. Being used as required

  Yes

  No

  N/A

• Skytrack for loading material has outriggers

  Yes

  No

  N/A

• Control access zone in place

  Yes

  No

  N/A

• Fire extinguishers on sky tracks

  Yes

  No

  N/A

• Housekeeping being done

  Yes

  No

  N/A

Painting

• Back up alarms working on equipment

  Yes

  No

  N/A

• Air hoses in proper working order

  Yes

  No

  N/A

• Electrical cords inspection

  Yes

  No

  N/A

• Materials/rags being stored properly

  Yes

  No

  N/A

• Safety glasses being worn when required(texturing etc.)

  Yes

  No

  N/A

• Nuisance mask being worn when sanding

  Yes

  No

  N/A

• Harness being worn properly

  Yes

  No

  N/A

• No flammables being stored in building

  Yes

  No

  N/A

• Proper use of ladders

  Yes

  No

  N/A

• Nuisance masks being worn when sanding floors

  Yes

  No

  N/A

• Housekeeping begin done?

  Yes

  No

  N/A

• Ladder inspection

  Yes

  No

  N/A

• Proper equipment to comply withSilica

  Yes

  No

  N/A

• Man lifts begin used correctly

  Yes

  No

  N/A

Confined Space

• Confined space permit required

  Yes

  No

  N/A

• Atmospheric conditions being monitored

  Yes

  No

  N/A

• Rescue plan submitted

  Yes

  No

  N/A

• Extraction equipment provided

  Yes

  No

  N/A

• Confined space entry posted with signage

  Yes

  No

  N/A

• Communication plan created and implemented

  Yes

  No

  N/A

• Ventilation required

  Yes

  No

  N/A

• Extraction equipment provided

  Yes

  No

  N/A

• Confined space training provided

  Yes

  No

  N/A

Northstar equipment inspections

• Bobcat/ATV/Street sweepers being inspected daily

  Yes

  No

  N/A

• Equipment operator qualified ?

  Yes

  No

  N/A

• Proper fire protection implemented

  Yes

  No

  N/A

• Back up alarms working?

  Yes

  No

  N/A

• All belts/hoses free of defects ?

  Yes

  No

  N/A

• Seat belts/fire extinguishers on equipment and inspected?

  Yes

  No

  N/A

• Tires and tracks in good shape?

  Yes

  No

  N/A

• Regular maintenance scheduled?

  Yes

  No

  N/A

• Housekeeping of machines being done

  Yes

  No

  N/A

Silica compliance

• Subcontractor have PPE

  Yes

  No

  N/A

• Subs have equipment Hepa filter

  Yes

  No

  N/A

• Silica program on site

  Yes

  No

  N/A

• Subs using the proper equipment

  Yes

  No

  N/A

• Proper equipment to comply with Silica

  Yes

  No

  N/A

• Housekeeping been done

  Yes

  No

  N/A

Misc. Issues

• Housekeeping been done

  Yes

  No

  N/A

• Guardrails in place

  Yes

  No

  N/A

• Open holes covered

  Yes

  No

  N/A

• Fire extinguisher in right locations<br>

  Yes

  No

  N/A

• Fire extinguisher begin inspected

  Yes

  No

  N/A

• Fall protection in place

  Yes

  No

  N/A

• Proper use of ladders

  Yes

  No

  N/A

Mill work

• Equipment in working order

  Yes

  No

  N/A

• Equipment guards in place

  Yes

  No

  N/A

• Cords in good shape

  Yes

  No

  N/A

• Proper PPE begin use

  Yes

  No

  N/A

• Competent person on site to inspect scaffolding

  Yes

  No

  N/A

• Proper use of scaffolding

  Yes

  No

  N/A

• Proper use of ladders

  Yes

  No

  N/A

• Ladders been inspected

  Yes

  No

  N/A

Fire sprinkler

• Threader machine in goodshape

  Yes

  No

  N/A

• Ladder used properly

  Yes

  No

  N/A

• Ladder inspected

  Yes

  No

  N/A

• Housekeeping begin done

  Yes

  No

  N/A

• Cords in good shapes

  Yes

  No

  N/A

Carpenters form work

• Face shield being used when grinding

  Yes

  No

  N/A

• Equipment being inspected

  Yes

  No

  N/A

• Housekeeping

  Yes

  No

  N/A

• Ladders being used correctly

  Yes

  No

  N/A

• Nail removed from forms

  Yes

  No

  N/A

• Dust mask, ear plugs used when grinding

  Yes

  No

  N/A

• Fall protection being used

  Yes

  No

  N/A

• Ladders built correctly

  Yes

  No

  N/A