Safety Snapshot

• Conducted on

  Date

• Prepared by

• Location
  Address

Site Documentation

• Job Hazard & Risk Assessment Complete?

  Compliant

  Non-Compliant

  N/A

• Safety topic covered today? Note Topic.

  Good

  Fair

  Poor

  N/A

• Emergency contacts, posters, clinic map and evacuation route posted?

  Compliant

  Non-Compliant

  N/A

• Is there an emergency eyewash station and/or first-aid kit on site?

  Compliant

  Non-Compliant

  N/A

• Is everyone on the site signed onto the JHRA?

  Compliant

  Non-Compliant

  N/A

• Can employees on site retrieve SDS's when required?

  Compliant

  Non-Compliant

  N/A

Asbestos Work

• Asbestos Work on site?

  Yes

  No

  N/A

• Negative Air Readings are Compliant (-0.02 ci)?

  Compliant

  Non-Compliant

  N/A

• 9 Point Plan in place?

  Compliant

  Non-Compliant

  N/A

• Are warning signs posted?

  Compliant

  Non-Compliant

  N/A

• Respirators inspected and in good shape?

  Safe

  At Risk

  N/A

• Workers are in required PPE? No facial hair with respirators?

  Compliant

  Non-Compliant

  N/A

• Required Permit in place? (If no permit required for project site, select Compliant)

  Compliant

  Non-Compliant

  N/A

• Worker hard-cards on site?

  Compliant

  Non-Compliant

  N/A

• Personal pumps in use?

  Yes

  No

  N/A

Equipment & Tools

• Are equipment guards in place covering moving parts?

  Compliant

  Non-Compliant

  N/A

• Is the correct tool in use? (Binding/Needs Excessive Force/Correct for Job)

  Compliant

  Non-Compliant

  N/A

• Worker trained in proper use of the tool?

  Safe

  At Risk

  N/A

• Do workers maintain clearance of moving equipment?

  Safe

  At Risk

  N/A

• Are GFCI's at electrical source in use on power tools and equipment?

  Compliant

  Non-Compliant

  N/A

• Exposed electrical wires verified for de-energized state?

  Safe

  At Risk

  N/A

• Pressurized cylinders stored, secured and protected from impact?

  Safe

  At Risk

  N/A

Site Safety/Housekeeping

• General Housekeeping appears in order?

  Safe

  At Risk

  N/A

• Equipment storage / laydown area is clean and orderly?

  Safe

  At Risk

  N/A

• Is required PPE being worn? Proper gloves for the task?

  Compliant

  Non-Compliant

  N/A

• Is there a charged fire extinguisher at the work site with current service tag?

  Compliant

  Non-Compliant

  N/A

• All waste is labeled and appears to be protected from the elements?

  Yes

  No

  N/A

Working at Heights

• At height work on site?

  Yes

  No

  N/A

• Are workers tied off, or protected by barriers when working above 6 ft?

  Compliant

  Non-Compliant

  N/A

• Floor holes >2", wall openings >12" protected with covers, barricades or fence?

  Compliant

  Non-Compliant

  N/A

• Do items at height have potential to fall?

  Safe

  At Risk

  N/A

• Are scaffolds compliant? (handrails, planks, toe-boards, access, inspected)

  Compliant

  Non-Compliant

  N/A

• Is area directly beneath work at heights clear of workers?

  Safe

  At Risk

  N/A

• Do ladders appear in good condition and stable?

  Safe

  At Risk

  N/A

• Workers on ladders maintain 3 points of contact?

  Safe

  At Risk

  N/A

• Are extension ladders 3 1/2' above the edge, stable and tied off?

  Compliant

  Non-Compliant

  N/A

• Scissor-Lift in use on site?

  Yes

  No

  N/A

• Scissor-lift inspection completed?

  Compliant

  Non-Compliant

  N/A

• Aerial-lift in use on site?

  Yes

  No

  N/A

• Aerial-lift inspection completed?

  Compliant

  Non-Compliant

  N/A

• Fall protection in use?

  Compliant

  Non-Compliant

  N/A

Confined Space Entry

• Confined Space work on site?

  Yes

  No

  N/A

• Was air quality recorded prior to entry?

  Compliant

  Non-Compliant

  N/A

• Is PRCS permit posted at confined space entrance?

  Compliant

  Non-Compliant

  N/A

• Is PRCS program on site?

  Compliant

  Non-Compliant

  N/A

• Affected equipment in confined space isolated?(LOTO)

  Safe

  At Risk

  N/A

• Entrants, Attendants trained for entry responsibilities?

  Safe

  At Risk

  N/A

• Rescue plan in place? (What method of rescue is in use?)

  Compliant

  Non-Compliant

  N/A

People Safety

• Has team member attended pre-start meeting /JHRA review that morning? Note Topic

• Is the team member able to describe the correct response to follow in an emergency situation? Detail

• Ask the team member to describe three hazards of the work they are performing today. Note Response

• Employee Signature - Review of People Safety responses with employee.

  Sign

Snapshot Review

• Supervisor Signature

  Sign

• Inspector Signature

  Sign