SafetyCraig Consulting, Inc.

• Jobsite Name

• Location
  Address

• Foremen

• Job description:

• Conducted on

  Date

• Prepared by

Access / Egress

• Portable Ladders

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• Ladder extends 3' over landing

  Yes

  No

  N/A

• 3 points of contact maintained while climbing

  Yes

  No

  N/A

• In good safe working condition. Proper ladder for the job.

  Yes

  No

  N/A

• Ladder set up at proper angle (4:1)

  Yes

  No

  N/A

• Daily ladder inspection form completed?

  Yes

  No

  N/A

• Ladder tied off securely

  Yes

  No

  N/A

• Fixed Ladders

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• Fall protection or cage available if 24' in height or greater

  Yes

  No

  N/A

• If cage or well is used, landing platform is provided at maximum of 50'

  Yes

  No

  N/A

• Minimum clearance between ladder and obstruction behind is 7"

  Yes

  No

  N/A

• Inside of cage or well is free of obstructions

  Yes

  No

  N/A

• Ladder in good repair, no visible damage

  Yes

  No

  N/A

• Stepladders

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• Stepladders in good repair. No visible damage to rails, rungs, or spreader

  Yes

  No

  N/A

• Ladder used in an open a-frame position

  Yes

  No

  N/A

• Proper ladder size used. Climbing on top of stepladder, or on first rung from the top, is prohibited

  Yes

  No

  N/A

• Stairs

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• Metal pan stairs are filled with with suitable material or barricaded to prevent access

  Yes

  No

  N/A

• Stairways with four or more risers, or rising more than 30" in height (whichever is less) have stair rails provided on each unprotected edge

  Yes

  No

  N/A

• Handrails are provided between 30" and 37", have at least 3" clearance between the handrail and structure behind, and are constructed so as to provide an adequate handhold

  Yes

  No

  N/A

• All railings are free from projection hazards such as nails, surfaced to prevent injuries or snagging of clothing

  Yes

  No

  N/A

• Other

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Electrical Safety

• GFCI utilized at all times

  Yes

  No

  N/A

• GFCI Functions Properly?

  Yes

  No

  N/A

• Cords and tools in good condition. Damaged cords / tools tagged out of service or rendered inoperable

  Yes

  No

  N/A

• All cords protected from damage (not exposed to vehicular traffic or crushing damage from doors or windows, etc.)

  Yes

  No

  N/A

• All ladders and equipment at least 10' from electrical lines

  Yes

  No

  N/A

• Other

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Fall Protection

• No fall from height exposures present. Typically ground work, high parapet walls (39" or greater), or similar structure is present which eliminates fall from height exposure.

• Warning Line Systems

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• Warning lines completely enclose the roof area

  Yes

  No

  N/A

• Warning lines kept minimum of 6' from edge of roof, or minimum of 10' from edge of roofs with mechanical equipment in use

  Yes

  No

  N/A

• Well maintained, a minimum of 34" off the working surface, a maximum of 39"

  Yes

  No

  N/A

• Stanchions utilized are designed to resist, without tipping over, a force of at least 16 lbs applied horizontally 30" above the walking / working surface

  Yes

  No

  N/A

• Employees adhering with requirement and remaining inside warning lines unless using a different fall protection system

  Yes

  No

  N/A

• Points of access connected to work area by access path formed by two lines. When not in use, a warning line is run across the path to fully enclose the work area

  Yes

  No

  N/A

• Guardrails System

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• Proper height: Top rail 39-45 inches above the walking working surface. Cable deflects 3" or less and does not sag below 39" with 200lbs of force applied. Midrails installed midway between top rail and walking / working surface

  Yes

  No

  N/A

• Guardrail system properly installed capable of withstanding 200lbs of force

  Yes

  No

  N/A

• Standard toe boards installed if exposure below exists

  Yes

  No

  N/A

• Guardrails surfaced to prevent injury. No protruding nails

  Yes

  No

  N/A

• Safety Monitoring System

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• Safety monitor in audible & visual distance, on same working level and performing monitoring duties only

  Yes

  No

  N/A

• Safety monitor educated to recognize fall hazards and aware of items that he/she should be looking for

  Yes

  No

  N/A

• Monitor used in conjunction with warning line, except for on roofs that are <50' in length or width

  Yes

  No

  N/A

• Employees ensuring a safety monitor is present prior to going outside warning lines or working on an unprotected roof

  Yes

  No

  N/A

• Personal Fall Arrest Systems

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• Anchorage points of suitable strength to support fall or restraint (5,000lbs arrest, 1,000lbs restraint). Roof anchors properly installed.

  Yes

  No

  N/A

• Equipment inspected prior to use

  Yes

  No

  N/A

• Harness & lanyards worn and adjusted properly. Lifelines installed properly, slack removed, pendulum effect and free fall distance considered and controlled

  Yes

  No

  N/A

• Anchorage connectors such as cross arm straps utilized to wrap units / structures. No wrapping of lifelines / lanyards and hooking them back to themselves

  Yes

  No

  N/A

• Skylight and hole protection

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• Skylight / holes protected by guardrail, cover, net, or personal fall arrest system is used

  Yes

  No

  N/A

• Hole covers capable of withstanding twice the intended load. "Hole" or "Cover" painted atop the cover

  Yes

  No

  N/A

• Hoist area fall protection

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• Guardrails or PFAS utilized in hoisting areas (areas where material / debris / equipment is being brought up to or removed from roof)

  Yes

  No

  N/A

• Employees using PFAS in hoist areas set them up for fall restraint

  Yes

  No

  N/A

• Other

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Fire Prevention

• Extinguishers in place, charged and in work area. Clear of obstruction. No more than 100' from employees, no more than 50' from flammables

  Yes

  No

  N/A

• No smoking near flammables

  Yes

  No

  N/A

• Proper flammable safety cans in use

  Yes

  No

  N/A

• Other

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General Safety

• First aid kits available onsite

  Yes

  No

  N/A

• SDS available onsite for all chemicals, chemicals properly labelled

  Yes

  No

  N/A

• Weekly tool box talks conducted

  Yes

  No

  N/A

• General housekeeping efforts kept up

  Yes

  No

  N/A

• All materials and debris secured daily. Public protected from falling / flying objects

  Yes

  No

  N/A

• General precautions taken to protect property from damages

  Yes

  No

  N/A

• Intakes covered or turned off when chemicals used

  Yes

  No

  N/A

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• Other

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Hand and Power Tools

• All hand and power tools in good repair. Damaged equipment tagged out of service or rendered inoperable

  Yes

  No

  N/A

• All power tools have proper machine guards in place

  Yes

  No

  N/A

• Hand tools used for the task they are designed for. No prying items with a utility knife

  Yes

  No

  N/A

• Utility knife blades kept sharp, cuts made away from body. Retracted or fully sheathed when not in use

  Yes

  No

  N/A

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• Other

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Material Handling

• Proper lifting techniques observed. Team lifts or mechanical equipment used when lifting heavy objects

  Yes

  No

  N/A

• Material handling equipment in good condition

  Yes

  No

  N/A

• Debris removed of promptly and safely. Chute provided when over 20'.

  Yes

  No

  N/A

• Crane Safety

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• Operators licensed / certified

  Yes

  No

  N/A

• Rigging in good condition. Capacities legible. Inspected prior to use with no visible damage.

  Yes

  No

  N/A

• Qualified rigger / signal person used

  Yes

  No

  N/A

• Outriggers fully deployed, pads/cribbing used on soft surfaces

  Yes

  No

  N/A

• Daily inspection of crane performed. Must be documented at least once per month and available on crane

  Yes

  No

  N/A

• Work zone established. Elevated visual aids in place to ensure crane maintains minimum approach distance from overhead power lines

  Yes

  No

  N/A

• Forklift Safety

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• Operator certified. License available and current (not more than 3 years old)

  Yes

  No

  N/A

• Daily inspection completed. All critical safety elements in good repair (back up alarm, windows & mirrors, boom angle indicator, load chart available, tires in good repair, etc)

  Yes

  No

  N/A

• Seatbelt worn at all times

  Yes

  No

  N/A

• Safe speeds maintained

  Yes

  No

  N/A

• Other

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Personal Protective Equipment

• Eye protection worn when hazard exits and per policy

  Yes

  No

  N/A

• Hard hats worn when hazard exits and per policy

  Yes

  No

  N/A

• Proper gloves worn when handling tear off debris, when handling sharp metal, and when handling chemicals requiring glove usage

  Yes

  No

  N/A

• Proper work attire worn (boots, pants, sleeved shirts, long sleeve shirts if handling hot asphalt)

  Yes

  No

  N/A

• Other

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Scaffolding

• Supported Scaffolding

• Competent person onsite - daily inspections conducted

  Yes

  No

  N/A

• All components in good condition, properly assembled

  Yes

  No

  N/A

• Safe access onto scaffold available

  Yes

  No

  N/A

• Guardrails and toeboards on all open sides of work area

  Yes

  No

  N/A

• Work platform fully decked with proper overhang / cleating of planks

  Yes

  No

  N/A

• All employees using have user training

  Yes

  No

  N/A

• Scaffold kept a safe distance (10' minimum) from overhead powerlines unless lines have been de-energized or other acceptable safeguards implemented

  Yes

  No

  N/A

• Falling object protection adequate if exposure below exists. Toe boards in place, or netting used if material stacked higher than toe boards

  Yes

  No

  N/A

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• Aerial Lifts

• All employees using have received user training

  Yes

  No

  N/A

• Inspections performed prior to operating. No dropoffs, depressions, holes, etc. surrounding the equipment that can be driven into

  Yes

  No

  N/A

• Guardrails in proper working condition. Safety chains latched closed on scissor lifts. Swing gates shut on boom lifts

  Yes

  No

  N/A

• Proper fall protection in place when working from boom lift. Retractable lanyard or other restraining device used. Harness worn properly

  Yes

  No

  N/A

• Equipment kept a safe distance from overhead powerlines (minimum of 10' unless power lines are de-energized or other acceptable safeguard is implemented)

  Yes

  No

  N/A

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• Other

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Specific Roof Systems Hazards

• Modified Bitumen - Torch Applied System (if not checked than N/A)

• Torch set up properly, in good working order. Stand in place. Connections and fittings leak checked prior to use

  Yes

  No

  N/A

• All sparks or open flame controlled and kept away from roof openings which could suck flame into structure

  Yes

  No

  N/A

• No torching to combustible surfaces

  Yes

  No

  N/A

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• BUR - Kettle Safety (if not checked than N/A)

• Propane tanks upright, in good condition and kept 10' from kettle & building

  Yes

  No

  N/A

• Kettle operator has face shield, long sleeves, proper fire extinguisher, spray bottle to check for leaks?<br>

  Yes

  No

  N/A

• Kettle area flagged / barricaded

  Yes

  No

  N/A

• Is kettle level?

  Yes

  No

  N/A

• Thermometer on kettle working or is probe or infrared thermometer being used?<br>

  Yes

  No

  N/A

• Proper temperature maintained. Ground man present and aware of temperature and flashpoint

  Yes

  No

  N/A

• Is hot pipe properly supported or NOT deflecting or bending

  Yes

  No

  N/A

• Kettle lid closed when not being loaded

  Yes

  No

  N/A

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• Other

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Jobsite Grading

• Acceptable: Jobsites which have no serious violations of federal requirements, or safety policies and have recognizable hazards controlled at the time of the inspection.<br><br>Needs Improvement: Jobsites in which violations occurred which may be serious in nature but the inspector does not believe them to be done intentionally or egregiously.<br><br>Unacceptable: Jobs in which egregious safety violations exist and are to believe to have been known by those involved.

  Compliant

  Needs Improvement

  Unacceptable

Follow-up

• Corrective Actions taken onsite to correct noted deficiencies:

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• On site representative

  Sign

• Auditor's signature

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