SE and Comm

• 201-2-21 WMH 5000 sample

• Safety inspection/audit

• 5000 WMH bed tower

• Conducted on

  Date

• Desmond Vincent

• Location
  Address

• Personnel

• PPE -Personal Protective Equipment

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Hard hats worn properly.

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Safety glasses, goggles, face shields worn properly.

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Gloves worn properly.

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• High visibility clothing worn, where appropriate.

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Hearing protection worn, where appropriate.

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Respirators/ dust masks worn, where appropriate.

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Falls

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Housekeeping

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Ladders and stairways used properly.

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Scissors lifts and boom lifts

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Scaffolding

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Fall protection -general -guard rails.

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Fall protection -wall and floor openings protected.

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Fall protection - Roof.

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Electrical Safety

• Assured grounding - turtle cords & extension cords.

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• GFCI checked and marked.

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Panel covers for live panels - Energized panel signs.

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• No exposed live parts - open J Box, KO

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Lockout/tag out is proper.

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Temporary Lighting

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• Temporary Power

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• TRENCHING AND EXCAVATION

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• CONFINED SPACE ENTRY

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

• HEAVY EQUIPMENT - LIFTS, CRANES, ECT

  Select SAFE AT RISK N/A

  • SAFE
  • AT RISK
  • N/A

Trenching & Excavation.

• Safe

  At Risk

  N/A

Confined Space Entry

• Safe

  At Risk

  N/A

Forklifts/ Trucks/ Mobile Equipment/Cranes.

• Safe

  At Risk

  N/A

Conduit Stub Protection

• Safe

  At Risk

  N/A

Hand & Power Tools

• Safe

  At Risk

  N/A

Air Quality

• Silica, Lead, Asbestos, Paint Exposures controlled

  Safe

  At Risk

  N/A

Flammable Liquid Storage - Container Labeling

• Safe

  At Risk

  N/A

Fire Extinguisher in Trailer

• Safe

  At Risk

  N/A

First Aid Kit & Biohazard Kit

• Safe

  At Risk

  N/A

Traffic Control

• Safe

  At Risk

  N/A

Dealing with Public

• Safe

  At Risk

  N/A

Misc Hazards -Not Otherwise Classified

• Yes

  No

  N/A

Safety Program Elements

• Tool Box Talks, Day by Day cards

  Yes

  No

  N/A

• Job Site Postings & OSHA Log

Positive Observations/Comments

• Yes

  No

  N/A

• Add signature

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