Site Safety Assessment

• Assessment Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

PROGRAM ADMINISTRATION

• OSHA POSTINGS

  Yes

  No

  N/A

• Emergency numbers / contacts posted

  Yes

  No

  N/A

• Weekly safety meetings/toolbox talks

  Yes

  No

  N/A

• First aid kits onsite and adequately supplied

  Yes

  No

  N/A

• Emergency action plan posted / up to date

  Yes

  No

  N/A

• Are documented safety audits available onsite

  Yes

  No

  N/A

• Fire extinguisher - office trailer

  Yes

  No

  N/A

Daily Forms

• Safety checklists complete

  Yes

  No

  N/A

• Frontend Loader Inspection

  Yes

  No

  N/A

• JSA's

  Yes

  No

  N/A

HOUSEKEEPING

• Work areas orderly

  Yes

  No

  N/A

• Trash picked up

  Yes

  No

  N/A

• Job site free of slips, trips and fall hazards

  Yes

  No

  N/A

• Break areas orderly (if applicable)

  Yes

  No

  N/A

ELECTRICAL / UTILITY

• Insulation intact on cords and wiring

  Yes

  No

  N/A

• GFCI protection utilized

  Yes

  No

  N/A

• Lockout / tagout procedures utilized

  Yes

  No

  N/A

HAND AND POWER TOOLS

• Hand tools in good working order

  Yes

  No

  N/A

• Electrical cords in good working order

  Yes

  No

  N/A

• All mechanical safeguards in use

  Yes

  No

  N/A

• Handles not broke / splinter free

  Yes

  No

  N/A

EQUIPMENT

• Brakes, lights, signals, and alarms operative

  Yes

  No

  N/A

• Daily inspections filled out

  Yes

  No

  N/A

• Seat belts worn - LOADERS, HOES, FORK TRUCKS, ETC.

  Yes

  No

  N/A

• Rigging equipment inspected - tag showing

  Yes

  No

  N/A

• Yes

  No

  N/A

BARRICADES

• Barricades affixed with proper signage

  Yes

  No

  N/A

• Floor openings planked or barricaded

  Yes

  No

  N/A

• Leading edges guarded

  Yes

  No

  N/A

EXCAVATION

• Underground electrical lines marked

  Yes

  No

  N/A

• Underground gas lines marked

  Yes

  No

  N/A

• Excavation daily checklist completed

  Yes

  No

  N/A

• Adequate benching, sloping, and/or trenching in place<br>

  Yes

  No

  N/A

• Access and egress means provided

  Yes

  No

  N/A

• Spoil set back at least 2 feet

  Yes

  No

  N/A

• Is the excavation more than 4ft if so, is it adequately protected and has a confined space permit been filled out

  Yes

  No

  N/A

• Excavation protected by barricade tape or other sufficient means appropriate for expected exposure

  Yes

  No

  N/A

LADDERS

• Ladders in good condition

  Yes

  No

  N/A

• Side rails extend 36 inches above landing

  Yes

  No

  N/A

• Proper for job and secure

  Yes

  No

  N/A

• Step ladders fully open when in use

  Yes

  No

  N/A

• Placement of ladder safe

  Yes

  No

  N/A

FIRE PREVENTION

• Are hot work permits in order (if required)

  Yes

  No

  N/A

• Fire extinguishers immediately available and inspection tags current

  Yes

  No

  N/A

• Is a fire watch monitoring the area

  Yes

  No

  N/A

• Propane tanks - barricade installed - labeled -( flammable,no smoking, fuel type)

  Yes

  No

  N/A

• Compressed gas cylinders secured- upright- protected from damage

  Yes

  No

  N/A

• Flashback arrestors installed on all torch leads at the source

  Yes

  No

  N/A

PPE

• Hard hats worn

  Yes

  No

  N/A

• Gloves being worn and adequate for the work activity

  Yes

  No

  N/A

• Face shields being used where required

  Yes

  No

  N/A

• Eye protection being worn and adequate for the work activity

  Yes

  No

  N/A

• Hearing protection

  Yes

  No

  N/A

• Safety harness and lanyards utilized with adequate anchorage points

  Yes

  No

  N/A

• Respirators and masks utilized, when needed

  Yes

  No

  N/A

• High visible clothing in use, when needed

  Yes

  No

  N/A

CONFINED SPACES

• Proper permits filled out

  Yes

  No

  N/A

• Permits posted at entry

  Yes

  No

  N/A

• Atmosphere tested and results documented

  Yes

  No

  N/A

• Entry Supervisor has classified confined space and authorized entry

  Yes

  No

  N/A

• Everyone has been properly trained

  Yes

  No

  N/A

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