Information
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Document No.
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Photos of tower
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Contractor
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Site number
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Site number photo
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Conducted on
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Aaron Steeneck
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Location Address
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Add media
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Project Number
Project and Site Details
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Site name
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Property Owner
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Number of personnel on site:
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Crew Foreman/Leader
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Scope of Work
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Are there any subcontractors on site?
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Subcontractor Name
Number of Personnel on Site
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Project Manager
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Will elevated work occur on this project site?
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Monopole
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Self-Supporting Tower
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Guyed Tower
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Water Tank
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Rooftop
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Crane Supported Work Platform
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Man Basket
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Aerial Lift of Scissor Lift
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Bucket/Boom truck
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Other
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Describe:
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Insert photo of structure where elevated work is occurring or will occur.
Jobsite Documentation
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Is a Daily Safe Plan of Action or a Job Hazard Analysis completed and on site? <br>
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Is a Safety Binder on site with all required documentation?
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Are originals or copies of the Competent Climber certifications of all personnel who will work at elevation available on site?
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Is there a completed Emergency Action Plan for the site?
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Is there a Competent Persons list on site?
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Are there at least 2 persons on site currently certified in First Aid/CPR?
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Is a first aid kit on site?
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Are overhead utilities and other electrical hazards addressed in the SPA/JHA?
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Are overhead or underground utilities present?
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Are MSDS's available on site for all chemicals, compounds, and hazardous substances?
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Overall compliance with field site documentation requirements:
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Describe deficiencies:
Deficiency
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Deficiency
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Add media
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Document remedial actions taken:
Jobsite Contitions
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Is the worksite clean of trash and debris?
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Are materials stored properly and orderly?
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Are measures taken to prevent access to the site by unauthorized personnel?
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Are work areas barricaded or fenced?
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Is there signage posted at the entrance to the site establishing PPE and access instructions for visitors?
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Is drinking water available?
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Are chemical, flammable and combustilble liquids stored properly? (No plastic storage cans)
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Is there adequate number of fire extinguishers available, fully charged and with current inspection?
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Proper sized water wagon on site?
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Are weather (heat, cold, precipitation, lightening, ice/snow) addressed and documented on the SPA?
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Overall compliance with jobsite conditions management
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Describe Deficiencies:
Deficiency
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Deficiency:
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Insert Photo of Deficiency, if applicable.
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Describe remedial actions taken:
PPE
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Are employees wearing hard hats 100% of the time?
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Document remedial actions taken:
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Hard hat(s) less than 5 years old, show no signs of cracks, or holes?
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Are employees weating ANSI Z87 safety glasses 100% of the time?
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Document remedial actions taken:
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Are employees wearing appropriate gloves for the tasks performed 100% of the time?
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Document remedial actions taken:
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Are employees wearing hi-viz clothing while heavy equipment is being used?
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Document remedial actions taken:
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Are employees wearing appropriate hard-toe footwear?
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Document remedial actions taken:
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Are employees dressed in appropriate work clothing?
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Document remedial actions taken:
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Is hearing protection needed for potential noise exposures over 85dB?
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Are ear plugs or ear muffs available for employees on site?
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Are employees with exposures to noise over 85dB wearing appropriate hearing protection?
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Document remedial actions:
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Other PPE in use on this site:
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Other PPE needed on this site:
- Chaps
- Metatarsal guards
- Overalls
- Protective sleeves
- Face shield
- Arc Flash/Flame Resistant Clothing
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Overall compliance with PPE requirements:
Fall Protection
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Do employees who are exposed to falls have proper training?
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Document remedial actions taken:
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If fall protection equipment being inspected daily and documented on the Elevated Work Permit?
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Document remedial actions taken:
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Are all inspection tags on fall protection equipment present and legible?
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Document remedial actions taken:
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Are all carabiners used a minimum of 25kn (5620lbs)?
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Are all carabiners self closing and self locking?
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Are inspection tags on climbing harness legible?
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Are climbing harness in working order and do not exceed 5years of use?
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If the work performed requires fall protection, is it being used 100% of the time?
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Persons in violation of 100% fall protection shall be removed from site. Further disciplinary procedures may apply.
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Document remedial actions taken.
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Is work being performed on a rooftop or other elevated flat surface?
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Are the following conditions met?
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Overall compliance with Fall Protection requirements:
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See specific remedial actions above and recommendations in Section 15.
RF
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Have RF hazards been considered and the safe plan documented on the Safe Plan of Acton?
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Is there a procedure in place to reduce RF exposure, if applicable?
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Does client of site owner require specific RF protection plans?
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Are our operations on site in compliance with client and owner requirements?
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Document remedial actions:
Hoists
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Is hoist operator qualified (Certified through training or Qualified through experience)?
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Document remedial actions taken:
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Are daily inspections being completed with documentation on site?
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Is there an operators manual for the unit(s) on site?
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Are the load charts readily available for hoist operators?
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Are all hoists secured and properly anchored for the load intended?
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Is the end connection properly secured?
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Are hoist controls clearly identified?
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Are hoist controls easily accessbile to the operator?
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Are all exposed parts properly guarded?
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Is the hour meter operational and functioning properly?
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Detail Hoist Unit Condition and Hours
Hoist
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Hoist Unit
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Condition:
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Hours:
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Overall compliance with hoist safety requirements:
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Comments or remedial actions required:
Cranes
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Is there crane work associated with this project?
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Document remedial actions taken:
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Overall compliance with crane requirements?
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Have crane picks been planned and the plans documented?
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Has the crane subcontractor submitted proof of annual inspection of the crane?
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Has the crane subcontractor submitted evidence of the crane operator's NCCCO certification?
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Does the crane signal person have current certification?
Elevated Work Platforms & Aerial Devices
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Are Elevated Work Platforms or other Aerial Work Devices being used or to be used on this site?
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Is the crane approved for lifting personnel?
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Does the personnel platform have an identification plate with weight of the platform, maximum intended load and personnel capacity?
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Was the Crane Suspended Work Platform planning checklist completed and made available on site?
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Has a pre-lift meeting been held, documented and made available on site?
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Was a trial lift completed and documented?
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Does the daily Safe Plan of Action adequately address the type of elevated work platform and hazards associated with the device?
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Were additional checklists or planning documents used to plan this work?
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Are all personnel performing elevated work using 100% fall protection?
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Are the equipment operators Qualified to operate the device?
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Overall compliance with elevated work platform and aerial device requirements:
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Describe remedial actions taken:
Rigging and Blocks
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Will there be rigging of equipment, materials or tools to be hoisted on this site?
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Are proper rigging practices being utilized?
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Are Riggers properly Qualified for the rigging work performed?
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Qualification is based upon:
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Is rigging equipment in good condition?
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Is rigging equipment being inspected daily and the inspection documented on the daily Safe Plan of Action or Elevated Work Permit?
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Has the equipment been thoroughly inspected on a quarterly basis and the inspection documented?
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Are ropes in good condition?
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Are tag lines in good condition?
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Overall compliance with rigging and blocking requirements:
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Describe remedial actions taken:
Gin Poles
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Are gin poles in use or to be used on this site?
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Has the gin pole been inspected prior to use, and is the inspection available on site?
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Does the sheave in the rooster head match the wire rope?
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Has the daily safe plan of action addressed the use and hazards associated with gin poles?
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Have other checklists been used to plan the work?
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Is gin pole being used in accordance with all requirements in Construction and Demolition of Telecommunications Towers?
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Document remedial actions taken:
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Is the gin pole rigging in good condition?
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Does the gin pole have an identification tag?
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Does the gin pole have a rated hoisting capacity?
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Are all intended loads less than 85% of the capacity of the gin pole?
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Document remedial actions taken:
Ladders
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Are all ladders on site rated at lease A1?
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Are all ladders on site in good condition?
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Has a daily pre-work inspection been completed of all ladders in use, and is the inspection noted in the daily Safe Plan of Action or available on site?
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Are A-frame ladders set up correctly with legs fully opened and locked in place?
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Are extension ladders set up at the proper slope of 4:1?
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Do extension ladders extend at least 36" above the landing level?
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Are ladders only set up on stable and level ground?
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Overall compliance with Ladder safety requirements:
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Deficiencies Noted:
Deficiency
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Describe deficiency:
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Insert photo of non-compliant item
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Describe remedial actions taken:
Electrical
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Are extension cord sets appropriate gauge for load?
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Are construction rated GFCIs used on all circuits greater than or equal to 120-volt, 15-20 amperes which are not connected to a building system?
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Is all cord set insulation in good condition? No nicks or cuts or frays?
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Do all cord sets have molded male and female end plugs with no gaps?
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Are all cover plates in place on outlets?
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Is any work occurring on live circuits greater than 50 volts AC or 100 volts DC?
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What type of work is occurring?
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Has an Arc Flash Hazard Analysis been conducted on the potential exposures and/or have the specific hazards been identified and a control plan put in place?
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Are work areas clearly marked and barricaded from unauthorized entry?
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Are all hand tools voltage-rated insulated tools?
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Overall Compliance with electrical safety requirements:
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Deficiencies Noted:
Deficency
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Describe deficiency
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Insert photo of deficiency, if applicable.
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Document remedial actions taken:
Excavations
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Does the scope of work on site include excavation?
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Is the operator Qualified to operate excavation equipment?
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Are designated safe walk paths or No Pedestrian zones established?
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Are back-up alarms functioning on all mobile equipment?
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Has the Pre-Excavation checklist been completed and made available on site?
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Are overhead and underground utilities identified and clearly marked?
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Is there potential that personnel may enter the excavation while it is open?
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How deep will the excavation be at its deepest point?
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Is a safe means of ingress and egress provided at least every 25-feet?
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Will the excavation exceed 5-feet deep at any point?
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Indicate means to prevent trench collapse:
- Sloping
- Benching
- Shoring
- Trench box
- Other
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Describe other means of preventing trench collapse:
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Overall compliance with trenching and excavation requirements:
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Deficiencies Noted:
Deficiency
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Describe Deficiency:
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Insert photo of deficiency, if applicable.
Conclusions
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Amount of time spent on site during visit:
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Were all deficiencies corrected immediately?
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Describe deficiencies yet to be corrected and time frame for abatement:
Deficiency
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Deficiency yet to be corrected:
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Time frame for abatement:
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Is there a need to follow up with written documentation?
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Describe documentation needed, responsible person and time frame expected for completion.
Documentation Needed
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Documentation:
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Person Responsible:
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Date for required completion:
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Overall Impression of visit:
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Comments:
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Report Reviewed With:
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Signature of Person Completing Audit:
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Signature of Site Foreman
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Signature of crew member
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Signature of crew member
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Signature of crew member
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Signature of crew member
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Additional photos
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Additional comments