Site Safety Observation -

• Job # & Job Name

• Location
  Address

• Task

• Foreman

• Conducted on

  Date

• Prepared by

PERSONAL PROTECTIVE EQUIPMENT

• Proper gloves for the task (latex, cotton, cut resistance)?

  Yes

  No

  N/A

• Hearing protection worn when required?

  Yes

  No

  N/A

• Hard hats are in good condition?

  Good

  Fair

  Poor

  N/A

• Steel toe boots are in good condition?

  Good

  Fair

  Poor

  N/A

• High viz vest and reflective clothing worn?

  Good

  Fair

  Poor

  N/A

• Pants has non rips?

  Good

  Fair

  Poor

  N/A

• Respirators are worn if needed?

  Yes

  No

  N/A

• Proper clothing for task (frc, tyveck)?

  Yes

  No

  N/A

• The right safety glasses for the job (clear, dark, goggles)?

  Yes

  No

  N/A

HEALTH AND SAFETY

• Was their a Health and Safety Meeting held?

  Yes

  No

  N/A

• Did everyone participate in the discussion?

  Yes

  No

  N/A

• Does everyone understand their task and possible risk involved in there job?

  Yes

  No

  N/A

• Does everyone know the muster point in case of an emergency?

  Yes

  No

  N/A

• Have all utilities been identified (sub-surface)?

  Yes

  No

  N/A

• Does the crew have drinking water?

  Yes

  No

  N/A

• Did everyone stretch?

  Yes

  No

  N/A

• Was smoking section identified?

  Yes

  No

  N/A

• Is there a first aid kit and eye wash available and is it current?

  Yes

  No

  N/A

• Is there a up to date fire extinguisher on each vehicle?

  Yes

  No

  N/A

• Spill kits identified?

  Yes

  No

  N/A

• Flammable liquids in approved safety container?

  Yes

  No

  N/A

• JSA's and SDS's are available?

  Yes

  No

  N/A

RIG

• Are the vehicles set-up in a safe & efficient way?

  Yes

  No

  N/A

• Is there overhead interference?

  Safe

  At Risk

  N/A

• Exclusion zone set-up properly?

  Pass

  Fail

  N/A

• Is there plastic under vehicles and work area?

  Good

  Fair

  Poor

  N/A

• Are the wheels chocked?

  Yes

  No

  N/A

• Whip checks are in place where it is needed?

  Yes

  No

  N/A

• Was the kill switches pointed out and tested?

  Yes

  No

  N/A

• 6' orange safety flags on retail site?

  Yes

  No

  N/A

• Trip free work area?

  Good

  Fair

  Poor

  N/A

• Pinch point identified?

  Yes

  No

  N/A

• Are shackles in good working condition?

  Good

  Fair

  Poor

  N/A

• Lines are in good working condition?

  Good

  Fair

  Poor

  N/A

• Guards are in place where needed?

  Yes

  No

  N/A

TASK

• Are spotters being used?

  Good

  Fair

  Poor

  N/A

• Are seat belts being worn?

  Yes

  No

  N/A

• Proper lifting technique being used when moving materials and augers?

  Good

  Fair

  Poor

  N/A

• Are drums being moved properly?

  Good

  Fair

  Poor

  N/A

• Are augers chocked ?

  Yes

  No

  N/A

• Proper body positioning when shoveling?

  Good

  Fair

  Poor

  N/A

• 3 bucket rinse?

  Yes

  No

  N/A

• No shoveling when augers are spinning when necessary?

  Yes

  No

  N/A

• Is face shield being worn when deconning?

  Yes

  No

  N/A

• Is there communication between workers (moving vehicles, new task, someone needs help)?

  Good

  Fair

  Poor

  N/A

• When jack hammering is a face shield being worn?

  Yes

  No

  N/A

• Hand signals when jack hammering, removing debris?

  Yes

  No

  N/A

• Work area kept clean from from debris, tools on the ground, tripping hazards?

  Good

  Fair

  Poor

  N/A

• Hands staying away from striking zone?

  Yes

  No

  N/A

• Loading for mob back to shop (is load secure from shifting debri secured)?

  Yes

  No

  N/A

• Are holes covered or delineated when not being used?

  Yes

  No

  N/A

• POSITIVE COMMENTS

• QUESTIONABLE OBSERVATIONS

• PREVENTIVE

• FEEDBACK/ CONCLUSION/ EMPLOYEES COMMENTS