Skanska Crew Review 2019

• Job Name and Number

• Plan Number and Creator

• Activity

• Conducted on

  Date

• Prepared by

• Location
  Address

• Foreman

SHEMS MMR

• Check box if you participated in the job site SHEMS Monthly Management Review Meeting OR Project Safety Leadership Team Meeting

• Comments regarding the review meeting.

• Photo of sign in sheet

  Media

Crew Review

• 1. Are all of the Crew members signed off on the DHA<br>and participating in the review process?

  Yes

  No

  N/A

• 2. What Safety and Environmental topics did you discuss today during your DHA?

• 3. Have all relevant inspections and permits for<br>the activity been completed? (Hot work permit,<br>confined space, soil erosion and sediment control, AWP, etc.)

  Yes

  No

  N/A

• 4. What triggers from the CWP were discussed and why were they relevant today?

• 5. What ongoing safety hazards and potential environmental impacts were discussed with the crew (in association with the activity, work area or job site)?

• 6. Are there any safety or environmental issues that<br>were discussed (either verbally or written on the DHA)<br>that have not been addressed?

  Yes

  No

  N/A

• Who did you talk to about getting them addressed?

• 7. Do you feel that the CWP that you have currently and<br>adequately addresses the scope of work & all risks that<br>are relative to your current activities? (What improvements<br>could be made to the CWP)?

  Yes

  No

• Any Improvements for CWP?

• 8. Did crew participate in stretch and flex today?

  Yes

  No

• 9. Does the crew have plans such as an inspection or testing today?

  Yes

  No

• Has this been reviewed with the crew?

  Yes

  No

• 10. Is the crew aware of the procedures in the emergency action plan including in the event of an environmental release? (Are all tools materials and equipment readily available)?

  Yes

  No

• 11. Are all appropriate signatures on the CWP? (specifically the Risk Acknowledgment sheet)

  Yes

  No

Observations

• PPE

  Satisfactory

  Unsatisfactory

  Not Applicable

• Housekeeping

  Satisfactory

  Unsatisfactory

  Not Applicable

• Scaffold and ladders

  Satisfactory

  Unsatisfactory

  Not Applicable

• Power/Hand tools:

  Satisfactory

  Unsatisfactory

  Not Applicable

• Vehicle/Equipment inspection

  Satisfactory

  Unsatisfactory

  Not Applicable

• Eye Wash Stations

  Satisfactory

  Unsatisfactory

  Not Applicable

• Rebar Exposure

  Satisfactory

  Unsatisfactory

  Not Applicable

• HazCom (Labels, Containment, SDS)

  Satisfactory

  Unsatisfactory

  Not Applicable

• Fire/Hot work safety

  Satisfactory

  Unsatisfactory

  Not Applicable

• Electrical

  Satisfactory

  Unsatisfactory

  Not Applicable

• Lock out/Tag out

  Satisfactory

  Unsatisfactory

  Not Applicable

• Rigging

  Satisfactory

  Unsatisfactory

  Not Applicable

• Excavation

  Satisfactory

  Unsatisfactory

  Not Applicable

• Demolition

  Satisfactory

  Unsatisfactory

  Not Applicable

• Confined space

  Satisfactory

  Unsatisfactory

  Not Applicable

• Fall Protection/Fall Arrest systems

  Satisfactory

  Unsatisfactory

  Not Applicable

Sign Off

• Foreman's Signature

  Sign

• Auditor's signature

  Sign