Skanska Crew Review / ESSV

• 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 sites SHEMS Monthly Management Review as part of your ESSV

• Comments regarding the review meeting.

• Photo of sign in sheet

  Media

Crew review / ESSV

• 1. Are all Crew members present, signed off on the DJB and engaged as part of the review process?

  Yes

  No

  N/A

• 2. What Environmental, Health & Safety (EH&S) issues did you discuss today during your DJB?

• 3. Are all the relevant inspections/permits completed for the current activity? (Hot works, confined space, excavation, AWP, Etc.)

  Yes

  No

  N/A

• 4. Did the crew participate in stretch and Flex today?

  Yes

  No

  N/A

• 5. What ongoing EH&S issues will you encounter while you are performed your work?

• 6. What are some of the risks associated with upcoming tasks in this activity? How does the crew plan to address them and is this indicated on the Construction Plan?

• 7. Are there any conditions being created that need to be addressed in order to lower our impact on the environment or the community in which work is taking place?

  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

• Rigging

  Satisfactory

  Unsatisfactory

  Not Applicable

• Excavation

  Satisfactory

  Unsatisfactory

  Not Applicable

• Demolition

  Satisfactory

  Unsatisfactory

  Not Applicable

• Confined space

  Satisfactory

  Unsatisfactory

  Not Applicable

• Lock out/Tag out

  Satisfactory

  Unsatisfactory

  Not Applicable

• MPT

  Satisfactory

  Unsatisfactory

  Not Applicable

• Fall Protection/Fall Arrest systems

  Satisfactory

  Unsatisfactory

  Not Applicable

• Cell Phone policy

  Satisfactory

  Unsatisfactory

  Not Applicable

Sign Off

• Foreman's Signature

  Sign

• Auditor's signature

  Sign