SO Blank

• Site conducted

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Yes

  No

  N/A

Scoring Sheet

• 1) FALLS

  Yes

  No

  N/A

• #AtRisk

  Yes

  No

  N/A

• 2) SCAFFOLDS

  Yes

  No

  N/A

• #AtRisk

  Yes

  No

  N/A

3) PPE

• #AtRisk

  Yes

  No

  N/A

• 15) Confined Spaces

  Yes

  No

  N/A

• #AtRisk

  Yes

  No

  N/A

• AtRisk

  Yes

  No

  N/A

• AtRisk

  Yes

  No

  N/A

• AtRisk

  Yes

  No

  N/A

• AtRisk

  Yes

  No

  N/A

• Body Harness/Fall Protection

  Yes

  No

  N/A

• Inspected & Tagged by Compentant

  Yes

  No

  N/A

• Hard Hats

  Yes

  No

  N/A

• Confined space entry training program on site

• 100% Tie Off Above 6'0"

  Yes

  No

  N/A

• Height < 3 x minimum base

  Yes

  No

  N/A

• Foot Protection

  Yes

  No

  N/A

• Signs posted to identify confined spaces

  Yes

  No

  N/A

• Lanyard / Retractable Anchored Properly

  Yes

  No

  N/A

• Scaffold Tied Off Securely

  Yes

  No

  N/A

• Eye Protection

  Yes

  No

  N/A

• PPE Specified

  Yes

  No

  N/A

• Handrail on Stairways

• Decking, Rails & Access

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Standby person identified

  Yes

  No

  N/A

• Carrying Things on Stairways

  Yes

  No

  N/A

• Solid Base

  Yes

  No

  N/A

• Nomex

  Yes

  No

  N/A

• Emergency equipment for standby person

  Yes

  No

  N/A

• All holes / openings properly covered, marked, secured

  Yes

  No

  N/A

• Not Over or Eccentrically Loaded

  Yes

  No

  N/A

• Hand Protection

  Yes

  No

  N/A

• Permit required precaution taken

  Yes

  No

  N/A

• Handrails: properly built top rail (42"), mid rail (21"), toe boards

  Yes

  No

  N/A

• Respiratory Protection (used when needed, stored properly)

  Yes

  No

  N/A

• Air monitoring equipment calibrated, area monitored, ventilated

  Yes

  No

  N/A

• Employees have been trained in fall protection

  Yes

  No

  N/A

• Permits posted prior to work and for duration

  Yes

  No

  N/A

• Harness/Lanyard current inspected Monthly

  Yes

  No

  N/A

• All required signatures for entry/testing

  Yes

  No

  N/A

TOTAL:

TOTAL:

TOTAL:

• TOTAL:

4) LADDERS

#AtRisk

5) Recordkeeping, Notices, Posters

#AtRisk

6) HOUSEKEEPING

• #AtRisk

  Yes

  No

  N/A

• 12) WORK ENVIRONMENT

  Yes

  No

  N/A

• #AtRisk

  Yes

  No

  N/A

• Proper Ladder

  Yes

  No

  N/A

• Emergency phones numbers posted

  Yes

  No

  N/A

• Clean Area / Proper Disposal

  Yes

  No

  N/A

• Sufficient Lighting

  Yes

  No

  N/A

• Proper Length

  Yes

  No

  N/A

• BG safety manual and substance abuse manual

  Yes

  No

  N/A

• Proper Storage / Labeling

  Yes

  No

  N/A

• Adequate Ventilation

  Yes

  No

  N/A

• Proper Angle

  Yes

  No

  N/A

• OSHA 29 CFR 1926 manual

  Yes

  No

  N/A

• Impalement Hazards Capped

  Yes

  No

  N/A

• Temperature Extremes Addressed

  Yes

  No

  N/A

• Tied Off

  Yes

  No

  N/A

• Emergency procedures and evacauation plans

  Yes

  No

  N/A

• Cords & Hoses Stored Properly

  Yes

  No

  N/A

• Awareness of Area Hazards

  Yes

  No

  N/A

• Secure Base / Footing

  Yes

  No

  N/A

• Requires posters displayed. "Job Safety and Helth Protection"

  Yes

  No

  N/A

• Cords Elevated 7' Crossing Aisles

  Yes

  No

  N/A

• Awareness of Area Alarms

  Yes

  No

  N/A

• HazCom Poster

  Yes

  No

  N/A

• Bend over nails

• Slip/Trip Hazards

  Yes

  No

  N/A

• OSHA 300 log on site for previous year

  Yes

  No

  N/A

• Do the Subs have drinking water

  Yes

  No

  N/A

• BG Hazard Communication manual

  Yes

  No

  N/A

• Toilets / Sanitary facilities adequate and clean

  Yes

  No

  N/A

• MSDS available on josite for all trades

  Yes

  No

  N/A

• Dust Control

  Yes

  No

  N/A

• Designated HazCom representatives posted on site

• Slips, Trips, and Falls

  Yes

  No

  N/A

TOTAL:

TOTAL:

TOTAL:

• TOTAL:

7) FIRE PREVENTION

#AtRisk

8) CRANE SAFETY

#AtRisk

9) TOOLS & EQUIPMENT

• #AtRisk

  Yes

  No

  N/A

• 16) Welding and Cutting

  Yes

  No

  N/A

• #AtRisk

  Yes

  No

  N/A

• Hot Work Permit

  Yes

  No

  N/A

• Swing Radius Barricade

  Yes

  No

  N/A

• Right Tool / Equipment for the Job

  Yes

  No

  N/A

• Welding hoses, leads and cords elevated or out of walkways

  Yes

  No

  N/A

• Proper Fire Extinguisher

  Yes

  No

  N/A

• Overhead Loads

  Yes

  No

  N/A

• Proper Use of Tool / Equipment

  Yes

  No

  N/A

• Welding shields and spark / slag catching blankets in place Flash arrestors present in proper location

• Fully Charged & Inspected

  Yes

  No

  N/A

• Tag Line Attached to All Loads

  Yes

  No

  N/A

• Guards in Place

  Yes

  No

  N/A

• Fire watches trained, in place with proper fire extinguishers

  Yes

  No

  N/A

• Combustible Storage

  Yes

  No

  N/A

• Crane & Operator Certified

  Yes

  No

  N/A

• User Properly Trained

  Yes

  No

  N/A

• Fire hazards / combustibles removed before hot work begins

  Yes

  No

  N/A

• Flammable Storage

  Yes

  No

  N/A

• Horn Sounding

  Yes

  No

  N/A

• Tools in Good Condition

  Yes

  No

  N/A

• Gas cylinders secured upright

  Yes

  No

  N/A

• Extinguisher Access / Hydrants

  Yes

  No

  N/A

• Signal person in site

• Correct / Current Inspection Tag

  Yes

  No

  N/A

• Fuel gas and oxygen cylinders separated in storage

  Yes

  No

  N/A

• Fire lane access

  Yes

  No

  N/A

• Daily inspection Completed

  Yes

  No

  N/A

• Seat Belts Worn by Occupants

  Yes

  No

  N/A

• Gauges and regulators maintained, removed when not in use

  Yes

  No

  N/A

• Hydrants Clear 15'0" radius

  Yes

  No

  N/A

• Outriggers have proper footing

  Yes

  No

  N/A

• Speed Limit Honored

  Yes

  No

  N/A

• Cylinder caps in place when regulators are off

  Yes

  No

  N/A

• Backup Alarm/Horn when Backing

  Yes

  No

  N/A

• Fire hazards checked / afterhours inspection, if necessary

  Yes

  No

  N/A

• Spotter when Necessary

  Yes

  No

  N/A

• Dikes bulk storage facilities

  Yes

  No

  N/A

• Parking Brake / Wheel Chocks

  Yes

  No

  N/A

• Fire extinguishers nearby but NOT on flammable storage units

  Yes

  No

  N/A

TOTAL:

TOTAL:

TOTAL:

• TOTAL:

10) BODY MECHANICS

#AtRisk

11) Excavations and Shoring

#AtRisk

17) RIGGING SAFETY

• #AtRisk

  Yes

  No

  N/A

• DATE:

  Date

• 50 lb. Lift Limit Not Exceeded

  Yes

  No

  N/A

• Designated competent person on site

• Personnel qualified?

  Yes

  No

  N/A

• Keeping Back Straight

  Yes

  No

  N/A

• Excavation permits in place

  Yes

  No

  N/A

• Procedures known/followed?

  Yes

  No

  N/A

• # OBSERVATIONS TOTAL:

• Lifting with Legs

  Yes

  No

  N/A

• Correct shoring / sloping for soil type

  Yes

  No

  N/A

• Pre planning required/done?

  Yes

  No

  N/A

• # SAFE OBSERVATIONS

  Yes

  No

  N/A

• Not Twisting While Lifting

  Yes

  No

  N/A

• Spoils pile placed 2' minimum from sides of excavation

  Yes

  No

  N/A

• Is this a Critical lift?

  Yes

  No

  N/A

• # AT RISK OBSERVATIONS

  Yes

  No

  N/A

• Not Over Stepping

  Yes

  No

  N/A

• Adjacent structures properly shored

  Yes

  No

  N/A

• Load weight known/verified?

  Yes

  No

  N/A

• Not Lifting Off Balance

  Yes

  No

  N/A

• Ladders or ramps every 25 feet

  Yes

  No

  N/A

• Center of gravity identified?

  Yes

  No

  N/A

• Required daily inspections

  Yes

  No

  N/A

• Softners used as needed?

  Yes

  No

  N/A

• Confined space requirements

  Yes

  No

  N/A

• Equip. condition, inspected?

  Yes

  No

  N/A

• Proper Barricades in place

  Yes

  No

  N/A

• Signal person present?

  Yes

  No

  N/A

TOTAL:

TOTAL:

• Proper rigging, sling angle?

  Yes

  No

  N/A

13) LINE OF FIRE

#AtRisk

14) ELECTRICAL SAFETY

#AtRisk

• Stable soil, footing, etc.?

  Yes

  No

  N/A

• Grinding / Flying Projectiles

  Yes

  No

  N/A

• Ground Fault Circuit Interrupter

  Yes

  No

  N/A

• Proper clearance from elect.?

  Yes

  No

  N/A

• Process Materials / Burns

  Yes

  No

  N/A

• Insulation Intact

  Yes

  No

  N/A

• Swinging Loads

  Yes

  No

  N/A

• Electrical LT3

  Yes

  No

  N/A

• Traffic

  Yes

  No

  N/A

• (Bee Keeper Suit, etc.) Nomex

  Yes

  No

  N/A

TOTAL:

TOTAL:

TOTAL:

• Rev 110210

  Yes

  No

  N/A

Observations

• Project Name:

• Job #:

• Date:

  Date

• SO Location:

• SO Team:

• OBSERVATION

  Yes

  No

  N/A

• AtRisk

  Yes

  No

  N/A

• AUDITOR

  Yes

  No

  N/A

CORRECTIVE ACTION

• RESPONSIBLE SUPERVISOR

  Yes

  No

  N/A

• ACTION REQUIRED

  Yes

  No

  N/A

• DATE CORRECTED

  Date

• Suggested:

• Taken:

• Suggested:

• Taken:

• Suggested:

• Taken:

• Suggested:

• Taken:

• Suggested:

• Taken:

• Suggested:

• Taken:

• Suggested:

• Taken:

• Suggested:

• Taken:

• Suggested:

• Taken:

• Suggested:

• Taken:

• Suggested:

• Taken:

• Suggested:

• Taken:

• Suggested:

• Taken:

• Suggested:

• Taken:

• Suggested:

• Taken:

• Suggested:

• Taken:

• Suggested:

• Taken:

• ATRISK #

  Yes

  No

  N/A

TOTALS :

Email Copy of SO to:

TOTAL OBSERVATIONS :

Operations and Safety Offices within 24 hours of SO

Closed SO items report to Safety Office (within 48 hrs)

• Inspected By:

SO Bullet Points

• Safety Observations (SO) Bullet Point Checklist. Use this sheet to understand what you need to be

  Yes

  No

  N/A

• looking for when performing an SO walk

  Yes

  No

  N/A

FALLS

• RECORDKEEPING/NOTICES

  Yes

  No

  N/A

• Body Harness/Fall Protection

  Yes

  No

  N/A

• Emergency phones numbers posted

  Yes

  No

  N/A

• 100% Tie Off Above 6'0"

  Yes

  No

  N/A

• safety manual and substance abuse manual

  Yes

  No

  N/A

• Lanyard / Retractable Anchored Properly

  Yes

  No

  N/A

• OSHA 29 CFR 1926 manual

  Yes

  No

  N/A

• Handrail on Stairways

• Emergency procedures and evacuation plans

  Yes

  No

  N/A

• Carrying Things on Stairways

  Yes

  No

  N/A

• Requires posters displayed. "Job Safety and Health Protection"

  Yes

  No

  N/A

• All holes / openings properly covered, marked, secured

  Yes

  No

  N/A

• HazCom Poster

  Yes

  No

  N/A

• Handrails: properly built top rail (42"), mid rail (21"), toe boards

  Yes

  No

  N/A

• OSHA 300 log on site for previous year

  Yes

  No

  N/A

• Employees have been trained in fall protection

  Yes

  No

  N/A

• Hazard Communication manual

  Yes

  No

  N/A

• Harness / Lanyard current inspected Monthly

  Yes

  No

  N/A

• MSDS/SDS available on jobsite for all trades

  Yes

  No

  N/A

• Retractable in use when access >12'

  Yes

  No

  N/A

• Designated HazCom representatives posted on site

LADDERS

• SCAFFOLDS

  Yes

  No

  N/A

• Proper Ladder

  Yes

  No

  N/A

• Inspected & Tagged by Competent Person

  Yes

  No

  N/A

• Proper Length

  Yes

  No

  N/A

• Height < 3 x minimum base

  Yes

  No

  N/A

• Proper Angle

  Yes

  No

  N/A

• Scaffold Tied Off Securely

  Yes

  No

  N/A

• Tied Off

  Yes

  No

  N/A

• Fully decked at working levels

  Yes

  No

  N/A

• Secure Base / Footing

  Yes

  No

  N/A

• Solid Base/Mudsills as needed

  Yes

  No

  N/A

• Maintain 3 points of contact

  Yes

  No

  N/A

• Not Over or Eccentrically Loaded

  Yes

  No

  N/A

• Current Monthly InspectionColor Coded

  Yes

  No

  N/A

• Rails and or fall protection provided / addressed

  Yes

  No

  N/A

FIRE PREVENTION

• CRANE SAFETY

  Yes

  No

  N/A

• Hot Work Permit

  Yes

  No

  N/A

• Swing Radius Barricade

  Yes

  No

  N/A

• Proper Fire Extinguisher

  Yes

  No

  N/A

• Overhead Loads

  Yes

  No

  N/A

• Fully Charged & Inspected

  Yes

  No

  N/A

• Tag Line Attached to All Loads

  Yes

  No

  N/A

• Flammable/Combustible Storage

  Yes

  No

  N/A

• Crane & Operator Certified

  Yes

  No

  N/A

• Flammable Storage

  Yes

  No

  N/A

• Signal person on site

• Extinguisher Access / Hydrants

  Yes

  No

  N/A

• Daily inspection Completed

  Yes

  No

  N/A

• Fire lane access

  Yes

  No

  N/A

• Outriggers have proper footing

  Yes

  No

  N/A

• Hydrants Clear 15'0" radius

  Yes

  No

  N/A

LINE OF FIRE

• ELECTRICAL SAFETY

  Yes

  No

  N/A

• Grinding / Flying Projectiles

  Yes

  No

  N/A

• Ground Fault Circuit Interrupter

  Yes

  No

  N/A

• Process Materials / Burns

  Yes

  No

  N/A

• Insulation Intact

  Yes

  No

  N/A

• Swinging Loads

  Yes

  No

  N/A

• Electrical LOTO

  Yes

  No

  N/A

• Traffic

  Yes

  No

  N/A

• Electrical Cord kept away from water

  Yes

  No

  N/A

HOUSEKEEPING

• PPE

  Yes

  No

  N/A

• Clean Area/Proper Disposal

  Yes

  No

  N/A

• Hard hats

  Yes

  No

  N/A

• Proper Storage/Labeling

  Yes

  No

  N/A

• Foot Protection

  Yes

  No

  N/A

• Impalement Hazards Capped

  Yes

  No

  N/A

• Eye Protection/Face shields/Welding Hoods

  Yes

  No

  N/A

• Cords / Hoses stored properly

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Cords Elevated 7' crossing aisles

  Yes

  No

  N/A

• High Visibility ANSI Class II Vest / Shirt

  Yes

  No

  N/A

• Slip / Trip Hazards

  Yes

  No

  N/A

• Hand Protection

  Yes

  No

  N/A

• Respiratory protection (used when needed, stored properly

  Yes

  No

  N/A

BODY MECHANICS

• EXCAVATIONS/SHORING

  Yes

  No

  N/A

• 50 lb. Lift Limit Not Exceeded

  Yes

  No

  N/A

• Designated competent person on site

• Keeping Back Straight

  Yes

  No

  N/A

• Excavation permits in place

  Yes

  No

  N/A

• Lifting with Legs

  Yes

  No

  N/A

• Correct shoring / sloping for soil type

  Yes

  No

  N/A

• Not Twisting While Lifting

  Yes

  No

  N/A

• Spoils pile placed 2' minimum from sides of excavation

  Yes

  No

  N/A

• Not Over Stepping

  Yes

  No

  N/A

• Adjacent structures properly shored

  Yes

  No

  N/A

• Not Lifting Off Balance

  Yes

  No

  N/A

• Ladders or ramps every 25 feet

  Yes

  No

  N/A

• Proper lifting technique

  Yes

  No

  N/A

• Required daily inspections

  Yes

  No

  N/A

• Confined space requirements

  Yes

  No

  N/A

• Proper Barricades in place

  Yes

  No

  N/A

TOOLS & EQUIPMENT

• WELDING AND CUTTING

  Yes

  No

  N/A

• Right Tool / Equipment for the Job

  Yes

  No

  N/A

• Welding hoses, leads and cords elevated or out of walkways

  Yes

  No

  N/A

• Proper Use of Tool / Equipment

  Yes

  No

  N/A

• Welding shields and spark / slag catching blankets in place Flash arrestors present in proper location

• Guards in Place

  Yes

  No

  N/A

• Fire watches trained, in place with proper fire extinguishers

  Yes

  No

  N/A

• User Properly Trained

  Yes

  No

  N/A

• Fire hazards / combustibles removed before hot work begins

  Yes

  No

  N/A

• Tools in Good Condition

  Yes

  No

  N/A

• Gas cylinders secured upright

  Yes

  No

  N/A

• Correct / Current Inspection Tag

  Yes

  No

  N/A

• Fuel gas and oxygen cylinders separated in storage or have a non combustible barrier at least 5' high with a fire resistant rating of 30 minutes

  Yes

  No

  N/A

• Seat Belts Worn by Occupants

  Yes

  No

  N/A

• Gauges and regulators maintained, removed when not in use

  Yes

  No

  N/A

• Speed Limit Honored

  Yes

  No

  N/A

• Cylinder caps in place when regulators are off

  Yes

  No

  N/A

• Backup Alarm / Horn when Backing

  Yes

  No

  N/A

• Fire hazards checked / afterhours inspection, if necessary

  Yes

  No

  N/A

• Spotter when Necessary

  Yes

  No

  N/A

• Dikes bulk storage facilities

  Yes

  No

  N/A

• Parking Brake / Wheel Chocks

  Yes

  No

  N/A

• Fire extinguishers nearby but NOT on flammable storage units

  Yes

  No

  N/A

PROCEDURES

• WORK ENVIRONMENT

  Yes

  No

  N/A

• Permit Completed & followed

  Yes

  No

  N/A

• Sufficient lighting

  Yes

  No

  N/A

• Thorough STA done

  Yes

  No

  N/A

• Adequate ventilation

  Yes

  No

  N/A

• Barricades, Proper Signage

  Yes

  No

  N/A

• Temperature extremes addressed

  Yes

  No

  N/A

• Trained for CSE/line break, etc

  Yes

  No

  N/A

• Awareness of area hazards

  Yes

  No

  N/A

• Special Permits acquired

  Yes

  No

  N/A

RIGGING SAFETY

• HAND SAFETY

  Yes

  No

  N/A

• Personnel qualified?

  Yes

  No

  N/A

• Gloves Used when Required

  Yes

  No

  N/A

• Procedures known / followed?

  Yes

  No

  N/A

• Proper Glove Type in use

  Yes

  No

  N/A

• Pre planning required / done?

  Yes

  No

  N/A

• Hands Free of Danger Zone

  Yes

  No

  N/A

• Is this a Critical lift?

  Yes

  No

  N/A

• Gloves in good condition

  Yes

  No

  N/A

• Load weight known / verified?

  Yes

  No

  N/A

• Putting hand/arm in blind spot

  Yes

  No

  N/A

• Center of gravity identified?

  Yes

  No

  N/A

• Avoids hot / cold, sharp or corrosive materials / objects

  Yes

  No

  N/A

• Softeners used as needed?

  Yes

  No

  N/A

• Avoids repetitive motion and awkward positioning

  Yes

  No

  N/A

• Equip. condition, inspected?

  Yes

  No

  N/A

• Recognized hand hazards properly addressed with guards or physical barriers

  Yes

  No

  N/A

• Signal person present?

  Yes

  No

  N/A

• Proper rigging, sling angle?

  Yes

  No

  N/A

• Avoids use of excessive force

  Yes

  No

  N/A

• Stable soil, footing, etc.?

  Yes

  No

  N/A

• Hand STA completed

  Yes

  No

  N/A

• Proper clearance from elect.?

  Yes

  No

  N/A