SoCal-Project Safety Report

• Audit Title

• Prepared by

• Location
  Address

• Document No.

• Conducted on

  Date

• Client / Site

FALL PROTECTION

• Are guard rails present at all perimeters/shafts?<br>

  Yes

  No

  N/A

• Contact responsible party immediately. Keep a safe distance from hazard and instruct others to avoid hazard.

• Are ladders inspected and in good condition?<br>

  Yes

  No

  N/A

• Tag ladder out of service and inform foreman and tool room.

• Is fall protection equipment inspected and in good condition?

  Yes

  No

  N/A

• If repairable, tag out of service and inform foreman and tool room. If not repairable, destroy so it will not be used and dispose. Inform foreman and tool room.

• Are PFAS anchor points capable of holding 5000 lbs. per person?

  Yes

  No

  N/A

• Stop personnel immediately. Inform foreman. Coach employees on proper anchor points. Issue infraction(s) if appropriate.

• Are holes > 2" protected?

  Yes

  No

  N/A

• Inform foreman. Tape area off if appropriate.

PERSONAL PROTECTIVE EQUIPMENT

• Is all required PPE available for use?

  Yes

  No

  N/A

• Assist foreman with obtaining proper PPE.

• Is PPE being worn at all times by employees?

  Yes

  No

  N/A

• Inform foreman and issue WRITTEN infraction.

ELECTRICAL

• Is temporary power out of the way of our work?

  Yes

  No

  N/A

• Inform foreman and assist with coordination with electrical contractor if requested.

• Are extension cords elevated to avoid tripping hazards?

  Yes

  No

  N/A

• Inform foreman and consider use of zip ties, J-hooks or other no conductive means to elevate cords.

• If permanent power is being used, are GFCI pigtails being used?

  Yes

  No

  N/A

• Inform foreman and assist with obtaining GFCI pigtails if necessary.

TOOLS

• Are auxiliary handles present on tools where they are required?

  Yes

  No

  N/A

• Inform foreman. If handle is not readily available, confiscate tool until handle can be replaced. Assist foreman with obtaining replacement handle if requested.

• Are pipe vises being used for cutting?

  Yes

  No

  N/A

• Inform foreman. Coach employees to use proper cutting techniques.

• Are cords on tools original from factory?

  Yes

  No

  N/A

• Inform foreman and tool room. Confiscate tool, tag it out of service and return to tool room for repair.

HOUSEKEEPING

• Is the area free of trash & trip hazards?

  Yes

  No

  N/A

• Inform foreman. Assist with clean-up efforts.

• Are barricades/tape/signs maintained?

  Yes

  No

  N/A

• Inform foreman. Assist with taping and signs.

  Yes

  No

  N/A

• Is there enough light to see clearly?

  Yes

  No

  N/A

• Inform foreman. General Contactor/Electricians are responsible for providing area lighting. We are responsible for task specific lighting.

MATERIAL HANDLING

• Are carts being used to move materials?

  Yes

  No

  N/A

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• Are materials being stored on carts?

  Yes

  No

  N/A

• Is the area free of excess materials?

  Yes

  No

  N/A

• Has rigging been inspected?

  Yes

  No

  N/A

• Inspect rigging.

• Is material handling equipment such as roustabouts or duct jacks inspected?

  Yes

  No

  N/A

• Use equipment checklists to complete inspections.

• For Genie duct jacks, are Genie extensions the only ones being used?

  Yes

  No

  N/A

• Inform foreman. Confiscate illegal extensions. Note: Vermette jacks allow use of pipes/units rut.

FIRE PREVENTION

• Are flammable materials being stored in a flammable cabinet?

  Yes

  No

  N/A

• Inform foreman. Assist in moving flammables to proper storage.

• Has welding equipment been inspected?

  Yes

  No

  N/A

• Inform foreman.

• Is there a fire watch present for hot work activities?

  Yes

  No

  N/A

• Inform foreman. Ensure fire watch is present for hot work.

• Are fire extinguishers inspected?

  Yes

  No

  N/A

• Inform foreman. Assist with inspecting and/or tagging cylinders.

• Are gas cylinders secured from falling?<br>

  Yes

  No

  N/A

• Inform foreman. Assist in securing cylinders.

• Inform foreman. Assist in securing cylinders.

PRE-TASK PLANNING

• Job Hazard Analysis Operation:

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• Will the Job Hazard Analysis be deviated from?

• What additional precautions will be taken?

• Procedure:

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• Hazards:

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• Precautions:

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ACKNOWLEDGEMENT

General Foreman: "I acknowledge that I have identified the hazards that my crew will be exposed to today and have taken the steps necessary to resolve or communicate those hazards. I further agree to adhere to the SoCal Division Foreman Safety Responsibilities."

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Foremen: "I acknowledge that I have identified the hazards that my crew will be exposed to today and have taken the steps necessary to resolve or communicate those hazards. I further agree to adhere to the SoCal Division Foreman Safety Responsibilities."

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Crew: “I acknowledge having reviewed the all sections of this Pre-Task Plan. I fully understand the information provided to me and I am competent to perform these tasks safely. I also understand that failure to follow these safe work practices is dangerous and can cause injury to myself or others. I further acknowledge that not adhering to this JHA is a violation of Southland’s Safety Program and is subject to disciplinary action up to and including termination. Lastly, I came to work fit for duty today and did not have any injury or illness to report.”

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DAILY SAFETY REPORT

• I did not OBSERVE any jobsite safety hazards today.<br>

  Yes

  No

  N/A

• Who did you notify?

• There were no incents to REPORT on the jobsite today.

  Yes

  No

• What type of incident?

  Yes

  No

  N/A

• Did you SUBMIT an Incident Report to the SoCal Safety Department?

  Yes

  No

• Was the incident work-related? If no, then SUBMIT a Non Work-Related Injury/Illness Report to the SoCal Safety Department.

  Yes

  No

• I did not RESOLVE any safety issues on the jobsite today.

  Yes

  No

  N/A

• Who did you notify?

• I did not WRITE-UP any employees for safety issues on the jobsite today.

  Yes

  No

  N/A

• Did you submit a Safety Infraction form to the SoCal Safety Department?

  Yes

  No

• I did not REWARD any employees for safety issues on the jobsite today.

  Yes

  No

  N/A

• Who did you reward and why?