Structural - Job site Safety Assessment (MSA)-Industrial-with COVID 19

• Conducted on

  Date

• Prepared by

• Location
  Address

• Area around swing radius is properly barricaded?

  Yes

  No

  N/A

• Workplace hazards identified before use?

  Yes

  No

  N/A

• Employees maintaining fall protection attachment(s)?

  Yes

  No

  N/A

• Railings not used for work access?

  Yes

  No

  N/A

• Equipment not used as a crane to lift materials?

  Yes

  No

  N/A

• Stable, level drive area?

  Yes

  No

  N/A

Compressed Air & Gas Cylinder Safety (Subpart - I)

• Yes

  No

  N/A

• Air compressors properly maintained and used w/OSHA valves?

  Yes

  No

  N/A

• All connections are double pinned with whip checks installed?

  Yes

  No

  N/A

• Compressed air receiver tanks equipped with blow off valves?

  Yes

  No

  N/A

• Compressed gas cylinders stored and secured vertically?

  Yes

  No

  N/A

• Threaded connection for airlines (2” or greater)

  Yes

  No

  N/A

• Cylinders have caps installed when not in use?

  Yes

  No

  N/A

• Flash back arresters installed at cylinder regulator?

  Yes

  No

  N/A

• OHSA Valves installed on 3/4” or greater lines (pneumatic tools)?

  Yes

  No

  N/A

• Oxygen and fuel gases stored 20’ apart or separated by fire proof wall?

  Yes

  No

  N/A

Confined Space Entry (Subpart - I)

• Natural/Mechanical ventilation in place?

  Yes

  No

  N/A

• Atmospheric gas testing completed (pre-entry/continuous)?

  Yes

  No

  N/A

• Gas detection equipment is calibrated and used properly?

  Yes

  No

  N/A

• Required permits current & available at entry point?

  Yes

  No

  N/A

• Emergency evacuation procedure in place?

  Yes

  No

  N/A

• Entry log being maintained/Confined Space Training Verified?

  Yes

  No

  N/A

Silica Exposure Control

• Silica Exposure Control Plan verified and reviewed by employees?

  Yes

  No

  N/A

• Silica Competent Person verified?

  Yes

  No

  N/A

• Engineering controls in place and utilized?

  Yes

  No

  N/A

• Administrative controls in place and utilized?

  Yes

  No

  N/A

• PPE being utilized as in written plan?

  Yes

  No

  N/A

• Proper disposal of all Silica Waste?

  Yes

  No

  N/A

Electrical Safety ( Subpart - K)

• Adequate lighting for work areas (guarded lenses?

  Yes

  No

  N/A

• Assured Grounding Inspection and taping done correctly?

  Yes

  No

  N/A

• Elec. tools unplugged if repairing or changing bits, blades, etc.?

  Yes

  No

  N/A

• Electric panel boxes have proper covers?

  Yes

  No

  N/A

• Extension cords are 12 gauge / 3wire minimum?

  Yes

  No

  N/A

• Documentation of tool inspections?

  Yes

  No

  N/A

• GFCI used for all cords and equipment at power source?

  Yes

  No

  N/A

Elevated Work Access (Subpart a M)

• Elevated work access properly planned?

  Yes

  No

  N/A

• Fall Protection measures in place for all work zones?

  Yes

  No

  N/A

• Primary and secondary egress routes available for all work zones?

  Yes

  No

  N/A

• Emergency rescue plan in place for all work zones?

  Yes

  No

  N/A

• Employees trained on their role in an emergency?

  Yes

  No

  N/A

• Operational non-powered descent device on site?

  Yes

  No

  N/A

• Adequate level of comm. between ground/upper work elevation?

  Yes

  No

  N/A

Fall Protection (Subpart - M)

• Anchor point of 5000 lbs. per employee or engineered anchorage?

  Yes

  No

  N/A

• Floor & walkway openings protected?

  Yes

  No

  N/A

• Fall equipment inspections are complete?

  Yes

  No

  N/A

• Employees are maintaining 100% fall Protection program?

  Yes

  No

  N/A

• Floor openings covered, clearly marked and secure?

  Yes

  No

  N/A

• Handrails are properly constructed top; middle; toe board?

  Yes

  No

  N/A

• Vertical & horizontal life lines properly used and inspected?

  Yes

  No

  N/A

Fire Safety (Subpart - F)

• Equipment turned off while fueling?

  Yes

  No

  N/A

• Exit, stairs, and walkways are clear (36” minimum walkway)?

  Yes

  No

  N/A

• Fire extinguishers are of adequate size and placement (20lb min.)?

  Yes

  No

  N/A

• Fire extinguishers are maintained & inspected monthly with tags?

  Yes

  No

  N/A

• Flammable storage area is 20’ from building?

  Yes

  No

  N/A

• OSHA Regulated fuel cans with flash arrestor/spring locks?

  Yes

  No

  N/A

• Fuel storage area: Signs/Containment/>

  Yes

  No

  N/A

• No smoking signs posted (smoking areas clearly marked)?

  Yes

  No

  N/A

• Oily rags stored in proper container w/self-closing lid?

  Yes

  No

  N/A

• Hot work permits in use: (when required)?

  Yes

  No

  N/A

• Welding/burning: No combustibles / fire extinguisher present

  Yes

  No

  N/A

• Fire watch monitoring area 30 minutes after hot work is complete?

  Yes

  No

  N/A

Tools & Equipment (Subpart - I)

• Air manifolds: OSHA valves; psi gauge operational, inspect plate?

  Yes

  No

  N/A

• Grinders: Inspected, used with guards and handles at all times?

  Yes

  No

  N/A

• Abrasive blasting: Equipment Inspections Verified?

  Yes

  No

  N/A

• Barricades / signage / containment adequate to control exposures?

  Yes

  No

  N/A

• Abrasive Blasting Procedure Available?

  Yes

  No

  N/A

• PPE: Blast hood for operator, Full Face Resp. for pot attendant?

  Yes

  No

  N/A

• Minimum 4’ wand?

  Yes

  No

  N/A

Concrete Demolition Procedures

• Hoses: OSHA Valves; whip checks; pins at all airlines?

  Yes

  No

  N/A

• Inspection documentation of pneumatic tools verified?

  Yes

  No

  N/A

• Concrete debris being cleaned up and not accumulating?

  Yes

  No

  N/A

• Barricades / signage / containment adequate to control exposures?

  Yes

  No

  N/A

• Employees wearing required PPE, Full face resp., Double hearing protection while chipping concrete?

  Yes

  No

  N/A

• Concrete demolition/pneumatic tool procedure available?

  Yes

  No

  N/A

Motorized Equip. (Forklift;Con. Biggie;Skid Steer)(Subpart - O)

• Employee certification to operate verified?

  Yes

  No

  N/A

• Equipment inspection completed before use (daily)?

  Yes

  No

  N/A

• Lift is used within rated capacity?

  Yes

  No

  N/A

• Attachments inspected and manufactured for intended use?

  Yes

  No

  N/A

• Equipment Operators Manuel available?

  Yes

  No

  N/A

Mixing / Grouting / Gunite Equipment (Subpart - Q)

• Dust Containments are established and adequate?

  Yes

  No

  N/A

• Employees are wearing correct PPE for identified tasks?

  Yes

  No

  N/A

• Employees review of Concrete Pumping Procedure?

  Yes

  No

  N/A

• Machines are inspected, maintained, and greased daily?

  Yes

  No

  N/A

• Safety devices are in place and operational?

  Yes

  No

  N/A

• Team lifting practices for bags (50lb or greater)?

  Yes

  No

  N/A

Jobsite Misc. Safety Procedures

• Jobsite trailers:

  Yes

  No

  N/A

• Emergency Action Plan Posted?

  Yes

  No

  N/A

• OSHA Minimum Wage, discrimination posted?

  Yes

  No

  N/A

• Assured Grounding Program available?

  Yes

  No

  N/A

• Haz Com Pictogram available?

  Yes

  No

  N/A

• Housekeeping of trailer is adequate?

  Yes

  No

  N/A

• First Aid/Blood Bourne Pathogen Kits available?

  Yes

  No

  N/A

• Field Managers First Aid/CPR training verified?

  Yes

  No

  N/A

• Jobsite Requirements:

  Yes

  No

  N/A

• SDS for materials onsite / reviewed by employees?

  Yes

  No

  N/A

• Flammable materials properly stored in Flammable Cabinet?

  Yes

  No

  N/A

• Assured Grounding Inspections Verified?

  Yes

  No

  N/A

• JSA / WEP / Permit are verified to job task being performed?

  Yes

  No

  N/A

• Employees aware of evacuation routes?

  Yes

  No

  N/A

• Housekeeping is adequate in work areas / laydown areas?

  Yes

  No

  N/A

Personal Protective Equipment (Subpart - E)

• Chemical Protective Clothing (Coveralls, gloves, boots) available (when required)?

  Yes

  No

  N/A

• Company issued helmets being worn correctly (chin strap connected as designed)?

  Yes

  No

  N/A

• Eye protection (Z-87.1 and rated for task)?

  Yes

  No

  N/A

• Flotation Devices (PFD - Personal Floating Device) available (if required)?

  Yes

  No

  N/A

• Hand protection adequate for task / Hand injury awareness identified/discussed?

  Yes

  No

  N/A

• Hearing Protection being worn as required?

  Yes

  No

  N/A

• Reflective Clothing / Vests being worn as determined by project?

  Yes

  No

  N/A

• Work Boots: Leather/die electric/steel toe/metatarsal/rubber being properly worn as required by task?

  Yes

  No

  N/A

Respiratory Protection (Subpart - E)

• All airborne (respiratory hazards) have been identified?

  Yes

  No

  N/A

• Employees are clean shaven when using respiratory equipment?

  Yes

  No

  N/A

• Fitted respirator user’s trainer, provided physicals, and fit tested?

  Yes

  No

  N/A

• Proper Respiratory protection has been selected for hazards?

  Yes

  No

  N/A

• Respirator cleaning / disinfection supplies provided?

  Yes

  No

  N/A

• Respirators are being worn properly?

  Yes

  No

  N/A

• Respirators are stored in protective bags when not in use?

  Yes

  No

  N/A

COVID-19

• Is there a written COVID plan in place and being followed?

  Yes

  No

  N/A

• Are employees adhering to social distancing requirements?

  Yes

  No

  N/A

• Are mask / face coverings being worn by all employees?

  Yes

  No

  N/A

• Is hand sanitizer, disinfectant wipes, soap easily available?

  Yes

  No

  N/A

• Are employees maintaining distancing during breaks?

  Yes

  No

  N/A

• Are disposable masks available for all employees?

  Yes

  No

  N/A

• Are common areas being cleaned on a regular basis?

  Yes

  No

  N/A

• Are tools being disinfected after use or before being used?

  Yes

  No

  N/A

• Is physical contact being avoided, e.g. hand shakes and fist pumps?

  Yes

  No

  N/A

• Are employees properly using face shields -Not sharing?

  Yes

  No

  N/A

• Are employees washing hands for 20 seconds or more?

  Yes

  No

  N/A

• Are employees following transportation guidelines?

  Yes

  No

  N/A

Scaffold and Ladder Access (Subpart - L)

• Ladder tip extends 36” beyond landing area?

  Yes

  No

  N/A

• Ladders are inspected daily and in good working condition?

  Yes

  No

  N/A

• Ladders are installed with 4:1 standard ratio?

  Yes

  No

  N/A

• Ladders are secured before employee accesses?

  Yes

  No

  N/A

• Ladders are non-conductive and have no skid feet?

  Yes

  No

  N/A

• 3 points of contact maintained on ladder?

  Yes

  No

  N/A

• Scaffold has adequate cross bracing with positive locking devices?

  Yes

  No

  N/A

• Scaffold modifications made by competent person only?

  Yes

  No

  N/A

• Scaffolding system is properly tagged and inspected?

  Yes

  No

  N/A

• Personal Fall Protection inspected and documentation verified?

  Yes

  No

  N/A

• Work decks are secured to scaffolding and free of debris?

  Yes

  No

  N/A

Trenching / Excavation Safety

• Competent person evaluating: shoring, benching, sloping

  Yes

  No

  N/A

• Excavation is being monitored for gases (greater than 4’ deep)?

  Yes

  No

  N/A

• Excavation access are properly guarded at ground level?

  Yes

  No

  N/A

• Ladder Access provided (min. 25’ travel distance) for entry and exits?

  Yes

  No

  N/A

• Shoring devices are engineered and in good working condition?

  Yes

  No

  N/A

• Yes

  No

  N/A