Information

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • # of Company employees on site

  • # 0f Company Subcontractors on site

Administrative/Housekeeping/PPE

  • Daily Tailboard completed and signed

  • Project JHA signed

  • Clinic / Hospital Directions Posted

  • SDS's available on site (hard copy or electronic)

  • Spill Kit on site

  • State Labor Law Poster is displayed

Housekeeping

  • Work Areas clean and unobstructed

  • Cords/leads/hoses elevated or protected

  • Cones and/or tape around floor openings

  • Cones and/or tape around open Trenwa

  • Crating material stacked neatly with nails removed or bent over

PPE

  • Cut resistant gloves worn as needed

  • Noise Level (dBa)

  • Hearing protection worn above 90 dBa

  • Safety Glasses (including prescription) with side shields

Hand and Power Tools

  • Power tools / cords GFCI protected

  • Manufacturer guards are in place and functioning

  • Cords are in good shape - no tears or cuts in the outer jacket, ground prong present

Falls/Work at Heights

Ladders

  • Base of the ladder is clear of trip hazards (min 3ft clearance)

  • Base of the ladder not clear

  • Workers below the top two rungs of the ladder

  • Ladder inspection reveals spreaders locked, no cracks in the fiberglass or bent/missing hardware

  • Workers facing the ladder with belt buckle between the uprights

  • Workers using three points of contact when climbing/descending the ladder

Fall Protection

  • PFA equipment inspected annually

  • PFA equipment worn with all buckles, snaps and fasteners secure and snug

  • Workers using PFA equipment are tied off 100% of the time.

Hot Work Operations

  • Hot Work permit completed and posted

  • Welding curtains/screens are used in high traffic areas

Excavations

  • Soil is sloped 1 1/2 (Horizontal) to 1 (Vertical) when deeper than 5 feet

  • One Call or GPR markings are visible?

  • Egress no more than 25' away when the excavation is deeper than 4'

  • Visual indicators (e.g. cones/flagging) are along trenches, trenwa or other steep sided excavations.

Aerial LIfts / Cranes

Aerial LIfts (Articulating Booms & Scissors)

  • Aerial Iift floors are free from excess materials and debris

  • Equipment Grounds are installed

  • Workers tied off to the manufactured anchor points, using SRL's.

  • Workers feet are on the floor of the platform

  • Operator has training certification for the equipment being operated

  • Spotter used in congested areas

  • Workers are maintaining the required minimum approach distances

  • Physical protection set up to protect equipment located below the work area.

Cranes

  • Crane swing radius cordoned off

  • No one is working below a suspended load

  • Crane cribbing or outrigger pads are level and 3-5 times the size of the oputrigger floats

  • Crane has functioning anti-two block device

  • A spotter is used when working around energized lines

  • Monthly crane inspection is complete and documented

  • Crane paperwork is current (3rd party inspection, operators license, crane registration, etc)

  • Rigging tags are legible and slings are free from deficiencies

  • Equipment grounds are installed on the crane

  • Hooks for all rigging have functioning safety latches

Manual & Mechanical Material Handling

  • Workers are using mechanical lifting aids where feasible

  • Workers position themselves to avoid getting caught between equipment and fixed objects

  • Forklift operators have valid certifcates/training for the equipment being operated

  • Manufacturer approved attachment is used for rigging material & equipment below the forks

Miscellaneous

  • Comments

  • Add drawing

  • Add media

  • Add signature

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