Information

  • Document No.

  • Site Name

  • SAM Number

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Administration

  • Is the project sign in good condition, plumb, level?

  • Are the Safety Manual, SDS, OSHA Posters, OSHA 300 Log, State and Federal Posters present on site?

  • Sub-Contractor Safety Plan and SDS, Proper Labeling

  • Public liability insurance certificates are valid and on display

  • Appropriate signs/notices erected around the site i.e. mandatory use of PPE, No Smoking, First Aid, Fire Assembly, etc.

  • Ensure that all contractors have been provided with the information related H&S -document

  • Competent Person’(s) Identified

  • Toolbox Safety Meeting Records Kept

  • Ensure Injury and Near Miss book is provided on site and is available to all personnel

  • Ensure site safety rules are displayed in prominent positions

  • Ensure all subcontractors have been assessed are adequately resourced and competent for the work they are undertaking

  • SWPP Environmental Plan/Permits Obtained

  • SWPP Best Practices in use

Site Security

  • Are perimeter fences & gates sound & maintained? Are known hazards fenced?

  • Where married quarters /crèches exist, do secondary fences secure the area?

  • Are signs & notices posted at entrances and around perimeter fences?

  • Is site regularly patrolled, especially high hazard areas? (Water courses, open pits, high voltage areas, etc…)

  • Are security cameras present and operational?

  • Are illumination adequate / security lights installed?

  • Are alarms installed / monitored?

  • Are unused buildings locked, windows shuttered, and key control in operation?

  • Barricades Properly Installed

  • Traffic control Plan

  • Is a site contractor / visitor log maintained?

Roads, Pathways, Site Access and Egress

  • Ensure site access points are clearly signposted on the approaches to the site.

  • Ensure adequate on-site signage is proved to warn and advise both vehicle drivers and pedestrians

  • Have access routes been agreed with the fire and other emergency series prior to the start of work

  • Are the roads, paths, bridges, etc… adequately maintained and kept clear?

  • Are emergency routes and egress points from site adequate and maintained?

  • Are the roads, paths, bridges, etc… free of trip hazards & protruding object hazards?

  • Are speed limit signs posted? (15 mph maximum recommended)

  • Are parking areas and main entrance-ways adequately illuminated?

  • Are speed reduction measures (traffic lights, speed bumps, yield signs, etc…) adequate at main road access?

  • Are parking areas free of potholes / elevation changes that could trip someone?

Condition of Buildings / Warehouses / Trailers

  • Are buildings / warehouses / trailers own hazards?

  • Is an inspection & maintenance program in place?

  • Is inspection & maintenance program successful?

  • Is labor law & emergency information posted in common areas?

  • Are trees / shrubbery / landscaping adequately maintained? (Fire hazards, falling limbs, etc…)

  • Are insect / vermin control measures in place and adequate?

  • Are office spaces clean, sanitary and is temperature / humidity control adequate?

  • Are restroom / lavatory / washing facilities adequate and sanitary?

Housekeeping

  • Are waste receptacles present and sufficient in number?

  • Ensure all debris and waste is removed from the work area upon completion of the work or at the end of each shift

  • Material properly stored

  • Are damage materials segregated to prevent them from being used

  • Are all pipes/tubes etc. securely wedged or chocked to prevent accidental movement?

  • Are electrical cords, hoses, welding leads, etc… elevated to prevent trip hazards?

  • Are barricades erected around high hazard work areas to prevent access?

  • Clear access to building site

  • Scrap material free of protruding nails or other puncture hazards

  • Walkways Clear and Unobstructed

Health & Safety Management Plan

Administrative

  • Project management plan is up to date and signed by all relevant parties.

  • Is the emergency plan defined and in place complete with emergency contact numbers?

  • Is the plan defined and in place complete with emergency contact numbers?

Fire Prevention

  • Are designated smoking areas established? Smoking only allowed in those areas?

  • Are fire extinguishers present in buildings, on mobile equipment, & in field as required?

  • Are fire extinguisher inspections / certifications being performed / documented?

  • Are fire exits identified and emergency egress lights operable?

  • Are flammable materials stored properly?

  • Are flammable material storage areas identified with proper signage?

  • Are combustibles being stored separately from flammables, and not accumulating?

  • Does evidence suggest that a hot work permitting process is in place and being adhered to?

  • Proper signs in storage area

  • Bottles upright, capped and secured

  • Flash arrest on torches

  • Fire watch when applicable

  • Torching and Welding leads in good condition

  • Permit Program in Place

Chemical

  • Is a list of onsite chemicals present?

  • Are Safety Data Sheets available for all onsite chemicals, and are they accessible by workers?

  • Are containers of chemicals labeled appropriately, including secondary containers?

  • Are chemical storage areas identified by appropriate signage?

  • Have IH assessments been conducted for operations known to have chemical exposures?

  • Are incompatible chemicals separated appropriately?

  • Are large quantities of chemicals stored in secondary containment areas?

Confined Space Management

  • Confined Spaces include manholes, shafts, pits/tanks, pipes/culverts, certain excavations, silo’s and other confined/enclosed spaces

  • All work in confined spaces is subject to a specific risk assessment and carried out in accordance with Permit to Work/Enter and a safe system of work.

  • Only appropriately trained and qualified persons who have undergone confined spaces entry course shall be permitted to enter a confined space

  • Are Confined Spaces present on this site?

  • Is a register of confined spaces available at the site?

  • Are confined spaces identified with proper signage at or near the point of entry?

  • Does evidence suggest a permitting process is being used to control entry into confined spaces?

  • Where confined space entries are performed, are detailed JSA’s available for each space?

  • Where confined space entries are performed, are training records for workers available?

  • Where confined space entries are performed, are trained rescue service arrangements made?

Electrical Safety

  • Cords in good condition with ground prong in place

  • Cords protected from traffic

  • Do drawings/blueprints onsite that identify the location of all underground electrical equipment?

  • GFCIs Used

  • Extension cords rated for Hard or Extra Hard usage

  • Has an arc flash hazard assessment been performed at the site, and is it available for review?

  • Where an arc flash hazard assessment has been performed, are arc flash labels present on equipment?

  • Are overhead supply cable runs maintained & protected with high voltage warning signs present?

  • Does onsite equipment contain PCB’s, and if so is the equipment labelled properly?

  • When PCB’s exist onsite, is a PCB control / removal plan present onsite?

  • Are detailed JSA’s available onsite for routine maintenance and repair activities to electrical equipment?

  • Are pre-task job briefings being conducted before the start of each task?

  • Are isolation procedures available for onsite equipment, and are they effective?

  • Is electrical equipment being inspected & maintenance provided? Are records available for review?

  • Electrical Room Protected and w/ proper signage

Excavation/Earthworks

  • Is excavation operations being performed on the site?

  • Protective system used for excavations > 5’

  • Access and egress provided every 25 ft., when > 4’

  • Spoils stored at least 2 ft. from trench

  • Adjacent structures properly shored

  • Sloping, Shoring and Shields in good condition

  • Underground utilities located and marked before digging

  • Competent person Present

  • Excavation > 20’Engineered

  • Water entering excavation

  • Perimeter Properly Protected WI Barricade

  • Materials, spoils stored away from the edge of the excavation to reduce the chance of collapse

LOTO

  • Is a written LOTO program available onsite with roles & responsibilities defined?

  • Are written LOTO procedures for routine activities available for review?

  • Are examples of completed LOTO activities available for review?

  • Is documentation of LOTO training for qualified workers available for review?

  • Is an adequate supply of approved LOTO equipment available onsite?

Compressed Gas Cylinders

  • Are compressed gas cylinders in use on site?

  • Is compressed gas cylinders being stored with proper separation & securing mean?

  • Are compressed gas cylinder storage areas being inspected weekly and records maintained?

  • Are the compressed gas cylinder storage areas properly marked / identified with signage?

  • Do all lines have anti-flashback arresters fitted (except for LPG fired blow heaters/torpedo heaters?

  • Do all line connections only have approved fittings and clips, with no Jubilee clips

Fall Prevention

  • Will operations requiring fall protection performed at the site?

  • Static lines/lifelines installed properly and capable of supporting 5,400 lbs.

  • Ext/Int Guardrail; Barricades, Floor and Wall Openings Protections, installed, maintained

  • Rebar Caps used; Impalement Hazards covered

  • Do locations identified on the fall hazard register have signs / notices posted requiring fall protection?

  • Are approved anchor points clearly identifiable for locations listed on the fall hazard register?

  • Are access points to roofs, towers, pit areas, etc… strictly controlled?

  • Is there an inspection program in place for ladders (including fixed ladders)? Documentation available?

  • Roof Edge Protected

  • 100% Fall Protection Used at > 6 ft.

Scaffolding/Working Platforms

  • Are scaffolding or working platforms in use on the site?

  • Check that any scaffold erection, alteration or dismantling is carried out by a competent person

  • Check that all standards are provided with base plates and timber sole boards which span at least two base plates

  • Check that all standards, ledgers, braces and struts are in position

  • Ensure that the scaffold is adequately tied to the building or structure to prevent collapse

  • Check that there are additional brick guards provided to prevent material falling from scaffold where they are used as a working platform.

  • Check that working platforms are fully boarded and that the boards are arranged to avoid tipping or tripping (i.e. no overlapping boards

  • Does all ladder access have self- closing gates fitted?

  • Ensure that there are effective warning notices in place to sop any person using an incomplete scaffold

  • Check that the scaffold is strong enough to carry the weight of materials stored on it and that they are evenly distributed

  • Ensure that scaffold has been properly maintained and inspected

  • Guardrails in place

  • Proper Decking used and Surface in Safe Condition

Ladders/Stairs

  • Are ladders in use on the site?

  • Proper Ladder Use

  • Inspected for defects

  • Area Top and Bottom clear of debris

  • Extension ladder 4:1 pitch and 3’ above landing

  • Stairs or Ladder provided for access point > 19” high

  • Stairs Properly illuminated and clear of material and debris

  • Stair rails provided along each unprotected side or edge w/4 or more risers

Scissor Lifts

  • Are scissor lifts in use on the site?

  • Gate or chain secured

  • Harness while in boom lifts

  • Nothing to increase height

  • Operating on flat surface free of holes

  • Operating safe distance from power lines

Personal Protective Equipment

  • Hard hats worn properly and in good condition

  • Hearing protection worn as required

  • Eye Protection/Face shield worn as required

  • Proper Clothing (Pants, Sleeved Shirt)

  • Hand protection worn as required

  • Visitor PPE Available

  • Are respirators worn as required

  • Is arc flash PPE worn as required?

  • Visitor PPE available

Emergency Planning

  • Is a site specific emergency action plan available at the site?

  • Are workers aware of the basic emergency response procedures?

  • Is documentation of training on the site specific emergency action plan available for review?

  • Are emergency phone numbers & contacts posted at common areas?

  • Is a list of emergency response equipment a part of the EAP, and is it adequate?

  • Is listed emergency response equipment present onsite, and is documentation of inspections available?

  • Are maps / postings of emergency escape routes posted identifying muster points?

  • Emergency Numbers Posted

  • Map to Medical facility

  • Where an SPCC plan is required, is one present and are expectations being met?

Medical & First Aid

  • Is a sufficient number of person’s onsite trained in first aid/CPR/AED/bloodborne pathogen protection?

  • Is documentation of training available?

  • Is an adequate amount of first aid supplies available onsite? Not expired?

  • Are eye wash stations & safety showers provided as necessary?

  • Is documentation of first aid supply, eye wash station & safety shower inspections available?

Written EHS Programs & Training Documentation

  • Are there written EHS programs / procedures onsite, are they current, and site specific?

  • Is documentation of training for employees on the site EHS programs available for review?

  • Is documentation for contractor / visitor site EHS orientations available for review?

  • Is documentation for “qualified worker” and “competent person” training available for review?

  • Is documentation for contractor pre-task hazard assessments / job briefing available for review?

  • Is work permitting expectations being met by contractors performing applicable work onsite?

Power Equipment

  • Is power equipment in use on the site?

  • Machine guards in place on rotating shafts, flywheels

  • Fuel and Oil systems are maintained and without leaks?

  • Diesel equipment is in good repair, no excessive smoke

Air Quality

  • Are there air quality concerns at the site?

  • Has an assessment been performed to identify activities that pose a potential threat to air quality?

  • Have air permits been applied for when required?

  • Are there written programs controlling activities that pose a potential threat to air quality?

  • Where air permits exist, are permit requirements being met with documentation available?

  • Has training been performed when required by air permit expectations?

Water Quality

  • Is there water quality concerns at the site?

  • Has training been performed when required by water discharge permit expectations?

  • Has an assessment been performed to identify activities that pose a potential threat to water quality?

  • Have water discharge permits been applied for when required? (Including onsite STP’s)

  • Are there written programs controlling activities that pose a potential threat to water quality?

  • Where air permits exist, are permit requirements being met with documentation available?

Waste Management

  • Is a documented waste register available for review?

  • Has an EPA or State waste generator number been applied for?

  • Is there a written waste management procedure onsite detailing how to handle individual waste streams?

  • Are records of waste disposal being maintained onsite?

  • Are reports being completed and submitted for waste disposal as required?

  • Are waste drums labeled & stored properly?

  • Waste is segregated and recycled

  • Hazardous waste and used oil stored in a dyked and covered area

Utilities

  • Are drawings available that identify underground water pipes? (Potable service, sewer, etc…)

  • Are above ground water lines identified as “potable water” or “non-potable water”?

  • Are water shutoff points identified and marked in case of emergency?

  • Are drawings available that identify underground natural gas lines?

  • Are above ground natural gas lines marked / labelled?

  • Are natural gas shutoff points identified and marked in case of emergency?

Vehicles/Mobile Equipment (ALL)

  • Lights, brakes, horns and back-up alarms strobe lights working properly

  • Seat belts provided and used

  • Properly maintained and not leaking fluids

  • Daily Inspection documentation upon request

Social and Environment Management Systems

  • Copies of Environment Policy, SEMS Manual etc. available

  • Environmental and Social Impact Assessment of Project Site is available

  • EASI report has an Environment and Social Management Plan

  • ESMP has a project information disclosure strategy

  • ESMP has a Grievance mechanism

  • Periodic Monitoring and action taken reports

  • Adequacy of the Internal and External Reporting system

Labor and Working Conditions:

  • Are there labor or working condition concerns?

  • Is the HR policy adopted for the site compliant to PS-2? Prohibition on forced labor; prohibition on child labor/minim age for employment; job severance/retrenchment; minim wage; working hours; occupational health and safety ; right to associations; right to organize and collective bargaining; non-discrimination; grievance redress system

  • Communication of HR policy and terms of employment to all categories of workers?

  • Proofs for legal compliance to country’s labor and employment laws: labor reports; external or internal reports

  • Screening or due diligence followed to prohibit child and forced labor

  • Employee selection and promotion procedures are based on pr4inciple of equal opportunity/fair treatment non-discrimination

  • Functioning of grievance redress mechanism for employees and workers

  • Due diligence in the process of selection of vendors supplying Non-employee workers

  • Non-employee workers are covered with respect to: prohibition of forced and child labor; minimum wage; working hours; occupational health and safety; right to association; non-discrimination; grievance redress system

  • Certification of received from the suppliers or due-diligence that covers wages, prohibitive labor practices and occupational and safety issues

Labor Accommodation Assessment

  • Are there labor accommodations at the site?

  • Due diligence on applicable National/Local Standards: <br>1. Building Quality as per national design and construction standard 2. Basic Amenities, 3. General Health Safety and Security, 4. Fire Safety, 5. Natural Disaster resistance<br>

  • General Living Facilities<br>1. site is free from flooding, stagnant water or landslide, 2. Reasonable distance from workplace, 3. safe transportation to workplace, <br>

  • Ventilation and light appropriate for local climatic condition <br>1. For cold weather 20 C, 2. Hot weather air-conditioning, 3. window area not less than 5% to 10% of floor area<br>

  • Water Quality and Quantity: <br>1. Free potable water 2. round the clock availability of water, 3. water supply should be between 80-180 liters depending on climatic condition, 4. Drinking water meets local/WHO drinking water standards, 5. Regular Monitoring of water Quality, 6. Safe storage of water (covered and free from potential contamination)<br>

  • Waste water and Solid waste:<br>1. Specific containers for rubbish collection, 2. Placement of rubbish container 30m away from shelter, 3. No unpleasant odors associated with decaying organic material, 4. Regular collection of waste.<br>

  • Pest examination, vector control and disinfection carried out in regular interval

  • Room and Dormitory Facilities: 1. Floor is built in easily cleanable flooring material, 2. Density standards should be 10-12.5 cubic meter or 4-5.5 sq. meter of the floor space. 3. Minimum ceiling height 2.1m, 8. doors and windows lockable and provided with mosquito screens, 9. Separate sleeping areas for men and women

  • Bed Arrangement and Storage Facilities: 1. separate bed for each worker, 2. One meter minimum space between beds, 3. In bunk beds the bed heights should be from 0.7 to 1.10m, 4. No Triple deck bunks used. 5. Each worker is provided with a comfortable mattress, pillow, cover and clean bedding, 6. Bed linens are washed regularly, 7. Storage space for PPE and other safety equipment, 8. Storage space for personal belongings in 475 liter cupboard/locker and 1m of shelf unit.

  • Sanitary and Toilet and Laundry Facilities: 1. 1. material used in floor and wall are easily cleanable, 2. Adequate privacy by high walls and lockable doors, 3. Different toilet facilities for men & women, 4. One toilet for every 6 to 15 persons, 5. One urinal for every 15 persons, 6. One shower/bathroom per 6 to 15 persons, 7. Adequate lighting and ventilation, 8. Cold and hot running water as per climatic condition, 9. Distance of toilet blocks not more than 60 meters and must be in same building in cold climate zones, 10. Adequate space for hanging drying and airing clothes, 11. Supply of soaps and disinfectants

  • Canteen Facility: 1. Easily cleanable construction material used, 2. Canteen is kept clean and hygienic, 3. If workers cook their own meals, kitchen space is provided separate from sleeping areas, 4. Canteens have 1-1.5 sq m space per worker, 5. Adequately furnished- tables, benches, individual cups and plates, drinking water fountain, 6. adequate facility for cleaning, disinfecting and storage of cooking utensils, 7. Food waste and other refuse are deposited in sealable containers and cleaned regularly

  • Nutrition and Food Safety: 1. appropriate level of nutritional value, 2. different choices of food if workers have different cultural/religious backgrounds, 3. Safe storage of raw-food material, 4. serve thoroughly cooked food, 5. use of safe water and raw-material.

  • Medical Facilities: 1. First Aid kits are available and adequately stocked, 2. Access to medical facilities in emergency 3. Telephone or other communication equipment for emergency communication, 4. Record book for recording medical incidents

  • Leisure, Social and Telecommunication Facilities: 1. Multi-purpose halls with TV/Radio/Video facilities, 2. Dedicated place for religious observance, 3. Access to public phones/internet facilities in affordable rates, 4. Sports and other recreational facilities.

  • Management of Workers Accommodation: 1. Should have a written management plan, 2. A person appointed as Manager of workers accommodation, 3. if contractors are involved then clear contractual responsibilities and reporting requirements, 4. Staff involved have received basic health, safety, nutrition and food -handling trainings

  • If Fees Charged for Accommodation and Services: 1. detailed description of all payments (rent, deposit, other fees) provided to workers, 2. Rules of company housing is communicated, 3. rent/fees constitute a small proportion of income and never above the market price, 4. Speculative profit not to be included, 5. The provision of accommodation and other services are not considered as a payment for work.

  • Security of Workers Accommodation: 1. security adequate to protect workers against theft and attack, 2. a clear policy on use of force, 3. background check of the security staff, 4. security staff is trained about respect for workers’ rights and rights of the communities, 5. workers have specific means to raise concerns about security arrangement and staff.

  • Workers’ Rights Rules on Workers Accommodation: 1. 24/7 access to accommodation site, 2. withholding of workers' identity papers, 3. respect to freedom of association, 4. Allowing workers to celebrate religious holidays and observations, 5. allowing visitor access, 6. Fair and non-discriminatory disciplinary procedures (right to defend).

  • Community Relations: 1. A senior manager is accountable for liaison with community, 2. Impacts of workers accommodation on local community are periodically reviewed, 3. Action taken to mitigate adverse impacts or concerns, 4. Functioning of grievance mechanism for the community to voice their opinion and lodge complaints.

  • Add signature

Pollution Prevention and Abatement

  • Are there pollution concerns at the site?

  • Monitoring and conservation of natural resources used- water, land, minerals etc.

  • Recording and monitoring waste generation at site

  • assessment of waste disposal practice at site or due diligence of the third party responsible for waste disposal off-site

  • Is risk assessment done and an emergency response plan is prepared?

  • Compliance to applicable technical guidelines for prevention of pollution and environmental protection

  • Prof of compliance to the country's laws, permits and regulations

Community Health Safety and Security

  • Is there a labor camp for the site?

  • Labor Camp Housekeeping Adequate

  • Fire Extinguishers are available in sleeping and cooking areas

  • Drinking water meets Potable water standards and is available for Men and Women

  • Septic system per local codes or is waste removed from site via an approved vendor?

  • Cooking areas separated from sleeping areas? No food preparation in sleeping areas?

  • Pest management program in Place

  • Indication of food/water or pest borne illness?

  • Grievance mechanism in place to receive Worker Complaints?

  • Eating area (canteen) clean?

  • Trash receptacles available, used and emptied regularly?

  • Wash areas available and clean?

  • Indication of underage workers?

Land Acquisition and Involuntary Settlement

  • Are there concerns about the land acquisition for the site?

Biodiversity Conservation

  • Are there any biodiversity conservation concerns?

  • Adequacy of coverage of biodiversity conservation impacts and issues in ESIA.

  • Documentation of the consultations held with stakeholders

  • Due diligence on potential to introduce any new invasive alien species by transportation of material or earthworks

  • Due diligence on impacts on life-supporting/eco-system services of air, water and soil eco-systems

Indigenous People

  • Are there any indigenous people affected by the site?

  • Does ESIA documents screening of presence of Indigenous People among project affected families?

  • Does ESIA document steps or measures considered to avoid or minimize impacts on indigenous peoples?

  • Documentation of engagements with indigenous population and their council of elders or recognized leaders

  • Documentation of due-diligence on applicability of free prior informed consent process:<br>1. Is there relocation of IPS? 2. Is land under customary use of IPS used for the project? 3. Is there any impact on cultural heritage of Indigenous People?<br>

Cultural Heritage

  • Are there any possible cultural heritage concerns?

  • Is there any requirement to remove or damage any tangible heritage?

  • Is there a Chance Find Procedure and workers engaged in excavation work is trained in it?

  • Is there a Chance Find Procedure and workers engaged in excavation work is trained in it?

  • Documentation of compliance to any laws and regulations of the country governing cultural heritage?

Observations and Corrective Actions

  • Add media

  • Add media

  • Observation

  • Observation

  • Observation

  • Safety Manager Signiture

  • Construction Manager Signiture

  • Date and Time Audit Completed

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.