Tappan Zee Hudson Crossing Project

• Supervisor/Crew:

• Conducted on

  Date

• Auditor

• Location
  Address

1.0 Work at Heights Including Scaffold, Ladders, and Gangplanks

• 1.1 Guardrails/rigid barricades in place and adequate?

  Yes

  No

  N/A

• 1.2 Hole covers in place and adequate?

  Yes

  No

  N/A

• 1.3 Scaffolding - tagged, signed off, contact name and number available?

  Yes

  No

  N/A

• 1.4 100% tie off being followed?

  Yes

  No

  N/A

• 1.5 Ladders- good condition, secured, correct angle, extend past landing?

  Yes

  No

  N/A

• 1.6 Gangplanks - secured at one end, correct angle, proper guardrails?

  Yes

  No

  N/A

• 1.7 Other:

  Yes

  No

  N/A

• 1.8 Ohter:

  Yes

  No

  N/A

2.0 Emergency Equipment/Supplies Available

• 2.01 First Aid Kit available and properly stocked?

  Yes

  No

  N/A

• 2.2 Eye wash station sealed and readily available?

  Yes

  No

  N/A

• 2.3 Fire extinguisher available and ready for use?

  Yes

  No

  N/A

• 2.4 Other:

  Yes

  No

  N/A

• 2.5 Other:

  Yes

  No

  N/A

3.0 Motorized Heavy Equipment

• 3.1 Pedestrian and vehicle traffic separated?

  Yes

  No

  N/A

• 3.2 Flagger in place?

  Yes

  No

  N/A

• 3.3 Highly-visibility clothing used?

  Yes

  No

  N/A

• 3.4 No approach of equipment until acknowledged by operator?

  Yes

  No

  N/A

• 3.5 Swing radius barricades or appropriate?

  Yes

  No

  N/A

• 3.6 Other:

  Yes

  No

  N/A

• 3.7 Other:

  Yes

  No

  N/A

4.0 Material Handling

• 4.1 Personnel are clear of line of fire when loads are moved?

  Yes

  No

  N/A

• 4.2 Loads are stable prior to unstrapping?

  Yes

  No

  N/A

• 4.3 Loads are secured before transit?

  Yes

  No

  N/A

• 4.4 Materials are stored properly as required?

  Yes

  No

  N/A

• 4.5 Other:

  Yes

  No

  N/A

• 4.6 Other:

  Yes

  No

  N/A

5.0 Confined Space Entry

• 5.1 Permit requirements followed and signed permit available?

  Yes

  No

  N/A

• 5.2 Forced ventilation in place?

  Yes

  No

  N/A

• 5.3 Atmospheric testing done?

  Yes

  No

  N/A

• 5.4 Attendant(s) in place?

  Yes

  No

  N/A

• 5.5 Other:

  Yes

  No

  N/A

• 5.6 Other:

  Yes

  No

  N/A

6.0 Cranes and Rigging

• 6.1 Crane and suspended load area is clear of unauthorized?

  Yes

  No

  N/A

• 6.2 Swing radius barricaded?

  Yes

  No

  N/A

• 6.3 Tag lines in use?

  Yes

  No

  N/A

• 6.4 Daily rigging inspection documented in team book?

  Yes

  No

  N/A

• 6.5 Other:

  Yes

  No

  N/A

• 6.6 Other:

  Yes

  No

  N/A

7.0 Trenching and Excavations

• 7.1 Competent person available and daily inspection in team book?

  Yes

  No

  N/A

• 7.2 Benched, sloped, shored properly when deeper than 5 feet?

  Yes

  No

  N/A

• 7.3 Spoil dirt, equipment and material storage at least 2 feet back?

  Yes

  No

  N/A

• 7.4 No water accumulation in excavations?

  Yes

  No

  N/A

• 7.5 Access and egress provided every 25 feet?

  Yes

  No

  N/A

• 7.6 Other:

  Yes

  No

  N/A

• 7.7 Other:

  Yes

  No

  N/A

8.0 Electrical Work

• 8.1 Working on live equiment to be avoided unless not possible?

  Yes

  No

  N/A

• 8.2 Proper PPE in place such as flame resistant clothing and voltage rated gloves as needed for live work?

  Yes

  No

  N/A

• 8.3 Work area properly barricated?

  Yes

  No

  N/A

• 8.4 Live work permits in place?

  Yes

  No

  N/A

• 8.5 All equipment, tools, and materials kep minimum of 20 feet?

  Yes

  No

  N/A

• 8.6 Other:

  Yes

  No

  N/A

• 8.7 Other:

  Yes

  No

  N/A

9.0 Hazardous Energy Control/Line

• 9.1 Identify and isolate potential energy sources and stored?

  Yes

  No

  N/A

• 9.2 Lockout, tag, verify zero energy prior to working on systems or equipment?

  Yes

  No

  N/A

• 9.3 Other

  Yes

  No

  N/A

• 9.4 Other

  Yes

  No

  N/A

Signatures

• Supervisor

  Sign

• Auditor

  Sign