TDPM Site Safety Survey Copy

• Contractor

• Work Area

• Date and Time

  Date

• Superintendent

• Foreman

• Crew size in work area

• Number of workers on site

• Contractor's Safety Representitive

• Survey completed by

Administrative:

• Is there JHA covering the scope of work being preformed?

  Yes

  No

  N/A

• Was a PTP filled out for scope of work and did it cover the hazards of their work?

  Yes

  No

  N/A

• Are there any additional hazards found not noted on the PTP/JHA?

  Yes

  No

  N/A

• Is there employee knowledge of GHS and hazards noted on the SDS of products being used?

  Yes

  No

  N/A

• Was an equipment inspection preformed by the operator before using the equipment?

  Yes

  No

  N/A

• Does the operator have proof that he has been trained to operate the equipment?

  Yes

  No

  N/A

Conditions

• Are tools being used in a proper and safe manner?

  Yes

  No

  N/A

• Are safe work practices in material handling being used?

  Yes

  No

  N/A

• For the work being preformed is the correct PPE being used?

  Yes

  No

  N/A

• Are there less than two employees working together in any one area or task?

  Yes

  No

  N/A

• Are any conditions present found to be in violation of the OSHA 1926 standards?

  Yes

  No

  N/A

• What training has employee received from his employer before performing this task or scope of work?

  Yes

  No

  N/A

Employee's perception of their role in safety and their perception of management

• What would be the most likely cause or condition for something to go wrong within your task today?

  Yes

  No

  N/A

• In this mornings Daily Huddle what hazard did you become most aware of?

  Yes

  No

  N/A

• Did you do your stretch and flex this morning or after lunch?

  Yes

  No

  N/A

• Did the meeting wake you up for the day?

  Yes

  No

  N/A

• Have you ever identified something that wad not on the PTP/JHA or that was missed by the crew?

  yes

  no

• Has anyone given you praise for working safely?

  yes

  no

• Do you feel that you have the correct PPE and tools for the task or job you are performing?

  Yes

  No

  N/A

• If you saw a hazard in the work place would you do something?

  Yes

  No

  N/A

• Is near miss reporting encouraged within your company?

  Yes

  No

  N/A

• Have you ever reported a near miss?

  yes

  no

• Does reporting an accident/incident cause you to worry about what your employer would do or say to you?

  Yes

  No

  N/A

• If you were involved in an incident would you feel like you could lose your job?

  Yes

  No

  N/A

• What would you like tho see more of that would help you do your job?

  yes

  no

Foreman's perception of their role in safety and providing a work area free of recognized hazards

• Have you ever made a safety suggestion to your management or site management?

  yes

  no

• Have you ever reported a near miss?

  yes

  no

• What safety conversation did you have with your crew today?

  yes

  no

• What risks do other trades pose to your employees in the area?

  yes

  no

• When hazards are identified do you feel that BARC or your company's management will address the hazard noted?

  Yes

  No

  N/A

Additional Comments

• Additional comments:

• Signature of foreman, superintendent, or crew leader

  Sign