The Levy Company Safety Observation Report - duplicate

• Project / Site Name

• Conducted on

  Date

• Prepared by

Observation

• Type of Finding

  Positive

  Negative

• Contractor

• Category

  Select Administration Aerial/Scissor Lifts Asbestos Confined Space Cranes and Hoisting Equipment Demolition Electrical Safety Excavation and Trenching Fall Prevention and Protection Fire Prevention and Protection Hand and Power Tools Hazard Communication Heavy/Motorized Equipment Hot Work Operations Housekeeping Ladders/Stairs Material Handling Medical/1st Aid/Emergency Occupational & Environmental P.P.E. Scaffolding Site/Public Protection Steel Erection SWPP Other

  • Administration
  • Aerial/Scissor Lifts
  • Asbestos
  • Confined Space
  • Cranes and Hoisting Equipment
  • Demolition
  • Electrical Safety
  • Excavation and Trenching
  • Fall Prevention and Protection
  • Fire Prevention and Protection
  • Hand and Power Tools
  • Hazard Communication
  • Heavy/Motorized Equipment
  • Hot Work Operations
  • Housekeeping
  • Ladders/Stairs
  • Material Handling
  • Medical/1st Aid/Emergency
  • Occupational & Environmental
  • P.P.E.
  • Scaffolding
  • Site/Public Protection
  • Steel Erection
  • SWPP
  • Other

• Subcategory

  Select Labor Law Poster (Posted & Current) OSHA 300A Posted (Feb - April) Post-Incident Review Held Pre-Con Meeting Documented SDS Manual Current Visitor PPE Available Visitor Release Form Other

  • Labor Law Poster (Posted & Current)
  • OSHA 300A Posted (Feb - April)
  • Post-Incident Review Held
  • Pre-Con Meeting Documented
  • SDS Manual Current
  • Visitor PPE Available
  • Visitor Release Form
  • Other

• Subcategory

  Select Area Below Protected Controls Legible and Functioning Daily Inspections Documented Equipment Loaded Properly Fall Protection In Use (If Applicable) Gate or Chain Secured Nothing to Increase Height Operators Trained Proper Clearance From Overhead Powerlines Surface Free of Holes / Flat Other

  • Area Below Protected
  • Controls Legible and Functioning
  • Daily Inspections Documented
  • Equipment Loaded Properly
  • Fall Protection In Use (If Applicable)
  • Gate or Chain Secured
  • Nothing to Increase Height
  • Operators Trained
  • Proper Clearance From Overhead Powerlines
  • Surface Free of Holes / Flat
  • Other

• Subcategory

  Select Area Air Monitoring Conducted Contractor License Valid Critical Barriers Established Daily Log Posted Danger Signs Posted Decontamination Room Established Disposal Facility Dumpster Secured Emergency Response Plan Fire Extinguisher Present Fire-Retardant Poly Used HEPA Machine Cert. Available Personal Air Samples Posted SDS Manual Available Work Plan Submitted Worker Licenses Posted Other

  • Area Air Monitoring Conducted
  • Contractor License Valid
  • Critical Barriers Established
  • Daily Log Posted
  • Danger Signs Posted
  • Decontamination Room Established
  • Disposal Facility
  • Dumpster Secured
  • Emergency Response Plan
  • Fire Extinguisher Present
  • Fire-Retardant Poly Used
  • HEPA Machine Cert. Available
  • Personal Air Samples Posted
  • SDS Manual Available
  • Work Plan Submitted
  • Worker Licenses Posted
  • Other

• Subcategory

  Select Adequate Ventilation Air Monitoring Conducted Assessment Completed Attendant Present Authorized Entrant Confined Space Inventory Entry Supervisor Entry Team Trained / Documentation LO/TO Required / Completed Monitor Calibrated / In Use Permit Posted / Completed Proper PPE In Use Rescue Plan / Equipment Present Respiratory Protection Other

  • Adequate Ventilation
  • Air Monitoring Conducted
  • Assessment Completed
  • Attendant Present
  • Authorized Entrant
  • Confined Space Inventory
  • Entry Supervisor
  • Entry Team Trained / Documentation
  • LO/TO Required / Completed
  • Monitor Calibrated / In Use
  • Permit Posted / Completed
  • Proper PPE In Use
  • Rescue Plan / Equipment Present
  • Respiratory Protection
  • Other

• undefined

  Select Annual Inspection Current Anti-Two Block Device Boom Angle Indicator On Crane Crane Leveled On Firm Surface Daily Inspections Documented Fire Extinguisher In Crane Hoist / Lift Plan On File Load Chart Posted Load Secured / Rigged Properly Means Of Communication No Overhead Loads Outriggers Fully Extended Proper Clearance From Overhead Powerlines Proper Sized Cribbing Rigging Inspected / Rated / Tagged Safety Latches On Hooks Signal Person Trained Swing Radius Barricaded Tag Lines Used Valid Hoisting License Weight Of Load Verified Other

  • Annual Inspection Current
  • Anti-Two Block Device
  • Boom Angle Indicator On Crane
  • Crane Leveled On Firm Surface
  • Daily Inspections Documented
  • Fire Extinguisher In Crane
  • Hoist / Lift Plan On File
  • Load Chart Posted
  • Load Secured / Rigged Properly
  • Means Of Communication
  • No Overhead Loads
  • Outriggers Fully Extended
  • Proper Clearance From Overhead Powerlines
  • Proper Sized Cribbing
  • Rigging Inspected / Rated / Tagged
  • Safety Latches On Hooks
  • Signal Person Trained
  • Swing Radius Barricaded
  • Tag Lines Used
  • Valid Hoisting License
  • Weight Of Load Verified
  • Other

• Subcategory

  Select Access Controlled / Restricted Demolition Debris Removed Dust Control Engineering Survey / Demolition Plan Fall Protection In Use Fire Protection Addressed Flammable / Combustible Materials Removed Hazardous Materials Survey Housekeeping / Access Maintained Pre-Demo Checklist / Walkthru Systems Drained / Locked Out Utilities Clearly ID'd / Protected Other

  • Access Controlled / Restricted
  • Demolition Debris Removed
  • Dust Control
  • Engineering Survey / Demolition Plan
  • Fall Protection In Use
  • Fire Protection Addressed
  • Flammable / Combustible Materials Removed
  • Hazardous Materials Survey
  • Housekeeping / Access Maintained
  • Pre-Demo Checklist / Walkthru
  • Systems Drained / Locked Out
  • Utilities Clearly ID'd / Protected
  • Other

• Subcategory

  Select Circuits Labeled Cords In Good Condition Cords Protected From Traffic Electrical Rooms / Panels Secured / Signage Energized Parts Protected Energized Work Procedure / NFPA 70E Generators Grounded GFCIs Used Knock-Outs Covered / Protected LO/TO Procedures Verified Outlets / Panels Mounted Properly Proper Temporary Lighting / Guards / Cages Other

  • Circuits Labeled
  • Cords In Good Condition
  • Cords Protected From Traffic
  • Electrical Rooms / Panels Secured / Signage
  • Energized Parts Protected
  • Energized Work Procedure / NFPA 70E
  • Generators Grounded
  • GFCIs Used
  • Knock-Outs Covered / Protected
  • LO/TO Procedures Verified
  • Outlets / Panels Mounted Properly
  • Proper Temporary Lighting / Guards / Cages
  • Other

• undefined

  Select >6' - Fall Protection Installed 4' Depth - Safe Access Access Within 25' All Utilities Marked Atmospheric Hazards Benched Appropriately (Type A / B Only) Competent Person Present Excavations >20' Engineered Perimeter Protection / Barricades Sloped / Shored Properly Soil Classified / Tested (A / B / C) Spoils 2' From Edge Surface Encumbrances Supported Surface Traffic Exposure Trench Box Installed Properly / Certs Available Utilities Protected / Supported Water Entering Excavation Other

  • >6' - Fall Protection Installed
  • 4' Depth - Safe Access
  • Access Within 25'
  • All Utilities Marked
  • Atmospheric Hazards
  • Benched Appropriately (Type A / B Only)
  • Competent Person Present
  • Excavations >20' Engineered
  • Perimeter Protection / Barricades
  • Sloped / Shored Properly
  • Soil Classified / Tested (A / B / C)
  • Spoils 2' From Edge
  • Surface Encumbrances Supported
  • Surface Traffic Exposure
  • Trench Box Installed Properly / Certs Available
  • Utilities Protected / Supported
  • Water Entering Excavation
  • Other

• undefined

  Select Competent Person Present Controlled Access Zone (CAZ) Established Equipment Inspected / Functioning Falling Object Protection Guardrails In Place (Floor / Wall Openings) Harness / Lanyard Use Hole Covers Adequate / Secured / Marked (≥ 2") Impalement Protection / Rebar Caps Midrail Height Midway b/t Top Rail & Walking Level Proper Anchor Points (5,000#) Rescue Plan In Place Safe Ladder Use / Access Stair / Ramp / Walkway Protected Toeboards Present Top Rail 39"-45" Workers Trained / Documentation Other

  • Competent Person Present
  • Controlled Access Zone (CAZ) Established
  • Equipment Inspected / Functioning
  • Falling Object Protection
  • Guardrails In Place (Floor / Wall Openings)
  • Harness / Lanyard Use
  • Hole Covers Adequate / Secured / Marked (≥ 2")
  • Impalement Protection / Rebar Caps
  • Midrail Height Midway b/t Top Rail & Walking Level
  • Proper Anchor Points (5,000#)
  • Rescue Plan In Place
  • Safe Ladder Use / Access
  • Stair / Ramp / Walkway Protected
  • Toeboards Present
  • Top Rail 39"-45"
  • Workers Trained / Documentation
  • Other

• Subcategory

  Select Emergency Vehicle Access Extinguisher Charged / Inspected Fire Suppression Equipment Available Fire Watch Present Hot Work Permit Issued (LRC) No Propane Stored Indoors Proper Combustible Material Storage Proper Fuel Containers Used Proper Liquid / Gas Storage Proper Signs In Storage Area Tarps / Enclosures Are Flame Retardant Other

  • Emergency Vehicle Access
  • Extinguisher Charged / Inspected
  • Fire Suppression Equipment Available
  • Fire Watch Present
  • Hot Work Permit Issued (LRC)
  • No Propane Stored Indoors
  • Proper Combustible Material Storage
  • Proper Fuel Containers Used
  • Proper Liquid / Gas Storage
  • Proper Signs In Storage Area
  • Tarps / Enclosures Are Flame Retardant
  • Other

• Subcategory

  Select Cords In Good Condition Emergency Shut-Off Switch Ground Prong / Double Insulated Guards In Place Information Label On Tool Powder Actuated Tool (PAT) Used Appropriately Proper Tool For The Job Signage For Laser Strain Relief Functioning Tool In Good Condition (Not Modified) Whip Checks Installed Other

  • Cords In Good Condition
  • Emergency Shut-Off Switch
  • Ground Prong / Double Insulated
  • Guards In Place
  • Information Label On Tool
  • Powder Actuated Tool (PAT) Used Appropriately
  • Proper Tool For The Job
  • Signage For Laser
  • Strain Relief Functioning
  • Tool In Good Condition (Not Modified)
  • Whip Checks Installed
  • Other

• Subcategory

  Select Employees Trained Inventory List Proper PPE (Per SDS) Proper Labels On Containers SDS (Site-Specific) SDS Readily Available Other

  • Employees Trained
  • Inventory List
  • Proper PPE (Per SDS)
  • Proper Labels On Containers
  • SDS (Site-Specific)
  • SDS Readily Available
  • Other

• Subcategory

  Select Back-Up Alarm Functioning Clearance From Overhead Hazards Equipment Manual Available Flagger Used (If Applicable) Glass Free Of Obstructions Hoisting / Operator's Licenses Horn Functioning Inspections Completed Moving Parts Guarded ROPS (Roll-Over Protection) Seat Belts Used Strobe Lights Training Documentation Available Other

  • Back-Up Alarm Functioning
  • Clearance From Overhead Hazards
  • Equipment Manual Available
  • Flagger Used (If Applicable)
  • Glass Free Of Obstructions
  • Hoisting / Operator's Licenses
  • Horn Functioning
  • Inspections Completed
  • Moving Parts Guarded
  • ROPS (Roll-Over Protection)
  • Seat Belts Used
  • Strobe Lights
  • Training Documentation Available
  • Other

• Subcategory

  Select Compressed Gas Cylinders Upright / Capped / Secured Compressed Gas Cylinders Stored Properly Cutting Torch Flashback Arrestor Hot Work Permit Issued (LRC) Fire Extinguisher Present Fire Watch Present Flammable / Combustible Materials Removed Gauges Working Properly Lead Terminals Covered Leads In Good Condition Proper PPE In Use Torch Hoses In Good Condition Welding Machine Ventilated Welding Screens Provided Other

  • Compressed Gas Cylinders Upright / Capped / Secured
  • Compressed Gas Cylinders Stored Properly
  • Cutting Torch Flashback Arrestor
  • Hot Work Permit Issued (LRC)
  • Fire Extinguisher Present
  • Fire Watch Present
  • Flammable / Combustible Materials Removed
  • Gauges Working Properly
  • Lead Terminals Covered
  • Leads In Good Condition
  • Proper PPE In Use
  • Torch Hoses In Good Condition
  • Welding Machine Ventilated
  • Welding Screens Provided
  • Other

• Subcategory

  Select Clear Access to Building / Site Cords / Hoses On Floor / Walkway Proper Material Storage Roadway Around Project Clear Slip / Trip / Fall Hazards Trash In Protected Containers Walkways / Aisles Clear & Clean Work Area Clean Other

  • Clear Access to Building / Site
  • Cords / Hoses On Floor / Walkway
  • Proper Material Storage
  • Roadway Around Project Clear
  • Slip / Trip / Fall Hazards
  • Trash In Protected Containers
  • Walkways / Aisles Clear & Clean
  • Work Area Clean
  • Other

• Subcategory

  Select 3-Points Of Contact Maintained Corral / Gate / Offset At Landing Extend 3' Above Landing Extension Ladder 4:1 Pitch Inspected For Defects Job-Made Ladders Built Properly (ANSI) Ladder Set-Up Appropriate Ladders Secured In Place Landings & Stair Treads Filled Proper Use Of Ladder Safe Access Break > 19" Safe Work Distance From Hazards Slip / Trip Exposure Eliminated Stairs Illuminated Top / Bottom Of Ladders Clear Other

  • 3-Points Of Contact Maintained
  • Corral / Gate / Offset At Landing
  • Extend 3' Above Landing
  • Extension Ladder 4:1 Pitch
  • Inspected For Defects
  • Job-Made Ladders Built Properly (ANSI)
  • Ladder Set-Up Appropriate
  • Ladders Secured In Place
  • Landings & Stair Treads Filled
  • Proper Use Of Ladder
  • Safe Access Break > 19"
  • Safe Work Distance From Hazards
  • Slip / Trip Exposure Eliminated
  • Stairs Illuminated
  • Top / Bottom Of Ladders Clear
  • Other

• Subcategory

  Select Assistance For Heavy / Awkward Items Clear Paths / Housekeeping Manual Lifting In 'Power-Zone' Material Storage On Rack / Dolly / Etc. No Over-Reaching No Twisting Proper Lifting Technique Safe / Efficient Work Station Use Of Mechanical Aid Other

  • Assistance For Heavy / Awkward Items
  • Clear Paths / Housekeeping
  • Manual Lifting In 'Power-Zone'
  • Material Storage On Rack / Dolly / Etc.
  • No Over-Reaching
  • No Twisting
  • Proper Lifting Technique
  • Safe / Efficient Work Station
  • Use Of Mechanical Aid
  • Other

• Subcategory

  Select Address Displayed On Perimeter Adequate 1st Aid Kits AED Available (If Applicable) Air Horn Present Coordination With Local Fire Department Emergency Action / Crisis Management Plan Emergency Number Posted Exits Marked / Signed First-Aid / CPR Trained Map To Medical Facility Team Contact Numbers Other

  • Address Displayed On Perimeter
  • Adequate 1st Aid Kits
  • AED Available (If Applicable)
  • Air Horn Present
  • Coordination With Local Fire Department
  • Emergency Action / Crisis Management Plan
  • Emergency Number Posted
  • Exits Marked / Signed
  • First-Aid / CPR Trained
  • Map To Medical Facility
  • Team Contact Numbers
  • Other

• Subcategory

  Select Air Monitoring For Contaminant Asbestos / Lead / Mold / Silica Concrete Cut Wet & Vacuumed Containers Labeled Eye Wash Present Hand Washing Station Present Hazardous Material Properly Stored Moisture Control Plan In Place Noise Exposure / Monitoring Nuisance Dust Proper Lighting Signage For Lead / Asbestos Posted Silica Control Plan In Place Spill Containment Adequate SWPP In Place Ventilation Adequate Other

  • Air Monitoring For Contaminant
  • Asbestos / Lead / Mold / Silica
  • Concrete Cut Wet & Vacuumed
  • Containers Labeled
  • Eye Wash Present
  • Hand Washing Station Present
  • Hazardous Material Properly Stored
  • Moisture Control Plan In Place
  • Noise Exposure / Monitoring
  • Nuisance Dust
  • Proper Lighting
  • Signage For Lead / Asbestos Posted
  • Silica Control Plan In Place
  • Spill Containment Adequate
  • SWPP In Place
  • Ventilation Adequate
  • Other

• Subcategory

  Select Face Shield Foot Protection Gloves Hard Hats Hearing Protection High Visibility Clothing / Reflective Vest Proper Clothing Respiratory Protection Safety Glasses Safety Goggles Other

  • Face Shield
  • Foot Protection
  • Gloves
  • Hard Hats
  • Hearing Protection
  • High Visibility Clothing / Reflective Vest
  • Proper Clothing
  • Respiratory Protection
  • Safety Glasses
  • Safety Goggles
  • Other

• Subcategory

  Select Access To Scaffold Approprate Bracing And Pins In Place Compatible Components Used Competent Person Present Fall Protection >6' Falling Object Protection Fully Planked Guardrails Installed Inspection Daily & Documented Proper Clearance From Overhead Powerlines Proper Height To Base Ratio Proper Loading Of Materials Properly Secured To Structure / Tie-Backs Rolling Scaffold Brakes Set / Wheels Locked Sills / Plates / Jacks Installed Surface In Safe Condition Suspended Scaffold Tie-Backs Toeboards Other

  • Access To Scaffold Approprate
  • Bracing And Pins In Place
  • Compatible Components Used
  • Competent Person Present
  • Fall Protection >6'
  • Falling Object Protection
  • Fully Planked
  • Guardrails Installed
  • Inspection Daily & Documented
  • Proper Clearance From Overhead Powerlines
  • Proper Height To Base Ratio
  • Proper Loading Of Materials
  • Properly Secured To Structure / Tie-Backs
  • Rolling Scaffold Brakes Set / Wheels Locked
  • Sills / Plates / Jacks Installed
  • Surface In Safe Condition
  • Suspended Scaffold Tie-Backs
  • Toeboards
  • Other

• Subcategory

  Select Access Restricted Adequate Lighting Barricades Installed Properly Excavation Protected Falling Object / Overhead Protection Fencing Secured / Weighted Pedestrian Crosswalk Appropriate Public Protection Signage Site / Perimeter Fences Traffic Control Plan Walkway Clear Walkways Delineated / Protected Other

  • Access Restricted
  • Adequate Lighting
  • Barricades Installed Properly
  • Excavation Protected
  • Falling Object / Overhead Protection
  • Fencing Secured / Weighted
  • Pedestrian Crosswalk Appropriate
  • Public Protection Signage
  • Site / Perimeter Fences
  • Traffic Control Plan
  • Walkway Clear
  • Walkways Delineated / Protected
  • Other

• Subcategory

  Select Controlled Decking Zone (CDZ) Training / Utilized Fall Protection Training Provided Falling Object Protection Multiple Lift Procedure (Christmas Treeing) Multiple Lift / Rigging / Connector Training Proper Anchorage Of Columns / Beams Site Layout / Sequence Plan Site-Specific Steel Erection Plan Written Approval Concrete Strength Other

  • Controlled Decking Zone (CDZ) Training / Utilized
  • Fall Protection Training Provided
  • Falling Object Protection
  • Multiple Lift Procedure (Christmas Treeing)
  • Multiple Lift / Rigging / Connector Training
  • Proper Anchorage Of Columns / Beams
  • Site Layout / Sequence Plan
  • Site-Specific Steel Erection Plan
  • Written Approval Concrete Strength
  • Other

• Location

• Description

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