Information
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Project Name / Raymond Job#
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Client / Project Site
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Conducted on
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Prepared by
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Project Location
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On-site Personnel
Safety Assessment
1. Safety Documents/Postings
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1.1 OSHA posters/permits/workers comp postings?
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1.2 SWP/IIPP reviewed as needed?
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1.3 Site Safety Plan?
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1.4 Routine Inspections, Monitoring, Audits?
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1.5 Job Hazard Analysis (JHA) for High-Risk Work?
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1.6 Training, Certified Operators, Skills, Experience?
2. Emergency Response
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2.1 Hospital / Clinic
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2.2 CPR Certification
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2.3 Emergency Procedures, Reviewed and Displayed at Site?
3. Work Environment
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3.1 Safe Work Practices
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3.2 PPE (task, conditions, weather)
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3.3 Amenities? (Drinking water, toilets, wash areas, lunch rooms, etc)
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3.4 First Aid Kits and Equipment on Site?
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3.5 Signage Posted?
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3.6 Safe Lifting / Team Lifting Techniques?
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3.7 Risk Controls? (Job Rotation, Lighter Loads, Board Carts, Lifting Equipment, etc)
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3.8 Respiratory Protection?
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3.9 Lighting?
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3.10 Trip Hazards (unmarked holes, floor protection, tarps, equipment etc)?
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3.11 Cleanup (dump buggies)?
4. Electrical Hazards
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4.1 Electrical Cords? (unsafe, damaged, cut, frayed, etc.)
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4.2 Lack of GFCI protection?
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4.3 Hazardous Issues (overhead electrical lines, near water, overloaded, near hazardous chemicals)?
5. Hazardous Chemical (paint, fuel, oil)?
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5.1 Safety Data Sheets on Site?
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5.2 Spill Containment Equipment?
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5.3 Storage Location? (lay out paint cans, flammables near ignition sources, spills could enter stormwater drains, etc)
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5.4 Ventilation?
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5.5 Is Fire Protection available?
6. Equipment (chop saws, p.a.t, screw guns, drills, etc.)
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6.1 Inspection Protocol?
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6.2 Certified Operators?
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6.3 PPE?
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6.4 Safe Work Practices?
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6.5 Fire Extinguishers (secured / pin has plastic tab / functioning / missing / inspected/ with in 75ft)?
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6.6 Unsafe or Damaged Equipment (gangboxes, missing or damaged guards, relief / safety devices)?
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6.7 Unsafe or incompatible attachments used with equipment?
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6.8 Clean-up (dump buggies)
7. Fall Protection
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7.1 Training (awareness)?
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7.2 Rescue Procedures in place?
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7.3 Inspection Protocol (harness, lanyard, hooks, yo yo, horizontal life line, beam claps
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7.4 PFAS Stored Properly?
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7.5 Safe Work Practices?
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7.6 Unsafe or uncertified anchor points?
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7.7 Fall risks (6 ft. or more, including voids, pits, and trenches)?
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7.8 Unprotected change of elevation >18"?
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7.9 Unsafe or incomplete edge protection?
8. Stilts
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8.1 Inspection Protocol?
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8.2 Safe Work Practices?
9. Ladders
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9.1 Safe Work Practices
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9.2 Unsafe or damaged ladders?
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9.3 Unsafe positioning of ladders?
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9.4 Ladder not properly secured?
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9.5 Is all labeling attached and legible?
10. Scaffolds (Perry, Tele Tower, Roll n Fold)
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10.1 Mobile / Rolling Scaffold Wheels Locked or Top Locks?
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10.2 Safe Work Practices
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10.3 Unsafe or Incomplete Scaffold (missing handrails, planks, out riggers etc.)?
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10.4 Aluminum / Safway Stair Scaffold
11. Scaffolds (Safway, Fraco, Swing Stage)
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11.1 Training (awareness, competent person)?
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11.2 Certified Operators?
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11.3 Inspection Protocol?
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11.4 Is there Safe Access & Egress?
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11.5 Safe Work Practices?
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11.6 Missing handrails, planks? Incompatible Scaffold Components? Unlabelled or do not meet SAIA standards?
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11.7 Safe Work Load (SWL) exceeded? (tools, stored materials, number of persons)
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11.8 Weather Conditions?
12. Aerial Work Platforms (scissor, boom)
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12.1 Training (awareness)?
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12.2 Certified Operators?
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12.3 Inspection Protocol?
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12.4 Safe Work Practices?
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12.6 Is Operators Manual on equipment?
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12.7 Weather Conditions?
13. Mixers, Pumps
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13.1 SWPPP?
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13.2 PPE?
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13.3 Containment Equipment?
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13.4 Inspection Protocol?
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13.5 Fire Extinguisher (secured, missing, pin has plastic tab)?
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13.6 Safe Work Practices?
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13.7 Hoses / Connections?
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13.8 Signage Posted?
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13.9 Cleanup / Maintenance?
14. Forklift (sit down rider, all terrain)
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14.1 Training (awareness)?
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14.2 Certified Operators?
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14.3 Inspection Protocol?
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14.4 Safe Work Practices?
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14.5 Does Fork Lift have a Fire Extinguisher attached?
15. Asbestos / Lead
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15.1 Good Faith Survey Reviewed?
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15.2 Training (awareness)?
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15.3 JHA Reviewed / Approved?
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15.4 Procedure Protocol Reviewed (work steps, containment, air monitor)?
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15.5 PPE?
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15.6 Safe Work Practices?
16. Traffic Management
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16.1 Traffic Management Plan (TMP) in place? (physical barriers, bollards, speed limits, flashing lights, spotters, etc)
17. Miscellaneous
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17.1
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17.2
Notes, Comments & Corrective Actions
Sign Off
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On site representative
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Auditor's signature Rudy Guillen Regional Safety Manager
