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. PPE (Personal Protective Equipment)
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1.1 Lack of, or inadequate PPE (including sun protection)
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1.2 Respiratory protection/equipment?
2. Safety Documents/Postings
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2.1 OSHA posters/permits/workers comp postings?
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2.2 Lack of, or inadequate system to review SWP/IIPPas needed?
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2.3 Lack of/or inadequate Site Safety Plan?
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2.4 Lack of, or inadequate, routine inspections, monitoring, audits?
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2.5 Lack of/or inadequate Job Hazard Analysis (JHA) for high- risk work?
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2.6 Lack of/or inadequate training, licenses, skills, experience?
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2.7 P.A.T./LASER/Fireproofing signage posted?
3. Positions & Actions of People
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3.1 Lack of training in risk controls and safe lifting/team lifting techniques?
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3.2 Lack of identification/assessment of hazardous manual tasks?
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3.3 Inadequate risk controls? (examples: no job rotation, lighter loads, trolleys, lifting equipment, etc)
4. Equipment (chop saws, drills, mixers, pumps, etc.)
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4.1 Lack of inspection regime?
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4.2 Unlicensed operators?
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4.3 Lack of safe work instructions?
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4.4 Unsafe or damaged equipment? (including missing or damaged guards, relief/safety devices)
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4.5 Incorrect equipment for job? (e.g. grinding discs for cutting)
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4.6 Unsafe or incompatible attachments used with equipment?
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4.7 Unsafe safe operation, clean-up and maintenance?
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4.8 Is Fire Protection available?
5. Slips, Trips & Falls
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5.1 Unprotected/unsecured/unmarked holes or depressions (>2" dia)?
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5.2 Trip Hazards?
6. Scaffolds
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6.1 Mobile scaffold wheels locked?
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6.2 Lack of inspection protocol for scaffold?
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6.3 Unsafe or incomplete scaffold (missing handrails, planks, etc.)?
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6.4 Incompatible scaffold components? Unlabelled or do not meet SAIA standards?
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6.5 Safe Work Load (SWL) exceeded? (tools, stored materials, number of persons)
7. Working at Heights
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7.1 Fall risks (6 ft. or more, including voids, pits, and trenches)?
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7.2 Unprotected change of elevation >18"?
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7.3 Unsafe or incomplete edge protection?
8. Fall Protection
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8.1 Lack of inspection protocol for equipment?
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8.2 Inadequate training for PFAS?
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8.3 Unsafe or damaged harness, lanyards, hooks or equipment?
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8.4 Unlabelled or does not meet Manufacturers standards?
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8.5 Unsafe or uncertified anchor points?
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8.6 Is PFAS stored properly?
9. Ladders
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9.1 Unsafe or damaged ladders?
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9.2 Unsafe positioning of ladders?
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9.3 Ladder not properly secured?
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9.4 Is all labeling attached and legible?
10. Lifting Equipment (scissor, boom, fork)
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10.1 Lack of daily inspection protocol?
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10.2 Unlicensed operators?
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10.3 Is Operators Manual on equipment?
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10.4 Does Forklift have a Fire Extinguisher attached?
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10.5 Unsafe operation observed?
11. Electrical Hazards
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11.1 Unsafe/damaged electrical cords? (damaged, cut, frayed, etc.)
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11.2 Lack of GFCI protection?
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11.3 Hazardous issues ( contact with overhead electrical lines, near water, overloaded, near hazardous chemicals)?
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11.4 Trip Hazard?
12. Work Environment
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12.1 Inadequate housekeeping?
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12.2 Lack of/or inadequate amenities? (toilets, wash areas, lunch rooms, etc)
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12.3 Insufficient lighting?
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12.4 Lack of, or inadequate noise/ vibration control?
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12.5 Is there adequate & Safe Access & Egress?
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12.6 Air quality acceptable?
13. Emergency Response
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13.1 Lack of, or inadequate first aid kits aid equipment for site?
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13.2 Lack of drinking water available? (2 gallons, per person, per 8 hour shift)
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13.3 Emergency procedures, available, reviewed and displayed at site?
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13.4 Fire Extinguishers secured/available/functioning/inspected?
14. Traffic Management
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14.1 Inadequate controls and Traffic Management Plan (TMP) I place? (physical barriers, bollards, speed limits, flashing lights, spotters, etc)
15. Hazardous Chemical (including fuel and oil)?
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15.1 Inadequate spill containment equipment?
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15.2 Unsuitable/missing/damaged Fire protection (fire extinguisher)
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15.3 Safety Data Sheets not accessible on site?
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15.4 Unsafe storage location? (e.g. flammables near ignition sources, spills could enter stormwater drains, etc)
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15.5 Insufficient ventilation?
16. Environmental Hazards
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16.1 SWPPP
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16.2 PACM/PLCM-ACM/LCM (Asbestos/Lead)?
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16.3 Lack of/or inadequate, dust suppression system?
17. Miscellaneous
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17.1 Safe / At Risk?
Notes, Comments & Corrective Actions
Sign Off
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On site representative
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Auditor's signature KIRK WILLIAMSON, The RAYMOND Group Director of Safety
