TZC 2019 - Life Critical

• Conducted on

  Date

• Prepared by

• Location
  Address

Housekeeping / Personal Protective Equipment

• Work area clean and free of excess trash/debris. <br>

  Yes

  No

  N/A

• Walkways and passageways clear. <br>

  Yes

  No

  N/A

• Material or equipment properly stored. <br>

  Yes

  No

  N/A

• Electrical cords, hoses, welding leads, etc. positioned to avoid trip hazards. <br>

  Safe

  At Risk

  N/A

• Required PPE being used and properly worn. <br>

  Safe

  At Risk

  N/A

• Notes / Other:

• Add media

  Media

Fall Protection

• Personal Fall Arrest System contains all proper components and is being used properly. <br>

  Safe

  At Risk

  N/A

• Body harness worn in proper manner if required. <br>

  Safe

  At Risk

  N/A

• Perimeter guarding where needed.<br>

  Safe

  At Risk

  N/A

• Fall protection equipment used only for fall protection. <br>

  Safe

  At Risk

  N/A

• Proper fall protection (or restraint) being used in aerial lifts. <br>

  Safe

  At Risk

  N/A

• 100% tie off being followed

  Safe

  At Risk

  N/A

• Notes / Other:

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  Media

Excavations

• Utility mark out performed and utilities identified prior to starting excavation

  Safe

  At Risk

  N/A

• Sloped and shored properly. <br>

  Safe

  At Risk

  N/A

• Access and egress provided every 25 feet. <br>

  Safe

  At Risk

  N/A

• Water accumulation managed appropriately

  Safe

  At Risk

  N/A

• Spill dirt, equipment & material storage at least 2 feet from edge<br>

  Yes

  No

  N/A

• Daily documented inspections conducted if employees are entering shored excavation, competent person identified <br>

  Yes

  No

  N/A

• Notes / Other:

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  Media

Scaffolds and Ladders

• Proper access and egress provided. <br>

  Safe

  At Risk

  N/A

• Scaffolding Inspected and tagged appropriately. <br>

  Safe

  At Risk

  N/A

• Ladders at proper angle (4:1) and exceeds the landing by 3 feet.

  Safe

  At Risk

  N/A

• Proper ladder for the job performed/properly secured. <br> <br>

  Safe

  At Risk

  N/A

• Gangplanks - Secured, correct angle, proper handrails, proper thickness (not dimensional lumber)

  Safe

  At Risk

  N/A

• Notes / Other:

• Add media

  Media

Fire Protection

• Flammables stored properly.

  Safe

  At Risk

  N/A

• Oxygen and Combustibles separated, a minimum distance of 20 feet or by a noncombustible barrier at least 5 feet high having a fire-resistance rating of at least one-half hour.

  Safe

  At Risk

  N/A

• Fire extinguishers properly located and inspected. <br>

  Safe

  At Risk

  N/A

• Containers labeled to content.

  Yes

  No

  N/A

• Regulator gauges properly attached or removed and capped. <br>

  Yes

  No

  N/A

• Notes/ Other:

• Add media

  Media

Motorized Heavy Equipment

• Pedestrian and vehicle traffic separated<br>

  Safe

  At Risk

  N/A

• Flaggers, Observers or Spotters in place if needed.

  Safe

  At Risk

  N/A

• High Visibility Safety Apparel (HVSA) utilized.

  Safe

  At Risk

  N/A

• Heavy Equipment swing radius barricaded

  Safe

  At Risk

  N/A

• No approach of equipment until acknowledged by operator<br>

  Safe

  At Risk

  N/A

• Notes / Other:

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  Media

Lifting & Rigging

• Crane and suspended load area is clear of unauthorized personnel<br>

  Yes

  No

  N/A

• Crane swing radius barricaded<br>

  Safe

  At Risk

  N/A

• Tag lines in use<br>

  Safe

  At Risk

  N/A

• Daily rigging inspection documented in team book<br>

  Yes

  No

  N/A

• Qualified Signal Person, Qualified Rigger readily identifiable

  Yes

  No

  N/A

• Specialized plans in place for high risk activities (critical lifts, man baskets)

  Yes

  No

  N/A

• Notes / Other:

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  Media

Confined Spaces

• Confined Space Entry Permit is completed prior to entering a permit-required confined space

  Safe

  At Risk

  N/A

• Atmospheric testing is conducted, and documented, by a qualified person who demonstrates knowledge and competency applying it appropriately

  Safe

  At Risk

  N/A

• Provisions for emergency response, evacuation and rescue are identified prior to entry

  Safe

  At Risk

  N/A

• Workers are trained and knowledgeable for their respective roles

  Safe

  At Risk

  N/A

• Attendant and communication are maintained for the duration of entry, and communication and coordination is established between host employer, controlling contractor, and/or entry employer

  Safe

  At Risk

  N/A

• Notes / Other:

• Add media

  Media

Electrical Work

• GFCIs are used in damp or wet (standing water) work areas, outdoors, industrial, maintance and or construction field locations, cord and plug applications, portable, electric hand tools with cord/plug connectors, and receptacles that are not part of the permanent structure wiring (including extension cords)

  Safe

  At Risk

  N/A

• Electrical cords are inspected and free of breaks in insulation

  Safe

  At Risk

  N/A

• Electrical workers are trained for tasks being performed

  Yes

  No

  N/A

• Electrical workers and rescue personnel are trained in first-aid, CPR, and AED

  Safe

  At Risk

  N/A

• Temporary electrical outlets, receptables, junction boxes, and panels are electrically grounded

  Safe

  At Risk

  N/A

• Notes / Other

• Add media

  Media

• Signature

  Sign

• Signature

  Sign