Universal Forming Jobsite Safety Audit and Risk Assessment

• Project Name:

  Select 237 - Wolfson's Children Hospital 239 - Modera Creative Village 240 - OH Randal Park 241 - JAX Ventures 243 - Joe DiMaggio 244 - Baycare 246 - Moffitt Expansion Hospital 247 - Sinai Residences 248 - Palmer House 249 - FIS 250 - Madison Highlands

  • 237 - Wolfson's Children Hospital
  • 239 - Modera Creative Village
  • 240 - OH Randal Park
  • 241 - JAX Ventures
  • 243 - Joe DiMaggio
  • 244 - Baycare
  • 246 - Moffitt Expansion Hospital
  • 247 - Sinai Residences
  • 248 - Palmer House
  • 249 - FIS
  • 250 - Madison Highlands
• Location:
  Address

• General Contractor:

  Select Barr & Barr Gilbane Building Company Robins & Morton DPR Construction Winter Park Construction Jack Jennings & Sons Whiting Turner Summit Contracting CPPI

  • Barr & Barr
  • Gilbane Building Company
  • Robins & Morton
  • DPR Construction
  • Winter Park Construction
  • Jack Jennings & Sons
  • Whiting Turner
  • Summit Contracting
  • CPPI

• Conducted on:

  Date

• Prepared by:

  Thomas Isola

  Richie Vicens

  Juan Medina

• Purpose of audit:

1. Universal Forming Program Requirements

• 1.1 UFI Safety Program Onsite?

  Yes

  No

• 1.2 SDS/Hazcom Program Current?

  Compliant

  Non-Compliant

  N/A

• 1.3 Pre-Task planning implemented?

  Compliant

  Non-Compliant

• 1.4 Weekly Safety Inspections Current?

  Compliant

  Non-Compliant

2. General Safety & Health Provisions

• 2.1 Work areas clean and free of excess trash and debris?

  Compliant

  Non-Compliant

• 2.3 Material stored properly?

  Compliant

  Non-Compliant

  N/A

• 2.4 Scrap material free of puncture hazards?

  Compliant

  Non-Compliant

  N/A

• 2.5. Insufficient lighting?

  Safe

  At Risk

3. Personal Protective Equipment

• 3.1 Full body harness maintained?

  Pass

  Fail

• 3.2 PPE functional and in good repair. Employees Wearing Appropriately?

  Compliant

  Non-Compliant

• 3.4 Proper glasses being worn for specific areas?

  Compliant

  Non-Compliant

• Respiratory Protection Program followed where required?

  Compliant

  Non-Compliant

  N/A

• Hearing Conservation Program followed where required?

  Compliant

  Non-Compliant

  N/A

4. Tools and Equipment

• 4.1 Broken tools taken out of service and tagged out?

  Yes

  No

  N/A

• 4.2 Are safety retainers installed on air hoses to prevent accidental disconnect?

  Yes

  No

  N/A

• 4.3 Do air compressor hoses have a shut off valve on the end and are hoses, blow pipes, etc. in good condition?

  Yes

  No

  N/A

• 4.4 All hand tools observed in good shape?

  Pass

  Fail

• 4.5 Lock out/tag out procedures followed?

  Yes

  No

  N/A

• 4.6 Unsafe or damaged equipment or power tools? (including missing or damaged guards)?

  Safe

  At Risk

• 4.7 Side handles being used on grinders and drills?

  Safe

  At Risk

• 4.8 Hammer head in good shape with no grinder cuts?

  Safe

  At Risk

• 4.9 Saw horses in use and top plate inspected?

  Pass

  Fail

• 4.10 Incorrect equipment or tools for job? (e.g. grinding discs for cutting)

  Compliant

  Non-Compliant

  N/A

5. Stairways and Ladders

• 5.1 Stairway or ladder provided in breaks of elevation of 19” or more with pull up ropes installed on ladders?

  Compliant

  Non-Compliant

  N/A

• 5.2 Is there more than one ladder for more than 25 people on the working area?

  Compliant

  Non-Compliant

  N/A

• 5.3 Stairways equipped with handrails installed between 30-37” above the treads with spacing between the wall and handrail?

  Compliant

  Non-Compliant

  N/A

• 5.4 Job built wood ladder rungs 12” on center & side rails 16” – 20” apart properly constructed

  Compliant

  Non-Compliant

  N/A

• 5.5 Job built ladder grab bars in use & secured with lag screws?

  Compliant

  Non-Compliant

  N/A

• 5.6 Ladder spreaders locked while the stepladder is being used?

  Yes

  No

  N/A

• 5.7 Are the top two steps on the stepladder not being used?

  Yes

  No

  N/A

• 5.8 Ladder side rail extends 36” – 42” above landing area and secured?

  Yes

  No

  N/A

• 5.9 Portable ladders secured at top to prevent accidental displacement?

  Yes

  No

  N/A

• 5.10 Extension ladder used only on stable and level surfaces and secured at the base?

  Yes

  No

  N/A

• 5.11 Defective ladders being disposed of?

  Yes

  No

6. Crane, Rigging & Lifting Equipment

• 6.1 Signal Person certified?

  Compliant

  Non-Compliant

  N/A

• 6.2 Rigging in good condition?

  Pass

  Fail

• 6.3 Tag line(s) in use?

  Yes

  No

  N/A

• 6.4 Unsafe or damaged lifting equipment, including ropes, slings, chains, hooks?

  Safe

  At Risk

• 6.5 Are slings permanently identified & legible stating size, grade, rated capacity, and sling manufacturer?

  Pass

  Fail

• 6.6 Materials stored and stacked on firm foundation at least 10’ from edge of slab?

  Compliant

  Non-Compliant

  N/A

• 6.7 Crane swing radius barricades in place?

  Safe

  At Risk

  N/A

• 6.8 Safe distance from heavy equipment?

  Safe

  At Risk

  N/A

7. Signs, Signals & Barricades

• 7.1 Stripping signs posted?

  Compliant

  Non-Compliant

  N/A

• 7.2 Stripping area barricaded?

  Compliant

  Non-Compliant

  N/A

• 7.3 All fall hazard areas barricaded correctly?

  Safe

  At Risk

  N/A

• 7.4 Lower levels & ground area barricaded under perimeter stripping operations?

  Compliant

  Non-Compliant

  N/A

• 7.5 Lower levels & ground barricades removed timely?

  Compliant

  Non-Compliant

  N/A

• 7.6 Proper signage at Outrigger?

  Yes

  No

  N/A

• 7.7 Men Working Above Signs in place?

  Compliant

  Non-Compliant

  N/A

• 7.8 Proper signage at Leading Edge?

  Yes

  No

  N/A

8. Shores, Reshores, Stripping, Stripping Nets

• 8.1 Perimeter lacing installed on all unsecured shores to prevent accidentally falling out of place?

  Compliant

  Non-Compliant

  N/A

• 8.2 Stripping nets in good shape?

  Safe

  At Risk

  N/A

• 8.3 Stripping nets installed per manufacturer?

  Compliant

  Non-Compliant

  N/A

• 8.4 Erection and dismantling procedures are followed under the direction of a competent person?

  Compliant

  Non-Compliant

  N/A

• 8.5 Scaffolding with a height to base ration greater than 4 to 1 is restrained from tipping by guy wires, bracing, or equivalent means?

  Compliant

  Non-Compliant

  N/A

• 8.6 Work planks cleated at the ends with a 2x4?

  Yes

  No

  N/A

9. Electrical Hazards

• 9.1 Aerial lift extension cord / GFCI free from damage with grounding pin

  Safe

  At Risk

  N/A

• 9.2 Extension cords proper ground pins, no wires showing , damage insulating sheathing or strain relief pulled

  Safe

  At Risk

• 9.3 Extension cords not hung with staples, nails, or suspended from wire?

  Compliant

  Non-Compliant

  N/A

10. Fire Protection

• 10.1 Fire extinguisher immediately available in work area for instant use while cutting or welding?

  Compliant

  Non-Compliant

  N/A

• 10.2 Approved RED safety cans for GASOLINE stored in ventilated area and tagged?

  Compliant

  Non-Compliant

  N/A

• 10.3 Approved YELLOW safety cans for DIESEL stored in ventilated area and tagged?

  Compliant

  Non-Compliant

  N/A

• 10.4 Fire Extinguisher 20-B located not less than 25 feet, nor more than 75 feet, from any flammable liquid storage area located outside?

  Compliant

  Non-Compliant

  N/A

11. Fall Protection

• 11.1 Adequate Temporary Guardrail systems installed properly?

  Compliant

  Non-Compliant

  N/A

• 11.2 Adequate Permanent Guardrail systems in place?

  Compliant

  Non-Compliant

  N/A

• 11.3 Are holes 2” or wider covered, secured , labeled “HOLE” and designed per program?

  Compliant

  Non-Compliant

  N/A

• 11.4 All hand rails installed properly up to leading edge barricades?

  Compliant

  Non-Compliant

  N/A

• 11.5 Outriggers have guardrails in place and approved anchor points?

  Yes

  No

  N/A

• 11.6 Horizontal lifelines installed correctly?

  Compliant

  Non-Compliant

  N/A

• 11.7 Are employees who construct leading edge or working protected from falling by approved methods?

  Yes

  No

  N/A

• 11.8 PFAS inspection training completed and documented for all employees?

  Yes

  No

  N/A

12. Scaffolds

• 12.1. OSHA competent person(s) erecting scaffold?

  Compliant

  Non-Compliant

  N/A

• 12.2. Unsafe or incomplete scaffold?

  Safe

  At Risk

• 12.3. Toe boards, hand rails and mid rails in place?

  Compliant

  Non-Compliant

  N/A

• 12.4. Safe Work Load exceeded? (tools, stored materials, number of persons)

  Safe

  At Risk

  N/A

• 12.5 Rolling scaffold wheels locked while used?

  Yes

  No

  N/A

• 12.6 Working level fully planked?

  Compliant

  Non-Compliant

  N/A

• 12.7 Each employee 6’ above a lower level protected by guardrails or lifelines?

  Compliant

  Non-Compliant

  N/A

• 12.8 Scaffold erectors and dismantlers tied off inside of scaffold?

  Compliant

  Non-Compliant

  N/A

• 12.9 All employees properly trained and documented?

  Compliant

  Non-Compliant

  N/A

• 12.10 Working level of scaffold fully planked with no more than 1” open space between planks?

  Compliant

  Non-Compliant

  N/A

• 12.11 Scaffold walkways at least 18” wide?

  Compliant

  Non-Compliant

  N/A

• 12.12 Scaffold planks extend at least 6” over a support brace and free from splits?

  Compliant

  Non-Compliant

  N/A

13. Motor Vehicles/Equipment

• 13.1 Seatbelts being used on all equipment?

  Yes

  No

  N/A

• 13.2 All equipment operators authorized?

  Compliant

  Non-Compliant

  N/A

• 13.3 Backup alarm functioning on heavy equipment?

  Yes

  No

  N/A

• 13.4 Equipment inspections current?

  Yes

  No

  N/A

• Rated load capacities, operating speeds, warnings, instructions posted on equipment?

  Yes

  No

  N/A

14. Trenching and Shoring

• 14.1 Spoil pile away from trench - 2 feet minimum requirement

  Pass

  Fail

  N/A

• 14.2. Proper egress in place?

  Safe

  At Risk

  N/A

• 14.3. Trench properly barricaded?

  Compliant

  Non-Compliant

  N/A

• 14.4 Employees protected by proper system?

  Safe

  At Risk

  N/A

• 14.5 Employee training complete?

  Compliant

  Non-Compliant

  N/A

• 14.6 Ladder provided for 4’ deep trench?

  Yes

  No

  N/A

Concrete Construction

• Impalement hazards negated?

  Safe

  At Risk

  N/A

• PT cable pulling operations protected?

  Yes

  No

  N/A

• Place and Finish Crew wearing proper PPE?

  Yes

  No

  N/A

15. Hazardous Material & Material Safety Data Sheet (MSDS)

• 15.1. Unsafe storage location? (e.g. flammables near ignition sources, etc)

  Safe

  At Risk

• 15.2. Inadequate spill containment equipment?

  Safe

  At Risk

• Chemical containers clearly labeled as to contents?

  Safe

  At Risk

• 15.4. Lack of emergency procedures for injury/spills/fire etc?

  Safe

  At Risk

• 15.5 Insufficient ventilation?

  Safe

  At Risk

• 15.6 Insufficient, or incorrect, PPE?

  Safe

  At Risk

13. Emergency Response

• 13.1. Lack of, or no emergency plans for site?

  Safe

  At Risk

• 13.2. Emergency procedures not displayed at site?

  Safe

  At Risk

• 13.3. Lack of knowledge, training and rehearsal of emergency plans?

  Safe

  At Risk

• 13.4. Lack of, or inadequate first aid kits aid equipment for site?

  Safe

  At Risk

• 13.5. Insufficient access to formally trained First Aiders for all shifts?

  Safe

  At Risk

• 13.6. Unsuitable or inadequate communication equipment?

  Safe

  At Risk

Craft Training

• Scaffold training provided?

  Yes

  No

  N/A

• Circular saw training provided?

  Yes

  No

  N/A

• Proper use of Ellis Jack training? Hand & foot placement?

  Compliant

  Non-Compliant

  N/A

• HLL use provided?

  Yes

  No

  N/A

• Ladder training provided?

  Yes

  No

  N/A

• Aerial Lift training completed?

  Yes

  No

  N/A

• Forklift training completed?

  Yes

  No

  N/A

Corrective Actions

• Enter any corrective actions that will be undertaken

Sign Off

• On site representative / Supervisor

  Sign

• Auditor's signature

  Sign