UPFraming Job-Site Pit-Stop Safety Review

• Document Title

• Document No.

• Job Site Builder/Name

• Conducted on

  Date
• What is the address of the Jobsite
  Address

• Foreman

• Additional Attendees (Besides Foreman + # of EE's on site)

Documentation

• Will you be checking Documentation on this site?

  Yes

  No

• A "Tailgate" safety meeting was held at least once this week? [1504] (21e)

  Compliant

  Non-Compliant

  Abated

  N/A

• Fall Protection Inspection Sheet filled out each morning and readily available

  Compliant

  Non-Compliant

  Abated

  N/A

• Readily available Safety Binder Containing: COSP [1509](21c), IIPP [1509,3203](90), HIPP [3395](81), HAZCOM [5194](77a), CPP [3205]

  Compliant

  Non-Compliant

  Abated

  N/A

• Readily Available (EMS) Emergency Medical Services Plan [1512](69b)

  Compliant

  Non-Compliant

  Abated

  N/A

• Forklift driver Certified [3650](72j) and Forklift Inspected (Form Completed)[3668(d)]

  Compliant

  Non-Compliant

  Abated

  N/A

• Posted: Labor Board Poster, Emergency Phone Numbers, UPF Safety Postings

  Compliant

  Non-Compliant

  Abated

  N/A

• Safety Data Sheets (SDS) Binder on site

  Compliant

  Non-Compliant

  Abated

  N/A

General Comments

• Add any additional relevant photos

  Media

Sign Off

• Name & Signature of Foreman

  Sign

• Name & Signature of Inspector

  Sign