URS Safety Project Review Form trial

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

URS corporation Programs and Procedures

• Site specific safety plan

  Yes

  No

  N/A

• Project Safety Representative

  Yes

  No

  N/A

• Are all STS certified employees participating in the safety program<br><br>2010 Safety Action Plan

  Yes

  No

  N/A

• Has the safety committee implemented the hand safety program<br><br>2010 Safety Action Plan

  Yes

  No

  N/A

• Contractors/Subcontractors meet URS Qualifications<br><br>Procedure 10 and 2010 Safety Action Plan

  Yes

  No

  N/A

• Contractors/Subcontractors Safety Representative<br><br>Procedure10

  Yes

  No

  N/A

• Contractors/Subcontractors following requirements<br><br>Procedure

  Yes

  No

  N/A

• Lessons learned distributed for all incidents

  Yes

  No

  N/A

• URS Corporation Corporate Safety Manual

  Yes

  No

  N/A

• OSHA 300 Log / 300A summary posting

  Yes

  No

  N/A

• First aid log

  Yes

  No

  N/A

• Supervisors Report of Injury

  Yes

  No

  N/A

• Emergency Action Plan / Crisis Plan

  Yes

  No

  N/A

• Emergency Drills scheduled and performed by local EMS

  Yes

  No

  N/A

• Required Government Posters, Safety Bulletin Board provided

  Yes

  No

  N/A

• Approved Traffic Plan

  Yes

  No

  N/A

• Sound and Air Quality Surveys

  Yes

  No

  N/A

• Base Line Studies Completed Soils / Employees etc.

  Yes

  No

  N/A

• SPCC Plan Being followed

  Yes

  No

  N/A

• Dust Control Plan being followed

  Yes

  No

  N/A

• Review Work Plans VS. Work Being Performed

  Yes

  No

  N/A

• Medical Clinic Established

  Yes

  No

  N/A

• Daily Equipment Inspection Plan effectiveness

  Yes

  No

  N/A

• Operator Maintenance Manuals on Equipment

  Yes

  No

  N/A

• Job Hazard Analysis

  Yes

  No

  N/A

• Required Weekly, Monthly Job Site Inspection Reports. Include Management Participation

  Yes

  No

  N/A

• Required Reporting

  Yes

  No

  N/A

• Safety Incentive Program in place

  Yes

  No

  N/A

• Inspection Program in place for Equipment, and Hand Tools (prior to coming on site or upon delivery)

  Yes

  No

  N/A

• Stretch and Flex Program

  Yes

  No

  N/A

Training and Education

• Effective New Employee Orientation Program

  Yes

  No

  N/A

• Competent Person listed and Qualifications / Training on file. Contractors and subcontractors

  Yes

  No

  N/A

• Emergency Response Training

  Yes

  No

  N/A

• Confined Space Training

  Yes

  No

  N/A

• Subcontractor Employees properly trained

  Yes

  No

  N/A

• Respiratory protection / test / medical

  Yes

  No

  N/A

• Toolbox Meeting. Verify Management Participation

  Yes

  No

  N/A

• Hazard Communication Training

  Yes

  No

  N/A

• Specialized Training (Forklift, powder actuated tools, etc.)

  Yes

  No

  N/A

• Ladder Training

  Yes

  No

  N/A

• Fire Extinguisher Training

  Yes

  No

  N/A

• SQS (Safety Qualified Supervisor) training for all Supervisors and Managers

  Yes

  No

  N/A

• STS (Safety Trained Supervisor) Certification for Supervisors and Managers

  Yes

  No

  N/A

• Scaffold Training

  Yes

  No

  N/A

• Fall Protection Training

  Yes

  No

  N/A

• ESP (Equipment Safety Program) Training. All Operators, Supervisors, and Managers

  Yes

  No

  N/A

• Personal Protective Equipment Training

  Yes

  No

  N/A

• Electrical Cords/Tools Inspection Training includes GFCI's and / or Assured Grounding Program.

  Yes

  No

  N/A

• Equipment Operator Qualifications

  Yes

  No

  N/A

• Forklift Operator Qualifications

  Yes

  No

  N/A

• Crane Operator Qualifications

  Yes

  No

  N/A

• Rigging Qualifications for Competent Person

  Yes

  No

  N/A

• Rigging Inspection Training

  Yes

  No

  N/A

• Crane Inspection Training

  Yes

  No

  N/A

• Gravity and Hazardous Energy Control<br><br>2010 Safety Action Plan

  Yes

  No

  N/A

• No Excuses for Poor Safety Performance<br><br>2010 Safety Action Plan

  Yes

  No

  N/A

• Defensive Driving Safety / Office Safety Training

  Yes

  No

  N/A

• First Aid / CPR Training

  Yes

  No

  N/A

• SOP/JHA Training

  Yes

  No

  N/A

• Accident Investigation Training

  Yes

  No

  N/A

• Proper Lifting Techniques

  Yes

  No

  N/A

• Safety Committee

  Yes

  No

  N/A

• Tracking System for all Training

  Yes

  No

  N/A

• Other Applicable Training

  Yes

  No

  N/A

General Safety and Health OSHA 1926.20 - 1926.32

• Housekeeping<br><br>1926.25

  Yes

  No

  N/A

• Trash containers provided and emptied regularly<br><br>1926.25 (c)

  Yes

  No

  N/A

• Accumulation of debris<br><br>1926.25 (a)

  Yes

  No

  N/A

• Employees familiar with Emergency Action Plans<br><br>1926.35 (a)

  Yes

  No

  N/A

• Fire Protection and Prevention Prpgram<br><br>1926.24

  Yes

  No

  N/A

• Illumination/Lighting Surveys for Night Work<br><br>1926.26

  Yes

  No

  N/A

• Means of Egress free from obstruction<br><br>1926.34

  Yes

  No

  N/A

• Employee Access to Medical Records<br><br>1926.33

  Yes

  No

  N/A

Office Conditions

• Ceiling tile

  Yes

  No

  N/A

• Flooring

  Yes

  No

  N/A

• No open flame source (candles, incense)

  Yes

  No

  N/A

• Windows and screens

  Yes

  No

  N/A

• Partitions

  Yes

  No

  N/A

• Heavy/hanging objects secured appropriately

  Yes

  No

  N/A

• Sharp objects guarded

  Yes

  No

  N/A

• Paper cutters secure

  Yes

  No

  N/A

• File cabinet doors closed

  Yes

  No

  N/A

• Heavy objects low

  Yes

  No

  N/A

• General office equipment in good condition

  Yes

  No

  N/A

Ergonomics

• Height of chair/adjustable

  Yes

  No

  N/A

• Adjustable armrest/backrest provided

  Yes

  No

  N/A

• Type of chair appropriate for task

  Yes

  No

  N/A

• Five point base chair

  Yes

  No

  N/A

• Desk height appropriate for chair height

  Yes

  No

  N/A

• Desktop organized/objects accessible

  Yes

  No

  N/A

• Adjustable keyboard tray

  Yes

  No

  N/A

• Keyboard easily accessible

  Yes

  No

  N/A

• Monitor correct height/clean screen

  Yes

  No

  N/A

• Monitor arranged with keyboard

  Yes

  No

  N/A

Toll booths

• Coin vaults carried properly

  Yes

  No

  N/A

• Coin vaults stored at easily accessible levels

  Yes

  No

  N/A

• Doors and latches in good operating condition

  Yes

  No

  N/A

• Housekeeping acceptable

  Yes

  No

  N/A

• Equipment in good condition

  Yes

  No

  N/A

• Doors, drawers, panels closed and secured when not in use

  Yes

  No

  N/A

• Floor level

  Yes

  No

  N/A

• Anti-fatigue mats in place; in good condition

  Yes

  No

  N/A

• Appropriate chairs provided

  Yes

  No

  N/A

Confined Space Entry Program

• Atmospheric Monitoring

  Yes

  No

  N/A

• Gas Testing Logs

  Yes

  No

  N/A

• Trained Personnel

  Yes

  No

  N/A

• Air quality test equipment

  Yes

  No

  N/A

• Retrieval Equipment

  Yes

  No

  N/A

• Confined Space Entry Program in place

  Yes

  No

  N/A

• Confined Space Entry Program being followed

  Yes

  No

  N/A

Health and Environmental Controls

• Availability of Medical Personnel. (Consultation)<br><br>1926.50 (a)

  Yes

  No

  N/A

• Provisions made prior to the start of project for Medical Care for injuries.<br><br>1926.50 (b)

  Yes

  No

  N/A

• Proper eye and body wash facilities available

  Yes

  No

  N/A

• First-aid kit fully stocked<br><br>1926.50 (d)1

  Yes

  No

  N/A

• Documented first-aid kit inspections (weekly)<br><br>1926.50 (d)2

  Yes

  No

  N/A

• Emergency phone numbers or radio call signs posted <br><br>1926.50 (f)

  Yes

  No

  N/A

• Emergency kits available (if in threat area)

  Yes

  No

  N/A

• Portable water available<br><br>1926.51 (a)1

  Yes

  No

  N/A

• Cups and waste can provided<br><br>1926.51 (a)3

  Yes

  No

  N/A

• Proper food storage

  Yes

  No

  N/A

• Employees knowledgable of HAZCOM<br><br>1926.59

  Yes

  No

  N/A

• Written HAZCOM program available<br><br>1926.59 (e)1

  Yes

  No

  N/A

• Proper labeling<br><br>1926.59 (f)5

  Yes

  No

  N/A

• MSDS's available in the workplace<br><br>1926.59 (g)8

  Yes

  No

  N/A

PPE

• Hard hats being used<br><br>1926.100 (a)

  Yes

  No

  N/A

• Safety glasses/face protection/gloves being used<br><br>1926.102 (a)1

  Yes

  No

  N/A

• Heavy duty work boots<br><br>1926.102 (a)1

  Yes

  No

  N/A

• Hearing protection program<br><br>1926.101 (a)

  Yes

  No

  N/A

• Respiratory protection program<br><br>1926.103

  Yes

  No

  N/A

• Safety belts, harnesses, lifelines and lanyards<br><br>1926.104

  Yes

  No

  N/A

• Safety nets<br><br>1926.105

  Yes

  No

  N/A

Hazardous Energy Control

• Clear, specific and documented energy control procedures that follow OSHA requirements are in place and followed for each piece of applicable equipment<br><br>1910.147(c) 5

  Yes

  No

  N/A

• Lockout/Tagout devices identify the employee applying the device<br><br>1910.147(c)(5)(ii)(d)

  Yes

  No

  N/A

• The energy control procedure is inspected at least annually to ensure the procedure and OSHA requirements are being followed<br><br>1910.147(c)(6)

  Yes

  No

  N/A

• Authorized employees trained in the recognition of applicable hazardous energy sources, the type and magnitude of the energy available in the workplace and the methods necessary for energy isolation and control<br><br>1910.147(c)(7)(i(A)

  Yes

  No

  N/A

• Affected employees trained in the purpose and use of energy control procedure<br><br>1910.147(c)(7)(i)(B)

  Yes

  No

  N/A

• All employees working in areas where energy control procedures are used instructed about the procedure and prohibition of attempting to reenergize equipment that is locked or tagged out<br><br>1910.147(c)(7)(i)(C)

  Yes

  No

  N/A

Working Over/Around Water

• Life jacket<br><br>1926.106

  Yes

  No

  N/A

• Ring buoys<br><br>1926.106

  Yes

  No

  N/A

• Life saving skiff<br><br>1926.106

  Yes

  No

  N/A

Fire Protection & Prevention OSHA 1926.150 -1926.155 subpart F

• Fire extinguishers available and conspicuously located<br><br>1926.150(a)(2)&(3)

  Yes

  No

  N/A

• Fire extinguishers available and not more than 100' away from work area<br><br>1926.150(c)1

  Yes

  No

  N/A

• Fire extinguishers inspected at least monthly and documented<br><br>1926.150(c)(1)(viii)

  Yes

  No

  N/A

• Properly stored LPG (outside of building)<br><br>1926.153(k)

  Yes

  No

  N/A

• Approved metal storage cabinets flammable/combustible liquids<br><br>1926.152(b)(2)

  Yes

  No

  N/A

• DOT approved containers for storage of less than 5 gallons<br><br>1926.152(a)

  Yes

  No

  N/A

• Use of bonding when transferring liquids from one container to another<br><br>1926.152(e)(2)

  Yes

  No

  N/A

Signaling And Barricades OSHA 1926.200-1926.203 subpart G

• Proper accident prevention, signs, caution, etc.<br><br>1926.200

  Yes

  No

  N/A

• Flag person wearing proper PPE (orange vest, reflective clothing)<br><br>1926.201(a)(4)

  Yes

  No

  N/A

• Flag person properly trained, qualified, certified<br><br>State/local jurisdiction

  Yes

  No

  N/A

• Barricades meet ANDI standards<br><br>1926.202

  Yes

  No

  N/A

• Are employees in roadway work zones protected by proper barricades, signs, or flat person<br><br>1926.203(a)

  Yes

  No

  N/A

Material Handling and Storage 1926.250 - 1926.252 Subpart H

• Material stored properly <br><br>1926.250(a)(1)

  Yes

  No

  N/A

• Fuel storage tanks properly protected, diked, and equipped with appropriate fire extinguisher

  Yes

  No

  N/A

• Generator fuel stored properly

  Yes

  No

  N/A

• Generator fired regularly

  Yes

  No

  N/A

• Housekeeping. Kept free from accumulations of material that constitute hazards such as fire, explosions, harboring of pests, vegetation control<br><br>1926.250(9)(c)

  Yes

  No

  N/A

• Safe passageways to material<br><br>1926.250(a)(3)

  Yes

  No

  N/A

• Rigging properly maintained/ inspected/ and marked for use<br><br>1926.251

  Yes

  No

  N/A

Tools (Hand and Power) OSHA 1926.300 - 1926.305 Subpart I

• All tools inspected prior to coming on site<br><br>1926.300(a)

  Yes

  No

  N/A

• Inspected for safe condition/ proper storage (wet)<br><br>1926.300(a)

  Yes

  No

  N/A

• Proper guards in place<br><br>1926.300(b)(1)

  Yes

  No

  N/A

• Changes in design adjustable wrenches<br><br>1926.301(b)

  Yes

  No

  N/A

• Double insulated tools (defects, cracks, moisture, etc.)<br><br>1926.302

  Yes

  No

  N/A

• Compressed air being used for cleaning (30 psi)<br><br>1926.302(4)

  Yes

  No

  N/A

• Grinding wheels and tools are designed for compatible RPMs.

  Yes

  No

  N/A

• Shut of switches operable per OSHA<br><br>1926.300(d)

  Yes

  No

  N/A

• Mushroomed chisel heads<br><br>1926.301(c)

  Yes

  No

  N/A

• Hammer/wood handles<br><br>1926.301(d)

  Yes

  No

  N/A

• Pneumatic tools (whip check)<br><br>1926.302

  Yes

  No

  N/A

• Powder actuated tools (operator trained by manufacturer)<br><br>1026.302

  Yes

  No

  N/A

• Abrasive wheels and tools<br><br>1926.303

  Yes

  No

  N/A

• Jacks-lever, ratchet, hydraulic<br><br>1926.305

  Yes

  No

  N/A

• Air receivers<br><br>1926.305

  Yes

  No

  N/A

Welding and Cutting OSHA 1926.350 - 1926.356 Subpart J

• Cylinders upright during use and storage and secured to prevent tipping over.<br><br>1926.350(a)(7)

  Yes

  No

  N/A

• Oxygen Cylinders separated from fuel gas cylinders in storage. (20 feet or 5 feet with barrier)<br><br>1926.350(a)(10)

  Yes

  No

  N/A

• Acetylene pressure less than 15 psi.

  Yes

  No

  N/A

• Proper PPE.<br><br>1926.353(e)(2)

  Yes

  No

  N/A

• Fire protection in place/screen or shield/fire watch where required<br><br>1926.352(e)

  Yes

  No

  N/A

• Adequate ventilation or respirators<br><br>1926.350(a)(2)

  Yes

  No

  N/A

• Cylinders capped and secured when not in use.<br><br>1925.350(a)(1)

  Yes

  No

  N/A

• Flashback protection

  Yes

  No

  N/A

Electrical PSHA 1926.400 - 1926.449 Subpart K Reference NEC

• Equipment (cords, outlet covers, lighting) in good repair

  Yes

  No

  N/A

• Check approvals of all electrical conductors and equipment<br><br>1926.403(a)

  Yes

  No

  N/A

• Post installation inspections of electrical equipment for recognized hazards<br><br>1926.403(b)

  Yes

  No

  N/A

• Electrical equipment shall not be used unless the manufacturer's name, trademark or other descriptive markings are present. The voltage, wattage and ratings are necesary markings.<br><br>1926.403(g)

  Yes

  No

  N/A

• Each disconnecting means for motors and appliances shall be legibly marked to indicate its purpose. Each service feeder and branch circuit, as its disconnecting means or overcurrent device, shall be legibly marked to indicate its purpose. All markings must be sufficiently durable to withstand the environment involved.<br><br>1926.403(h)

  Yes

  No

  N/A

• power strips extension cords used appropriatley

  Yes

  No

  N/A

• Appliances properly grounded

  Yes

  No

  N/A

• Workplace clearance in front and to side of breaker boxes(30 inches); panel doors closed<br><br>1926.403(h)(1)(i)

  Yes

  No

  N/A

• Conductors entering boxes, cabinets, or fittings shall be protected from abrasion. Openings through which conductors enter shall be effectively closed. Unused openings in cabinets, boxes, and fittings shall also be effectively closed.<br><br>1926.403(j)(2)

  Yes

  No

  N/A

• All Pull boxes, junction boxes and fittings shall be provided with covers. If metal covers are used they shall be grounded. In energized installations, each outlet box shall have a cover, face plate or fixture canopy. covers of outlet boxes having holes through which flex cord pendants pass shall be provided with bushings.<br><br>1926.405(b)(2)

  Yes

  No

  N/A

• GFCI/Assured grounding program<br><br>1926.404(b)(1)

  Yes

  No

  N/A

• Grounding for equipment per OSHA<br><br>1926.404(f)(1)

  Yes

  No

  N/A

• Flexible cords have proper markings and are properly protected<br><br>1926.404(g)(2)(ii)

  Yes

  No

  N/A

• No Splices allowed in flexible cord<br><br>1926.405(g)()(iii)

  Yes

  No

  N/A

• Strain relief for cables connected to tools and equipment<br><br>1926.405(g)(2)(iv)

  Yes

  No

  N/A

• Equipment inspection before use<br><br>1926.416(e)(1)

  Yes

  No

  N/A

• Cords suspended properly; no tripping hazards<br><br>1926.416(e)(2)

  Yes

  No

  N/A

• Energy source lockout/tagout and permits in place<br><br>1926.417

  Yes

  No

  N/A

• Proper clearance from overhead lines<br><br>1910.333(3)(iii)

  Yes

  No

  N/A

• Portable hearers - automatic shutoff; appropriate location (free from flammables); unpluged when not in use<br><br>

  Yes

  No

  N/A

• Verify weekly electrical inspections at jobsite

  Yes

  No

  N/A

Scaffolding OSHA 1926.451 Subpart L

• Check the scaffold for proper capacity. Weight of scaffold and 4X the intended load<br><br>1926.451(a)

  Yes

  No

  N/A

• Guardrails/toeboards adequate<br><br>1926.451(a)(4)

  Yes

  No

  N/A

• No defective or damaged parts<br><br>1926.451(a)(8)

  Yes

  No

  N/A

• Safe access(ladder or equipment)<br><br>1926.451(a)(13)

  Yes

  No

  N/A

• Inspected by competent person<br><br>1926.451(f)(7)

  Yes

  No

  N/A

• Secure connections<br><br>1926.451

  Yes

  No

  N/A

• No intermixing/ modification of components of different manufacturer<br><br>1926.451(10)

  Yes

  No

  N/A

• Solid foundation/locked wheels<br><br>1926.451

  Yes

  No

  N/A

• Employees riding scaffolds<br><br>1926.451

  Yes

  No

  N/A

• Clear access (housekeeping- free from obstruction)<br><br>1926.451

  Yes

  No

  N/A

Fall Protection Systems OSHA 1926.500 - 1926.503 Subpart M

• 100% fall protection at/above 6 feet - systems in place<br><br>1926.501(b)(10

  Yes

  No

  N/A

• Fall arrest system shall include full body harness and locking snap hooks, 6 foot shock absorbing lanyard<br><br>1926.501(b)(1)

  Yes

  No

  N/A

• Are programs and equipment in place. Monthly safety harness and lanyard inspection checklist in use and on record

  Yes

  No

  N/A

• Competent person<br><br>1926.501

  Yes

  No

  N/A

Crane and Aerial Lifts OSHA 1926.550 - 1926.556 Subpart N

• Operators/maintenance manual in operators cab<br><br>1926.550(a)

  Yes

  No

  N/A

• Warning signs visible and instructions available at operators station<br><br>1926.550(a)(2)

  Yes

  No

  N/A

• Area barricaded<br><br>1926.550(a)(9)

  Yes

  No

  N/A

• Inspected prior to use (daily) check all documentation<br><br>1926.550(a)(5)

  Yes

  No

  N/A

• Inspect monthly inspection and maintenance records<br><br>1926.550

  Yes

  No

  N/A

• ANSI hand signals posted at job site<br><br>1926.550(a)(4)

  Yes

  No

  N/A

• Competent person/inspector<br><br>1926.550(a)(5)

  Yes

  No

  N/A

• Operator qualifications available<br><br>WGINT

  Yes

  No

  N/A

• Wire rope inspection/evidence of heat damage<br><br>1926.550

  Yes

  No

  N/A

• Lift plans in place/proper plans being used<br><br>WGINT

  Yes

  No

  N/A

• Annual Inspection on hand<br><br>1926.550(a)(6)

  Yes

  No

  N/A

Motor Vehicles and Mechanized Equipment OSHA 1926.600 - 1926.602 Subpart O

• Inspected prior to use<br><br>1926.601(b)(14)

  Yes

  No

  N/A

• Haulage trucks have a cab shield<br><br>1926.601(b)(6)

  Yes

  No

  N/A

• Audible back-up alarm or alternative<br><br>1926.601(a)(9)

  Yes

  No

  N/A

• Parking brake, wheel chocks, hydraulic components down

  Yes

  No

  N/A

• Lights

  Yes

  No

  N/A

• Horn

  Yes

  No

  N/A

• Broken glass

  Yes

  No

  N/A

• Cleanliness

  Yes

  No

  N/A

Excavation OSHA 1926.650 - 1926.652 Subpart P

• Access - egress in place<br><br>1926.651(c)(2)

  Yes

  No

  N/A

• Barricades<br><br>1926.651(f)

  Yes

  No

  N/A

• Spils and material > 2 feet from edge<br><br>1926.651(j)(2)

  Yes

  No

  N/A

• Inspection by competent person<br><br>1926.651(k)

  Yes

  No

  N/A

• Protection of workers per OSHA<br><br>1926.651(a)(1)

  Yes

  No

  N/A

• No Hazardous atmospheres<br><br>1926.651(g)

  Yes

  No

  N/A

• Fall protection<br><br>1926.651(I)(1)

  Yes

  No

  N/A

• Dig alert log<br><br>1926.651(b)(1&2)

  Yes

  No

  N/A

• Trenching inspection log WGI ES&H manual<br><br>1926.651(k)(1)

  Yes

  No

  N/A

Concrete & Masonry Construction OSHA 1926.700 - 1926.706 Subpart Q

• Rebar caps in place<br><br>1926.701(b)

  Yes

  No

  N/A

• Limited access zone established<br><br>1926.706(a)

  Yes

  No

  N/A

Stairways, Ladders and Walkways OSHA 1926.1050

• proper type and use<br><br>1926.1053

  Yes

  No

  N/A

• No trip hazard

  Yes

  No

  N/A

• Stairs/ladder provided per OSHA<br><br>1926.1051(a)

  Yes

  No

  N/A

• Area clear for access/egress<br><br>1926.1053(b)(9)

  Yes

  No

  N/A

• Ladder properly secured<br><br>1926.1053(b)(8)

  Yes

  No

  N/A

• Ladder extends 3 feet above landing<br><br>1926.1053(b)

  Yes

  No

  N/A

• Stair rail systems (200 lbs. out-down pressure)<br><br>1926.1052

  Yes

  No

  N/A

• Stairway handrails and platform per OSHA (proper dimensions)<br><br>1926.1052(a)(1)

  Yes

  No

  N/A

• Stair riser height and tread depth (uniform)<br><br>1926.1052(a)(3)

  Yes

  No

  N/A

Substance Abuse Prevention Program

• Program and testing in place

  Yes

  No

  N/A

• Is the conditional access form being used if an employee is put to work before the results of his test come back (cannot be used for DOT personnel)

  Yes

  No

  N/A

• Are DOT guidelines being followed? Awareness of of DOT guidelines

  Yes

  No

  N/A

• Facility set up for post-accident testing

  Yes

  No

  N/A

• Employee handbooks handed out at time of hire

  Yes

  No

  N/A

• Labcorp or Labcorp-affiliated facility used for collection

  Yes

  No

  N/A

• Facility using company program and following correct protocols

  Yes

  No

  N/A

• Does facility have updated manual

  Yes

  No

  N/A

Approvals

• Construction Manager Signature

  Sign

• Subcontractor Representative Signature

  Sign

• S&H Site Manager Signature

  Sign