V SIMULATED OSHA SITE SAFETY WORK REPORT

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

A. WORKING HABITS/COMPETENCY/BEHAVIOURS

"At Risk" answer to the following questions requires immediate action!

• Safe work environment?

  Safe

  At Risk

  N/A

• Proper PPE [use, storage, inspections & handling]

  Safe

  At Risk

  N/A

• Risk awareness<br>

  Safe

  At Risk

  N/A

• Positions of people when working

  Safe

  At Risk

  N/A

• Workers & operators competency and training

  Safe

  At Risk

  N/A

• Supervisor competency etc.

  Safe

  At Risk

  N/A

• Emergency procedures

  Safe

  At Risk

  N/A

• Traffic control

  Safe

  At Risk

  N/A

• Action taken / notes:

B. HOUSEKEEPING/WORK ENVIROMENT

• Access/ Egress to work area / site

  Safe

  At Risk

  N/A

• Clean & neat work area / site?

  Safe

  At Risk

  N/A

• Slips/trips/falls/tidy workplace

  Safe

  At Risk

  N/A

• Lighting [if required ]

  Yes

  No

  N/A

• Material handling & storage?

  Safe

  At Risk

  N/A

• Scaffolding [if used ]

  Safe

  At Risk

  N/A

• Hygiene // Hot / cold weather procedures // clean rest/break areas?

  Safe

  At Risk

  N/A

• Section notes

C. COMMUNICATION & PROCEDURES

• Proper sign in procedure [if required]?

  Yes

  No

  N/A

• All required postings correct and up to date

  Yes

  No

  N/A

• First aid kits correct and available / maps to nearest hospital available?

  Yes

  No

  N/A

• Site emergency and contact numbers posted

  Yes

  No

  N/A

• Safety signage correct and visible?

  Yes

  No

  N/A

• Toolbox talks up to date and records properly kept?

  Yes

  No

  N/A

• SDS up to date and readily available?

  Yes

  No

  N/A

• JHA covering job [job hazard analysis]

  Yes

  No

  N/A

• SWP covering activity if needed? [storm water plan]

  Yes

  No

  N/A

• Critical procedures in place and followed?

  Yes

  No

  N/A

• Permits & lock-out's?

  Safe

  At Risk

  N/A

• Section notes.

D. MANUAL HANDLING & ERGONOMICS

• Awkward positions/posture

  Safe

  At Risk

  N/A

• Repetitive motions

  Safe

  At Risk

  N/A

• Over exertion

  Safe

  At Risk

  N/A

E. ELEVATED WORK / RESCUE

• Elevated work / rescue audited?

  Yes

  No

  N/A

• When elevated , workers properly attached as needed?

  Safe

  At Risk

  N/A

• Proper elevated work procedures followed?

  Safe

  At Risk

  N/A

• Overhead protection [as needed]

  Safe

  At Risk

  N/A

• Lanyards on all tools [when required]

  Yes

  No

  N/A

• Barricading work area [as needed]

  Safe

  At Risk

  N/A

• Rescue plan / procedures and proper equipment [when needed] readily accessible at all times?

  Yes

  No

  N/A

• Section notes

F. PLANT & EQUIPMENT

• Plant and equipment audited?

  Yes

  No

  N/A

• Mechanical

  Safe

  At Risk

  N/A

• Electrical/energy

  Safe

  At Risk

  N/A

• Lock out / Tag out program in place and used

  Yes

  No

  N/A

• all electric cords in good condition ? [ no pulled wires, missing ot taped insulation or missing ground prong]

  Safe

  At Risk

  N/A

• Fire extinguisher near all gasolene equipment?

  Safe

  At Risk

  N/A

• Tools & portable equipment

  Safe

  At Risk

  N/A

• Mobile / transport

  Safe

  At Risk

  N/A

• Lifting & rigging

  Safe

  At Risk

  N/A

• Vehicles / heavy equipment

  Safe

  At Risk

  N/A

• Section notes

G. HAZARDS & HAZARDOUS WORK

• Hazards and hazardous work audited?

  Yes

  No

  N/A

• Physical

  Safe

  At Risk

  N/A

• Chemical

  Safe

  At Risk

  N/A

• Biological

  Safe

  At Risk

  N/A

• Environmental

  Safe

  At Risk

  N/A

• Confined space

  Safe

  At Risk

  N/A

• Hot work

  Safe

  At Risk

  N/A

• Section notes

SAFE ACTS OBSERVED & COMMENDATIONS

AT RISK BEHAVIOURS OBSERVED

CORRECTIVE ACTIONS REQUIRED

• Audit completed by:

  Sign