WaterOne Safety

Job Site Details

• WaterOne Division

• Date/Time

  Date

• Location

• Work Group

• Foreman/Manager

• Work Activity

• Prepared by

Traffic Control

• Traffic Control set up properly and visible?

  Yes

  No

  N/A

• Are walkways clear for pedestrians if needed?

  Yes

  No

  N/A

Housekeeping

• Walkways and Passageways clear?

  Yes

  No

  N/A

• Material stored safely and properly?

  Yes

  No

  N/A

Personal Protective Equipment

• Hard Hats worn when required?

  1 employee

  2 employees

  3 employees

  Full Crew Safe

• Safety Glasses, Goggles, Face Shield worn when required? Are

  Yes

  No

  N/A

• Hearing Protection worn when required?

  Yes

  No

  N/A

• Respirators worn when required (dust, fumes, etc)?

  Yes

  No

  N/A

• High Visibility Clothing worn at all times (vests/jackets)?

  1 employee

  2 employees

  3 employees

  Full Crew Safe

• Gloves in use handling material?

  Yes

  No

  N/A

• Safety Toed Shoes worn at all times?

  1 employee

  2 employees

  3 employees

  Full Crew Safe

Excavations

• Have utilities been located & protected?

  Yes

  No

  N/A

• Adequately sloped or shored if below 5' in depth?

  Yes

  No

  N/A

• Means of egress every 25 feet?

  Yes

  No

  N/A

• Spoil pile & equipment back at least 2 feet from edge?

  Yes

  No

  N/A

• Water being pumped out if present?

  Yes

  No

  N/A

Hand & Power Tools

• Power tools free from damage (switches, cords, guards, etc)?

  Yes

  No

  N/A

• Hand tools free from damage (shaft, head, splinters, etc)?

  Yes

  No

  N/A

Ladders

• Are ladders in good working condition w/o damages?

  Yes

  No

  N/A

• Do ladders extend 36" above landing?

  Yes

  No

  N/A

Power Industrial Equipment & Vehicles

• Back-up alarms working on equipment?

  Yes

  No

  N/A

• Operators wearing seat belts?

  Yes

  No

  N/A

• Are overhead power lines located greater than 10 feet of equipment?

  Yes

  No

  N/A

Fire Protection

• Are NFPA containers used for fuel storage?

  Yes

  No

  N/A

• Fire extinguishers located on-site (within vehicles)?

  Yes

  No

  N/A

• Container Labeling

  Safe

  At Risk

  N/A

Cranes & Rigging

• Are employees communicating with operator properly?

  Yes

  No

  N/A

• Slings in good condition?

  Yes

  No

  N/A

• Is material rigging conducted safely?

  Yes

  No

  N/A

Fall Protection

• Are employees protected from heights greater than 4 feet?

  Yes

  No

  N/A

• Is fall prevention installed and in safe condition (handrail)?

  Yes

  No

  N/A

• Is fall protection (harness/lanyard/retractable/etc) being utilized safely?

  Yes

  No

  N/A

Observation Summary

• Observation Notes

• Pictures

  Media

• Inspection Completed By:

  Sign