Title Page
-
Site conducted
-
Conducted on
-
Prepared by
-
Location
Untitled Page
1. Housekeeping
-
Project work areas are clean and free of excess trash, debris
-
Walkways and passageways clear
-
Material or Equipment properly stored
-
Electrical cords, hoses, welding leads, elevated to prevent trip hazards
-
Scrap material free of protruding nails or other puncture hazards
-
Trash receptacles are provided for work areas and water kegs
-
Barricades, and/or rebar caps installed and maintained
-
Washrooms available and clean
-
Comments/Corrective Actions
2. Fall Protection
-
Body harness required and worn in a proper manner
-
Lanyards are adequately secured to suitable anchorage
-
Fall protection equipment is used only for fall protection
-
Fall protection maintained and has current inspection
-
Fall Protection Plan in place where required
-
Comments/Corrective Actions
3. Tools and Equipment Protection
-
Electrical cables are off the ground
-
Tools are maintained in a safe condition
-
Tools are properly carried and stored
-
Pneumatic/Hydraulic hose connections secured (whip checks)
-
Proper tools used for the job performed
-
Comments/Corrective Actions
4. Fire Protection
-
Flammables stored properly
-
Oxygen and combustibles separated
-
Containers labeled as per contents
-
Fire extinguishers properly located and inspected
-
Compressed gas cylinders properly maintained
-
Containment of hot work and welding screens as required
-
Comments/Corrective Actions
5. Human/Construction Traffic Interface
-
A local traffic management plan for this area
-
Dedicated pathwas for pedestrians to separate from vehicle routes
-
Posted speed signs
-
Spotters used in congested/high risk areas
-
Barriers to separate work areas from vehicle traffic
-
Comments/Corrective Actions
6. On-Site Field Personnel
-
Supervision and safety present at work site
-
All have completed orientation
-
New works identified
-
Comments/Corrective Actions
7. Personnel Protective Equipment
-
Hard hats worn and maintained
-
Hearing protection worn as required
-
Eye protection required and worn
-
Proper foot protection worn for job performed
-
Face Shield or goggles work as required
-
Comments/Corrective Actions
8. Excavations
-
Sloped and shored properly allowable slope
-
Materials or equipment at least 2 feet (0.68 meters) from the edge of the excavation
-
Access and egress provided at appropriate intervals
-
Comments/Corrective Actions
9. Scaffolds and Ladders
-
Proper access and egress provided
-
Tagged correctly
-
Proper ladder for the job performed/properly secured
-
Comments/Corrective Actions
10. Hoisting and Rigging Equipment
-
Chains falls, come-a-longs, chokers in good condition with current inspection
-
Softeners used as required
-
Tag lines used
-
Comments/Corrective Actions
11. Vehicles/Mobile Equipment
-
Lights, brakes, horns, alarms working properly
-
Seat belts provided and used
-
Inspections completed
-
Back-in policy compliant
-
Comments/Corrective Actions
12. Permits/Safety Task Assignment/JSA/Workplans
-
Applicable permits posted
-
Current STA/FLRA with each crew
-
JSA is referenced on the STA/FLRA
-
Lift Plans and Critical Lift Plan is in place where required
-
Comments/Corrective Actions
Items
-
Needs Attention/Stop Work Items
-
Action Taken
-
Closed?
-
Remarks