Weekly Safety Evaluation

• Project Name/ #

• Location
  Address

• Conducted on

  Date

• Evaluator

  Sign

• Project Manager

  Sign

• Superintendent

  Sign

• Prepared by

• Document No.

Observations

• In the section below, list three positive observations you made while on this jobsite. If you did not positively reinforce this observation do so now.
  Next, list three areas in which improvements can be made. Be detailed in your response
  

• 1. Positive Observation

• Add media

  Media

• 2. Positive Observation

• Add media

  Media

• 3. Positive Observation

• Add media

  Media

• Needs Improvement:

• Have all corrections been made from the previous evaluation?

  Yes

  No

  N/A

Baker Policy

• Have MTAs or PTS been completed for the work being performed?

  Yes

  No

  N/A

• Have all coworkers signed MTAs or PTS for the work they are performing?

  Yes

  No

  N/A

• Has this jobsite been incident and injury free since the last evaluation? (This question is not for points)

  Yes

  No

  N/A

• What occurred on this job?

  Select injury incident

  • injury
  • incident

• has the hazard that caused the injury been corrected?

  Yes

  No

  N/A

• Has the case been closed out?

  Yes

  No

  N/A

• Has the hazard that caused the incident been corrected?

  Yes

  No

  N/A

• Has a weekly toolbox talk been conducted and uploaded?

  Yes

  No

  N/A

Cranes and Equipment

• Is the rigging equipment in proper condition?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Is rigging being stored properly?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are whistles/horns being used during picks?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are taglines being used?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Is the swing radius protected?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Has the daily equipment inspection been completed?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Do the back up alarms on equipment work?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are seat belts being worn in equipment and vehicles?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

Electrical

• Are proper extension cords in use and in good shape?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are extension cords standing alone? (not plugged into one another)

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are danger signs posted around high voltage areas?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are GFCIs being used at the receptacles?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Is equipment at least 10 feet from power lines?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Is there adequate lighting for night work?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

Excavation

• Is the excavation properly shored/sloped/shielded for the soil type and depth?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Have all underground utilities been located prior to digging?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Is there proper access/egress to the trench?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are the spoil piles properly located?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

Fall Protection

• Are ground openings covered or barricaded?

  Yes

  No

  N/A

• Has this been corrected? If no, explain why.

  Yes

  No

  N/A

• Are floor openings covered, labeled, and secure?

  Yes

  No

  N/A

• Has this been corrected? If no, explain why.

  Yes

  No

  N/A

• Has all rebar been capped to prevent impalement? (carnie caps must be installed with 2X4s)

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are personal fall arrest systems in use where required?

  Yes

  No

  N/A

• Has this been corrected? If no, explain why.

  Yes

  No

  N/A

• Is fall protection equipment installed correctly?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are coworkers inspecting fall protection before each use? (If you find a piece of fall protection equipment in use that fails your inspection mark No)

  Yes

  No

  N/A

• Take the fall protection out of service and coach the coworker using the equipment.

• Are the guardrails and toeboards in good repair?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

Fire Safety

• Are fire extinguishers readily available and in good condition?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are fire extinguisher inspections up to date?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are no smoking signs posted where needed?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are flammables/combustibles properly stored?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are containers clearly identified/labeled?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are oxygen/acetylene cylinders being stored properly? (fire wall or 20ft apart)

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

First Aid and Health

• Is drinking water readily available?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Is a first aid kit available and stocked?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Is eye wash and neutralite available at concrete placement areas?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are toilets available and clean?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

Hand and Power Tools

• Are all guards in place and working properly?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are power tool cords in good condition?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are the donuts on burke bars in the appropriate location?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are wooden handles free of splinters/cracks?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are impact tools free from mushroomed heads?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are power tools double insulated or grounded?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are safety whip cables and OSHA valves in place on air compressors?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

HAZCOM - SDS

• Are all chemical containers labeled?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Is a site specific HAZCOM program on file?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are chemical containers being stored correctly? (look at secondary containment and refueling areas)

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

Housekeeping

• Are all means of egress clear and open?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are all work areas clean and orderly?

  Yes

  No

  N/A

• Identify the work areas that need improvement and captures these areas with a picture.

• Add media

  Media

• Is there regular site clean up and trash disposal?

  Yes

  No

  N/A

• Why is the trash not regularly cleaned and disposed of?

• Have all protruding nails been removed?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are proper barricades up with signage where required?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

Ladders

• Are ladders in good condition?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Do ladders extend 3 feet above the landing surface?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are ladders secured to prevent slipping/falling?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Is a rope provided for material hoisting?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Is access provided at elevations 19 inches and greater?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

Personal Protective Equipment

• Are all coworkers wearing the appropriate PPE ? (Hard hats, safety glasses, Sleeves equal to or greater than 4 inches, gloves, long pants, and work boots are mandatory for all coworkers. )

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are face-shields being worn when required?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Is all additional PPE being worn when required? (ear plugs, respirators, sleeves, etc.)

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

Scaffolds

• Are scaffolds properly erected? (fully planked, footings secured, cross bracing, tied into the structure, etc.)

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Is ladder access provided?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Is proper fall protection in place? (guardrails, PFAS)

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Has an inspection been completed by a competent person?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

Silica

• Are engineering controls in place to prevent silica exposures?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Have co-workers in respirators been medically cleared and fit tested?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

Stairways

• Are handrails/stair rails in place?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are handrails/stair rails free of nails/screws/splinters/etc.?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are the sides and edges of stairway landings protected by guardrail systems?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Are stairways free from trash and debris?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

Miscellaneous

• Have job specific permits been completed?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Is this site free of any other hazards that are not specifically addressed?

  Yes

  No

  N/A

• Has this issue been corrected? If no, explain why.

  Yes

  No

  N/A

• Overall Comments