WEEKLY SAFETY INSPECTION II

• Project Name & Number

• Location
  Address

• Conducted on

  Date

• Superintendent

• Project Manager

  Select Bill Smiley Josh Snowden Brad Hawkins Danny Grimes Matt Tolbert Greg Gilgreath Enrique Alegria Superintendent Brian Springer Mike Broom Tyler Jenkins Brad Hawkins Mark Purvis

  • Bill Smiley
  • Josh Snowden
  • Brad Hawkins
  • Danny Grimes
  • Matt Tolbert
  • Greg Gilgreath
  • Enrique Alegria
  • Superintendent
  • Brian Springer
  • Mike Broom
  • Tyler Jenkins
  • Brad Hawkins
  • Mark Purvis

• Inspection reviewed with?

• Prepared by:

Soft Tissue Operations Mitigation Program

• Material handling plan in place. No lifting over 50 Lbs.

  Yes

  No

  N/A

• Material Moving Equipment on site and in use (i.e. carts, dolleys,hoist, wire carts, fork lifts, etc.)

  Safe

  At Risk

  N/A

• Proper lifting procedures addressed on site specific plan and enacted on the field?

  Safe

  At Risk

  N/A

• Team members trained on STOMP procedures

  Yes

  No

  N/A

• Repetitive motion tasks addressed and plan in place to prevent injuries?

  Yes

  No

  N/A

• Daily Safety Huddle being done

  Yes

  No

  N/A

• what was today's topic

• was there a JHA Performed.

  Yes

  No

  N/A

• Safety Observations being performed?

  Yes

  No

  N/A

• Is safety Training being performed

  Yes

  No

  N/A

• Supervisor Audits and Observations being performed

  Yes

  No

  N/A

• Supervisor set proper example to address STOMP issues – mechanical aids – Observations.

Personal Protective Equipment

• Hard hats, safety glasses in use by all personnel

  Safe

  At Risk

  N/A

• Gloves (sharp edges, using knives, handling materials)

  Safe

  At Risk

  N/A

• Proper foot gear and protective clothing. Traffic vest if necessary

  Safe

  At Risk

  N/A

• comments

Administration

• Is site specific Plan in place?

  Yes

  NO

• Employees on site signed

  Yes

  No

  N/A

• JHA updated according to changing scope of work?

  Safe

  At Risk

  N/A

• Emergency program in place

  Safe

  At Risk

  N/A

• trained personnel

  Safe

  At Risk

  N/A

• Emergency Phone Number posted

  Yes

  No

  N/A

• State / Fed. Posters (English-Spanish) Posted?

  Yes

  No

  N/A

• Safety manual available?

  Yes

  No

  N/A

• Hazard communication program available?

  Yes

  No

  N/A

• IS there cold water provided

  Yes

  No

  N/A

Hazard Communication (HazCom)

• Employees trained on Hazard communication Risks ?

  Yes

  No

  N/A

• Proper labels on containers?

  Safe

  At Risk

  N/A

• (SDS) Safety data Sheets manual current?

  Safe

  At Risk

  N/A

• Emergency Action Plan available?

  Yes

  No

  N/A

• First-Aid Kit Available?

  Safe

  At Risk

  N/A

• First-Aid/CPR trained personal onsite

  Safe

  At Risk

  N/A

• (BBP) Bloodborne Pathogens control plan available?

  Safe

  At Risk

  N/A

• Is there a Silica Exposure Control Plan In Place?

  Yes

  No

  N/A

• Is the competent person performing inspections and implementing the ECP?

  Yes

  No

  N/A

• Can the competent person identify existing and foreseeable silica hazards

  Yes

  No

  N/A

• are exposed employees trained on silica exposure and know how to mitigate it?

  Yes

  No

  N/A

• Do employees have access to SDS sheet on silica exposure in the workplace

  Yes

  No

  N/A

Medical/Emergency

• Incident investigation proecedure in place and forms available

  Yes

  No

  N/A

• Employees understand Incident<br>Reporting procedure

  Yes

  No

  N/A

• Map to medical facility posted

  Yes

  No

  N/A

• Have there been any incidents onsite

  Yes

  NO

• Employees trained to prevent similar incidents

  Safe

  At Risk

  N/A

• Is employee back to work

  Yes

  No

  N/A

• Why

Electrical (General)

• Are electrical rooms Compliant with company policies?

  Yes

  No

  N/A
Electrical Rooms

• Adequate lighting

  Safe

  At Risk

  N/A

• Signage present

  Safe

  At Risk

  N/A

• Electrical room protected

  Safe

  At Risk

  N/A

• Electrical panels protected and locked

  Safe

  At Risk

  N/A

• Energized parts protected

  Safe

  At Risk

  N/A

• Extension cords in compliance per company policy

  Yes

  No

  N/A
Extension Cords

• Outer insulation damage on cords

  Safe

  At Risk

  N/A

• Approves three wire extension cords

  Safe

  At Risk

  N/A

• Ground prongs on cords

  Safe

  At Risk

  N/A

• Cords protected from pulling

  Safe

  At Risk

  N/A

• Cords protected from traffic

  Safe

  At Risk

  N/A

• Temporary Panels in compliance

  Yes

  No

  N/A
Temporary Panels

• GFCI's used and functioning

  Safe

  At Risk

  N/A

• Signage present

  Yes

  No

  N/A

• Proper use of temporary power<br>boxes

  Safe

  At Risk

  N/A

• Safety plates on outlets and J boxes

  Safe

  At Risk

  N/A

• J box knockouts utilized

  Safe

  At Risk

  N/A

• Hardware splices in J boxes

  Safe

  At Risk

  N/A

LOCK OUT/ TAG OUT (LOTO)

• LOTO procedures actionable

  Yes

  No

  Will

• Are employees Authorized for the procedure?

  Yes

  No

  N/A

• Do they need to be Trained?

  Yes

  No

  Will

• LOTO procedures log being used according to company policy

  Yes

  No

  N/A

• Do we have the necessary equipment for LOTO procedures including kit, tags, permanent locks

  Yes

  No

  N/A

• Is company procedure being followed?

  Yes

  No

  N/A

• what is the deficiency and how will it be corrected?

Hot Electrical Work

• Is hot electrical work being conducted

  Yes

  NO

  N/A

• JSA completed

  Safe

  At Risk

  N/A

• All affected employees briefed

  Safe

  At Risk

  N/A

• Proper level of PPE being used

  Safe

  At Risk

  N/A

• Insulated gloves tested and up to<br>date

  Safe

  At Risk

  N/A

• Electrical PPE inspected

  Safe

  At Risk

  N/A

• LOTO procedures being used

  Safe

  At Risk

  N/A

• Boundaries established and barriers set

  Safe

  At Risk

  N/A

• Back up person trained in emergency<br>procedure

  Safe

  At Risk

  N/A

• JSA steps and procedure being<br>observed

  Safe

  At Risk

  N/A

• Components de‐energized

  Safe

  At Risk

  N/A

• Energized parts protected

  Safe

  At Risk

  N/A

Ladders & Stairs

• Are there ladders being used

  Yes

  No

  Will

• Safe procedures being followed

  Safe

  At Risk

  N/A

• Ladders inspected

  Safe

  At Risk

  N/A

• Safe work distance kept from hazards

  Safe

  At Risk

  N/A

• Employees not using top two rungs

  Safe

  At Risk

  N/A

• Extension ladders only used to gain access? extend 3 feet above landing or secured at top

  Safe

  At Risk

  N/A

• Step ladders in the open position

  Safe

  At Risk

  N/A

• Rope for hoisting present with<br>extension ladders

  Safe

  At Risk

  N/A

• Landings and treads filled on stairs

  Safe

  At Risk

  N/A

• Handrails on stairs and landings

  Safe

  At Risk

  N/A

• Stairs illuminated

  Safe

  At Risk

  N/A

• Ladder inspection

  Yes

  No

  N/A
Ladder Inspection

• Side rails in good condition?

  Safe

  At Risk

  N/A

• Steps or rungs not loose or damaged?

  Yes

  No

  N/A

• Spreader braces not damaged and open fully

  Yes

  No

  N/A

• Rivets, screws or bolts not missing or damaged

  Yes

  No

  N/A

• free from oil grease or slippery materials

  Yes

  No

  N/A

• All Decals are legible

  Yes

  No

  N/A

• Non slip feet in good condition

  Yes

  No

  N/A

• is ladder stable not loose or wobbly?

  Yes

  No

  N/A

• Are hinges spreaders in good condition?

  Yes

  No

  N/A

Fall Protection (29CFR 1926.500's)

• Are there fall hazards present?

  Yes

  No

  N/A

• Fall protection plan (site specific)

  Safe

  At Risk

  N/A

• Guardrails present

  Safe

  At Risk

  N/A

• Floor wall and window openings protected

  Safe

  At Risk

  N/A

• Fall protection being used at 6 feet or higher

  Safe

  At Risk

  N/A

• Proper anchorage points used

  Safe

  At Risk

  N/A

• Harness being worn properly

  Safe

  At Risk

  N/A

• Employees trained

  Safe

  At Risk

  N/A

• Safety harness, lanyards, and<br>retractable inspected?

  Safe

  At Risk

  N/A

• Overhead protection from falling<br>objects in place

  Safe

  At Risk

  N/A

• HLL and vertical life lines inspected<br>and used properly

  Safe

  At Risk

  N/A

Scissor & Aerial Lifts

• Are aerial lifts being used

  Yes

  No

  N/A

• Operators trained

  Safe

  At Risk

  N/A

• Equipment/workplace inspections<br>completed and documented

  Safe

  At Risk

  N/A

• Operators following safety<br>procedures

  Safe

  At Risk

  N/A

• Harness and lanyard used in aerial lifts

  Safe

  At Risk

  N/A

• Safe work distance kept from<br>elevation changes

  Safe

  At Risk

  N/A

• Gate or chain secured

  Safe

  At Risk

  N/A

• Nothing used to increase height

  Safe

  At Risk

  N/A

• Load ratings observed

  Safe

  At Risk

  N/A

• Is equipment operated on a flat level surface?

  Safe

  At Risk

  N/A

Motorized Equipment (Sky Jack, Backhoe etc.)

• Is there earthmoving or telescopic handler equipment being used?

  No

  yes

• Operator trained on that particular<br>equipment

  Safe

  At Risk

  N/A

• What kind of equipment?

  Select Scissor Lifts Boom Lifts Back Hoe Mini Excavator Telescopic Handler Fork lift Trencher

  • Scissor Lifts
  • Boom Lifts
  • Back Hoe
  • Mini Excavator
  • Telescopic Handler
  • Fork lift
  • Trencher

• Name the employees that require training and equipment.

• How many years of experience does he have operating the equipment?

• When do we need to conduct training?

  With in two weeks

  3 weeks

  other

• inspections done?

  Yes

  No

  N/A

• Training documents available

  Safe

  At Risk

  N/A

• Equipment inspections documented

  Safe

  At Risk

  N/A

• Seat belt utilized

  Safe

  At Risk

  N/A

• Back up alarm functioning

  Safe

  At Risk

  N/A

• Horn functioning

  Safe

  At Risk

  N/A
Earth moving Equipment Inspection

• What kind of equipment?

  Back hoe

  Mini Excavator

  Trencher

  Skytrak

• inspections done?

  Yes

  No

  N/A

• Training documents available

  Safe

  At Risk

  N/A

• Seat belt utilized

  Safe

  At Risk

  N/A

• Back up alarm functioning

  Safe

  At Risk

  N/A

• Horn functioning

  Safe

  At Risk

  N/A

• Are there any problems with the equipment

  Safe

  At Risk

  N/A

Hand & Power Tools

• Is there a risk associated with hand and power tools?

  No

  yes

• Employees trained

  Safe

  At Risk

  N/A

• Additional PPE provided or available

  Safe

  At Risk

  N/A

• Safe practices being observed

  Safe

  At Risk

  N/A

• Tool in good condition

  Safe

  At Risk

  N/A

• Proper tool for the job

  Safe

  At Risk

  N/A

• Information label on tool

  Safe

  At Risk

  N/A

• Manufacturer instructions being<br>observed

  Safe

  At Risk

  N/A

• Cord in good condition

  Safe

  At Risk

  N/A

• Guards in place

  Safe

  At Risk

  N/A

Excavations

• Are there any risk associated with excavations?

  No

  yes

• Competent person present

  Safe

  At Risk

  N/A

• Walls sloped or shored to prevent cave in prior to employees getting inside?

  Safe

  At Risk

  N/A

• Utilities located and marked

  Safe

  At Risk

  N/A

• Employees trained

  Safe

  At Risk

  N/A

• Daily Inspections documented

  Safe

  At Risk

  N/A

• Proper access if is more than 4' deep

  Safe

  At Risk

  N/A

• Access and exits within 25 feet

  Safe

  At Risk

  N/A

• Fissures, cracks or shrinkage evident

  Safe

  At Risk

  N/A

• Surface conditions acceptable

  Safe

  At Risk

  N/A

• Perimeter protected/barricaded

  Safe

  At Risk

  N/A

• Traffic exposure controlled

  Safe

  At Risk

  N/A

• Top of shoring18 inches above ground

  Safe

  At Risk

  N/A

• More than 6 inches between box &<br>excavation wall

  Safe

  At Risk

  N/A

• Spoil 2 feet back from edge

  Safe

  At Risk

  N/A

• Excavations more than 20 feet deep<br>engineered

  Safe

  At Risk

  N/A

• Water entering excavation

  Safe

  At Risk

  N/A

Housekeeping

• slip trip hazards risk

  No

  yes

• Slip, trip, fall hazards protected and<br>clearly visible

  Yes

  No

  N/A

• Slip, trip, fall hazards eliminated

  Yes

  No

  N/A

• Stairs clear of tripping hazards

  Yes

  No

  N/A

• Work platforms clean

  Yes

  No

  N/A

• Walkways clear

  Yes

  No

  N/A

• Clear access to building or site

  Yes

  No

  N/A

• Materials properly stored

  Yes

  No

  N/A

• Trash in protected container

  Yes

  No

  N/A

• Superintendent Signature

  Sign

• Comments

• Add media

  Media

• Project Manager

  Sign

• Address behavioral issues positive and negative – Other general comments – PPE worn – Supervisor set proper example – accidents / near misses reported