Title Page

  • Report Title

  • Type of Work (Description)

  • Location
  • Conducted on

  • Prepared by

  • Personnel in attendance

Housekeeping

  • Is site free of debris, trash, material waste ? (Debris is piled or gathered)

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable

Hot Work

  • Is the site following a hot work permitting process? (Wegmans or the General Contractors)

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable

Fire Protection / Emergency Response

  • Fire Extinguishers charged, inspected, properly placed?

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable

  • Site NO SMOKING policy being followed? (Wegmans or General Contractor)

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable

  • Fire EXITS marked and not blocked?

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable

  • First aid kit on site?

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable

Scaffolding, Scissors Lifts, Aerial Lifts, Material Handling Equipment

  • Scaffolding - Is properly erected, inspected, used and maintained. Note: competent person must be directing the build and removal of scaffolding.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable

  • Scissors lift- Is user following site policy? (Wegmans or General Contractor)

  • What part of policy not being followed?

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable

  • Aerial Lift- Is user following site policy? (Wegmans or General Contractor)

  • What part of policy not being followed?

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable

Fall Hazards

  • Holes covered- Openings or gaps >2" wide are covered.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Fall Protection/Prevention - Is properly established and has sufficient structural integrity to protect from falls greater than 6 feet.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Walking / Working Surfaces - Are free from obstructions & slipping hazards

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Ladders - Are used properly (3 points of contact when ascending or descending ladders, work facing ladder, ladder secured, etc.)

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

Struck by Hazards

  • Traffic Flow - Pedestrian and vehicle/mobile equipment traffic flow are controlled.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Elevated Materials/Tools/Equipment - Protected from dropping/falling to lower levels (toe boards, debris nets, secure materials, etc.)

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

Caught In/Between Hazards

  • Mobile Equipment - Has operable back-up alarms.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Swing-Radius - Cranes and other rotating construction equipment swing-radius is protected.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Tag lines - Are used to control loads during lifts.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Guards - In place for tools and equipment with moving and rotating parts.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Trenches/Excavations - Greater than 5 ft. in depth have cave-in protection consistent with regulatory requirements.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Confined Space Hazards - Atmospheric, entrapment, engulfment, mechanical, electrical and other pertinent hazards are identified and controlled. Permit on hand.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

Electrical Hazards

  • Elevated Energized Power Systems - Cranes and lifts maintain at least 10 ft. distance from elevated energized power systems.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Underground Energized Power Systems - Identified and protected prior to digging.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Power Cords - Have electrically protective elements intact (outer insulation, ground pin, etc.) and are protected/elevated to prevent damage.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • GFCI/Assured Grounding Conductor Program - is utilized to protect employees from electric shock.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Energized Parts - are guarded to prevent contact & isolated from wet conditions.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Lockout/Tagout - Is contractor / employee following LO/TO requirements?

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Arc Flash Protections - Safe arc blast boundaries,PPE, and other control methods are utilized.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • PPE - is utilized to prevent electricity from harming person(s).

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Insulated Tools - Are used in the proximity of electrical sources (insulated screw driver, etc.).

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

Laceration Hazards

  • Sharp Edges - Are protected to prevent contact or proper PPE is utilized (gloves, chaps, sleeves, etc.).

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Guards - Are maintained as designed/installed on cutting tools.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

Ergonomic (Physical Stress) Hazards

  • Material Handling Equipment - Is utilized when handling loads > 50 lbs. / person.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

Safety Planning

  • Hazard Identification through Pre-task plan, Risk Assessments or JHA's - Are conducted daily by construction crews and include safety and ergonomic hazards.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

Hazard Communication

  • SDS's available for chemicals, including liquids and gasses, on site.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Chemicals, including liquids and gases labeled and stored properly.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

Safety Training

  • Project-Specific Safety Orientations - Completed by construction field employees prior to commencing work on site.

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

Lead by Example

  • Site complies with all hazard controls while on the worksite (barriers, PPE, warning signs, etc.)

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Is Site Manager holding contractors /employees to the Wegmans or site PPE policy?

  • What type of PPE not being worn?

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

  • Is Project Manager conducting periodic safety inspections?

  • What are the action items needed to be completed to eliminate the hazard or reduce risk to an acceptable level?

  • Action Item
  • Recommended Solution

  • Contractor Name if applicable.

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.