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?
- Hard Hat not being worn
- No chain or guard across opening
- Standing on rail or toe board with no personal fall equipment
- Working outside of lift with no fall protection
- No spotter while on retail sales floor
-
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?
- Hard hat not be worn
- Personal fall harness and lanyard not being used
-
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?
- Safety Glasses
- Safety Shoes
- Hard Hat
- high-visibility vest
- Hearing Protection
- Personal Fall Protection
- Electrical Safety PPE (70E category)
-
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.