Western Specialty Contractors

• Conducted on

  Date

• Prepared by

• Location
  Address

Scope of Work Performed

• Scope of work:

Safety Documentation

• SSSP in place and all sections completed and up-to-date?

  Yes

  No

  N/A

• SDS sheets identified in SSSP and located on the project?

  Yes

  No

  N/A

• OSHA required postings in place?

  Yes

  No

  N/A

• HAZCOM, silica, glove, and noise chart posters in place?

  Yes

  No

  N/A

• Safety Bucket in place?

  Yes

  No

  N/A

Safety Training

• Hard hat stickers in place (new hire/tasks)?

  Yes

  No

  N/A

• Training certification cards for operators of equipment?

  Yes

  No

  N/A

• New Hire Program in place (green sticker)?

  Yes

  No

  N/A

• Employees are properly trained for tasks performed?

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• Hard hats?

  Yes

  No

  N/A

• Eye protection (safety glasses/face shields)?

  Yes

  No

  N/A

• Gloves?

  Yes

  No

  N/A

• Hearing protection (noise above 85 db)?

  Yes

  No

  N/A

• Proper foot protection/boots?

  Yes

  No

  N/A

• Respiratory protection?

  Yes

  No

  N/A

Tool Safety

• Right tool and equipment for the job?

  Yes

  No

  N/A

• Guards and handle in place?

  Yes

  No

  N/A

• GFCI use in place?

  Yes

  No

  N/A

• Tool and equipment energy shut off during repairs/maintenance?

  Yes

  No

  N/A

• Razor knives used properly with PPE?

  Yes

  No

  N/A

• Tools are not modified?

  Yes

  No

  N/A

Aerial Lift Safety

• Controls, gauges, and labeling visible and not covered by product material (paint, caulk, concrete, etc.)?

  Yes

  No

  N/A

• Operating Manual located on lift?

  Yes

  No

  N/A

• Fire extinguisher located on lift?

  Yes

  No

  N/A

• Right size lift for task?

  Yes

  No

  N/A

• Operated on flat, level surface?

  Yes

  No

  N/A

• Not used as a crane? - No suspended loads from lifts allowed.

  Yes

  No

  N/A

• Wind monitored and not used when wind speeds are 25+ mph or recommended speeds by the manufacturer?

  Yes

  No

  N/A

• Aerial lift inspections performed?

  Yes

  No

  N/A

Material Handling Equipment Safety

• Seatbelt use in place?

  Yes

  No

  N/A

• Back-up alarms in place and functional?

  Yes

  No

  N/A

• Load capacity identified?

  Yes

  No

  N/A

• Picking attachments used - No loads suspended from forks only?

  Yes

  No

  N/A

• No damage to windows, mirrors, or lights?

  Yes

  No

  N/A

• Horn in good working order?

  Yes

  No

  N/A

• Equipment inspections performed for forklift, lull, skidsteer, etc.?

  Yes

  No

  N/A

Crane Safety

• Certified Crane Operator - NCCCO or equivalent?

  Yes

  No

  N/A

• Rigging/Signaling completed by a competent person?

  Yes

  No

  N/A

• Signaling chart posted on the crane?

  Yes

  No

  N/A

• Loads being picked within crane's capacity?

  Yes

  No

  N/A

• Hoist Plan completed?

  Yes

  No

  N/A

• Tag lines used?

  Yes

  No

  N/A

• Safe distance from power lines?

  Yes

  No

  N/A

Fall Protection

• Individual harness inspections in place?

  Yes

  No

  N/A

• Anchor points rated for 5000 lbs.?

  Yes

  No

  N/A

• Fall protection equipment set up properly so employees reduce fall distance (6')?

  Yes

  No

  N/A

• Aerial lift fall protection in place?

  Yes

  No

  N/A

• Floor/roof openings protected?

  Yes

  No

  N/A

• Warning lines / hard barricades in place?

  Yes

  No

  N/A

• Roof Safety Monitor approved by Branch Manager?

  Yes

  No

  N/A

Silica Exposure

• Site specific Exposure Control Plan in place?

  Yes

  No

  N/A

• Vacuum systems used and maintained?

  Yes

  No

  N/A

• Water-fed systems used and maintained?

  Yes

  No

  N/A

• Work area properly ventilated (fans)?

  Yes

  No

  N/A

• Plan in place to rotate workers?

  Yes

  No

  N/A

• Proper signage in place to communicate silica hazard(s)?

  Yes

  No

  N/A

• Silica tasks not outlined in Table 1 properly controlled? Plan discussed with Safety Department?

  Yes

  No

  N/A

• Are any exposure assessments needed for job tasks?

  Yes

  No

  N/A

• Respiratory protection in place?

  Yes

  No

  N/A

• Respiratory storage in place?

  Yes

  No

  N/A

• Are employees clean shaven for respirator use?

  Yes

  No

  N/A

HAZCOM & Fire Protection

• Proper containment and labeling in place?

  Yes

  No

  N/A

• Flammables stored away from combustibles?

  Yes

  No

  N/A

• Propane cylinders secured and stored away from truck/equipment traffic?

  Yes

  No

  N/A

• Welding bottles stored upright/secured/capped?

  Yes

  No

  N/A

• Fire extinguishers located near flammables/generators/equipment?

  Yes

  No

  N/A

Soft Tissue Injury Prevention - STOMP

• ERGO tools/methods utilized?

  Yes

  No

  N/A

• Manual material handling not greater than 50 lbs.?

  Yes

  No

  N/A

• Material handling equipment used (forklifts, dollies, carts, wheels on trash cans)?

  Yes

  No

  N/A

• ERGO body positions: Proper lifting? Raised work height to prevent bending over? Arms overhead? Over-reaching?

  Yes

  No

  N/A

• ERGO body positions: Raised work height to prevent bending over?

  Yes

  No

  N/A

• ERGO body positions: Arms overhead?

  Compliant

  Non-Compliant

  N/A

• ERGO body positions: Over-reaching?

  Compliant

  Non-Compliant

  N/A

Housekeeping

• Safe access to work areas (clear paths)?

  Yes

  No

  N/A

• Work area free of slips, trips, and holes?

  Yes

  No

  N/A

• Barricades in place with proper communication?

  Yes

  No

  N/A

• Scrap/debris is addressed as it is created?

  Yes

  No

  N/A

• Trash cans/containment available?

  Yes

  No

  N/A

• Materials properly staged and organized?

  Yes

  No

  N/A

• Protection in place (STEPPS): STOP - THINK - EMPLOYEES - PUBLIC - PROPERTY - SAFETY

  Yes

  No

  N/A

• Adequate lighting in place?

  Yes

  No

  N/A

Ladder Safety

• Ladder use approved by Branch Manager?

  Yes

  No

  N/A

• Ladders Type 1 or 1A depending on weight capacity?

  Yes

  No

  N/A

• Ladder labels in place?

  Yes

  No

  N/A

• Ladders secured to prevent accidental displacement?

  Yes

  No

  N/A

• Ladders extend 3' beyond landing?

  Yes

  No

  N/A

• Ladders set up for 4' to 1' pitch?

  Yes

  No

  N/A

• Ladder rungs/rails free of dents and defects?

  Yes

  No

  N/A

• No ladder use on the top two steps?

  Yes

  No

  N/A

• Employees working within the rails of the ladder?

  Yes

  No

  N/A

Electrical Safety

• Assured grounding color coded tape installed on cords/tools?

  Yes

  No

  N/A

• Cords in good condition (no lacerations, no insulation showing)?

  Yes

  No

  N/A

• 12 gauge cords being used (construction grade)?

  Yes

  No

  N/A

• Swing stage power cable in good condition/properly set up?

  Yes

  No

  N/A

• Temporary power inspected?

  Yes

  No

  N/A

• GFCI's in use?

  Yes

  No

  N/A

General Safety Focus

• Radio frequency/microwave antennas verified "OFF?"

  Yes

  No

  N/A

• Tools and equipment have means to secure/lock overnight?

  Yes

  No

  N/A

• Fencing/barricading in place to protect public?

  Yes

  No

  N/A

• Foreman or any other crew member bi-lingual when necessary?

  Yes

  No

  N/A

Suspended Scaffolding

• Inspected daily by a competent person?

  Yes

  No

  N/A

• Beams properly connected with a beam splice security cable?

  Yes

  No

  N/A

• Beams have the correct ratio of counterweights?

  Yes

  No

  N/A

• Tools and equipment tethered?

  Yes

  No

  N/A

• Beams tied back and secured to a proper anchor point?

  Yes

  No

  N/A

• Fall protection anchor points rated for 5,000 lbs. and properly secured?

  Yes

  No

  N/A

• Have roof davits been inspected within the last 12 months?

  Yes

  No

  N/A

• If "C" hooks are being used - Is parapet inspected by a competent person?

  Yes

  No

  N/A

• Emergency brake and overspeed device have been tested?

  Yes

  No

  N/A

• Scaffolding is a safe distance from power lines?

  Yes

  No

  N/A

• Scaffold netting, guardrails, toeboards, and fall protection are in place?

  Yes

  No

  N/A

• Areas barricaded below to prevent struck-by hazards (Controlled Access Zone - CAZ)?

  Yes

  No

  N/A

• Are all materials secured in case of high winds that create flying debris?

  Yes

  No

  N/A

• Resources available to monitor wind speeds (25 mph. max)?

  Yes

  No

  N/A

Frame Scaffolding

• Inspected daily by a competent person?

  Yes

  No

  N/A

• Safe access for employees is provided (proper ladders, hatch openings secured)?

  Yes

  No

  N/A

• Baseplates and mudsills are installed on flat, level surfaces?

  Yes

  No

  N/A

• All gaps are less than 1" apart?

  Yes

  No

  N/A

• All working levels are fully planked?

  Yes

  No

  N/A

• Debris and trash being removed?

  Yes

  No

  N/A

• Scaffolding is a safe distance from power lines and electrical sources?

  Yes

  No

  N/A

• Scaffold capacity identified?

  Yes

  No

  N/A

• Weight is within capacity limits?

  Yes

  No

  N/A

• Guardrails, toeboards, and fall protection is set up properly?

  Yes

  No

  N/A

• Areas barricaded below to prevent struck-by hazards (Controlled Access Zone - CAZ)?

  Yes

  No

  N/A

• Are all materials secured in case of high winds that create flying debris?

  Yes

  No

  N/A

Roofing

• Safe access to roof areas (ladders, boom lifts, roof access)?

  Yes

  No

  N/A

• Warning lines in place and properly installed (flags every 6')?

  Yes

  No

  N/A

• Skylights/open holes properly covered/protected?

  Yes

  No

  N/A

• Roof hatch kept closed, or if left open, a guardrail system is in place to prevent falls?

  Yes

  No

  N/A

• All materials are secured in case of high winds that create flying debris?

  Yes

  No

  N/A

• Material landing/receiving area is set up with fall protection in place (warning lines, hard barricades, tie-off)?

  Yes

  No

  N/A

• Ladders set up for 4' to 1' pitch?

  Yes

  No

  N/A

• Ladders secured to prevent accidental displacement?

  Yes

  No

  N/A

• Ladders extend 3' beyond landing?

  Yes

  No

  N/A

• Fall protection in place outside of warning lines (raptor carts, retractables, rope grabs, etc.)?

  Yes

  No

  N/A

• Flammable materials are properly stored?

  Yes

  No

  N/A

• Fire watch being used?

  Yes

  No

  N/A

• Combustibles removed?

  Yes

  No

  N/A

• Safety Monitor use approved by Branch Manager?

  Yes

  No

  N/A

• Safety Monitor has completed the Western training course

  Yes

  No

  N/A

• Safety Monitor is wearing the required SM vest?

  Yes

  No

  N/A

Sheet Metal

• Proper cut rated gloves being used?

  Yes

  No

  N/A

• Sleeves in place when handling sharp metal?

  Yes

  No

  N/A

• Safety glasses and face shield being used for cutting metal?

  Yes

  No

  N/A

• Hands and body are clear of pinch points?

  Yes

  No

  N/A

• Sharp edges are protected from snagging clothing/body parts?

  Yes

  No

  N/A

• Proper cutting tools available?

  Yes

  No

  N/A

• Cords are protected from sharp metal edges?

  Yes

  No

  N/A

Deck Coating/Painting

• Mixing area is set up properly with good housekeeping practices?

  Yes

  No

  N/A

• Employees are protected from mixing material on clothes and skin?

  Yes

  No

  N/A

• Mixing materials are properly stored with fire extinguisher in place?

  Yes

  No

  N/A

• Painting and coating application is performed with ERGO long handled tools?

  Yes

  No

  N/A

• Respiratory protection is in place (if needed)?

  Yes

  No

  N/A

• Proper ventilation is in place (if needed)?

  Yes

  No

  N/A

• Barricading and signage is in place to protect employees and pedestrians?

  Yes

  No

  N/A

Hot Kettle

• All workers are trained on Hot Kettle safe work practices?

  Yes

  No

  N/A

• Hot Kettle set up is a safe distance from combustibles?

  Yes

  No

  N/A

• Has the structural capacity of the deck been verified to hold the weight of the kettle and materials?

  Yes

  No

  N/A

• Kettle operator is in close proximity to Hot Kettle when in operation?

  Yes

  No

  N/A

• Minimum of 2 fire extinguishers are in place?

  Yes

  No

  N/A

• Hot Kettle has a working thermometer?

  Yes

  No

  N/A

• Employees are instructed on how to properly use mops to prevent splashing of hot materials on their skin and clothing?

  Yes

  No

  N/A

• First Aid/Burn Kit is available on the project?

  Yes

  No

  N/A

Concrete/Masonry

• Traffic Control Plan formulated for work areas?

  Yes

  No

  N/A

• Signs, barriers, barricades, flashing lights, and flaggers utilized?

  Yes

  No

  N/A

• Demo plan engineered?

  Yes

  No

  N/A

• Rebar capped?

  Yes

  No

  N/A

• Deck capacities known and not overloaded?

  Yes

  No

  N/A

• Materials are stored a safe distance away from leading edges?

  Yes

  No

  N/A

• Materials are secured in case of high winds?

  Yes

  No

  N/A

• Holes are properly covered, secured, and labeled "HOLE?"

  Yes

  No

  N/A

• Silica - Use "Silica Exposure" section

  Yes

  No

  N/A

• Hearing protection in place?

  Yes

  No

  N/A

• Post tension safety practices in place and communicated to crew?

  Yes

  No

  N/A

• CO monitored and controlled to keep below action levels?

  Yes

  No

  N/A

• Air compressor safety is in place (pins in connections, hose whip devices)?

  Yes

  No

  N/A

Worker Observation

• Is the employee performing the task safely?

  Safe

  At Risk

  N/A

• Focus on the "Safe" things identified and positively reinforce them.

  Yes

  No

  N/A

• Discuss any "At Risk" acts or conditions identified and communicate corrective actions.

  Yes

  No

  N/A

• Express concern for the employee's well-being and thank them for taking the time to speak with you.

  Yes

  No

  N/A

• Comments:

• General Comments:

• Inspector's Signature:

  Sign