WorkWISE NH Construction Visit - Andrew Lusignan

• Client:

• This report contains the preliminary findings of the recently conducted safety hazard survey at your company's facility or job site. It is intended to be used for the early correction of hazards, pending completion of the official report from the WorkWISE NH consultant. WorkWISE NH reserves the right to add to or alter the preliminary report according to their findings during the inspection. Any additions or alterations will be made on the official report from the WorkWISE NH consultant within 1 month of the date of inspection.

  

• Conducted: Andrew Lusignan

  Date

• Prepared by: Andrew Lusignan, CSP

• Location:
  Address

• Company Representative(s):

• Confidentiality and Stipulations

  

• Add signature

  Sign

• Would the company like a copy of the agreement sent to them by email?

  Yes

  No

General Information

• Would the consultants like to use the general information checklist?

  Yes

  No

Union

• Union or not union?

  Union

  Not Union

Company General Information

• Age of Company

• Company Services and Service Area

• How many square feet is the site?

Employees

• Number of employees on site

• General Notes

Opening Conference Chechlist

• Would the consultant like to use the digital version of the checklist?

  Yes

  No

OSHA 300 Logs

• Are they required?

  Yes

  No

• Are they present?

  Yes

  No

Foreign Workers

• Do you have any foreign workers who have a hard time or cannot read English?

  Yes

  No

• Do you have a OSHA poster that they can read in the language they are most comfortable reading?

  Yes

  No

Reward System

• Is there one in place?

  Yes

  No

• Description

Disciplinary Policy

• Is there one in place?

  Yes

  No

• Description

Workplace Audits

• Is there an audit system in place?

  Yes

  No

• Are workers compensation carriers, private consultants or in house audits used?

  Workers Compensation Carrier

  Private Consultants

  In House Audits

  Safety Committee

Emergency Response

• Is there a written program?

  Yes

  No

• Do employees have a meeting spot during a fire or emergency?

  Yes

  No

Fire Extinguishers

• Are they inspected annually?

  Yes

  No

• Are they inspected monthly?

  Yes

  No

• In the event of a fire will employees be able to use the extinguishers?

  Yes

  No

• Are employees trained to use extinguishers?

  Yes

  No

Scaffolding

• Are they inspected prior to each shift?

  Yes

  No

  N/A

Flammable material, liquid, gases on site?

• Storage tank, refuel stations, portable containers?

  Yes

  No

• Diesel

  Yes

  No

• Stored in

  Portable Cans

  Storage Tanks/Stations

  On/in vehicle?

  Other

Gasoline

• Stored in

  Portable Cans

  Storage Tanks/Stations

  On/in vehicle?

  Other

Propane

• Stored in

  Torch

  Storage Tanks/Refuel Stations

  On/In vehicle

  Other

• Are employees trained?

  Yes

  No

• Are daily inspection preformed?

  Yes

  No

Respirator Program

• Do employees use respirators; including paper dust masks?

  Yes

  No

• Are employees required to use these respirators, or are they using them voluntarily?

  Mandatory

  Voluntary

• Is there a respirator program?

  Yes

  No

• Have employees been medically evaluated?

  Yes

  No

• Have employees been fit-tested for their respirators?

  Yes

  No

• Have employees been medically evaluated?

  Yes

  No

Hazard Communication

• Is there a written program?

  Yes

  No

• Have all employees been trained on the new GHS system?

  Safe

  At Risk

  N/A

• Have MSDS's been converted to SDS?

  Yes

  No

• Are chemicals at the worksite labeled?

  Yes

  No

• Do you have a plumbed or portable Eye Wash Station?

  Yes

  No

• What a hazard inspection completed during the visit?

  Yes

  No

  N/A
Items

• Serious Hazards

  Yes

  No

  N/A

• Condition

• Location

• Picture of Hazard

  Media

• This report obtains the preliminary findings of the recently conducted inspection of your facility or job site. It is intended to be used for the early correction of hazards, pending completion of the official report from the WorkWISE NH consultant. WorkWISE NH reserves the right to add to or alter the preliminary report according to their findings during the inspection. Any additions or alterations will be made on the official report from the WorkWISE NH consultant within 1 month of the date of inspection.