WorkWISE NH Preliminary Hazard Report - General Construction

• Preliminary Safety Report

• Client

• 

• Conducted on

  Date

• Prepared by

• Location
  Address

• Walk through accompaniment and title

General Information

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

  Yes

  No

  N/A

Employees

• Number of employees on site

• Number of employees company wide

• Are there temporary workers?

  Yes

  No

  N/A

• Number of temporary workers

Union

• Union or not union?

  Union

  Not Union

Company General Information

• Age of company, in years

• What does the company do? Processes, operations, etc.

OSHA and Consultation

• Last OSHA Inspection

  Date

• Last Consultant Inspection or Visit

  Date

Project Information

• Project Start Date

• Project Projected Finish Date

• Project Description

• General Notes

Opening Conference Chechlist

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

  Yes

  No

  N/A

Capstone + Intern

• Client interested in a capstone project?

  Yes

  No

  N/A

• Client interested in potential intern?

  Yes

  No

  N/A

OSHA 300 Logs

• Are they required?

  Yes

  No

  N/A

• Are they present?

  Yes

  No

  N/A

Health and Safety Program

• Is it a requirement?

  Yes

  No

  N/A

• Is it present ?

  Yes

  No

  N/A

Safety Committee

• Is it a requirement?

  Yes

  No

  N/A

• Does the safety committee meet?

  Yes

  No

  N/A

• How often do they meet?

  Once a month

  Once a week

  Every other month

  Every other week

  Quarterly

• How many members are on the committee?

• Number of employees

• Does someone take meeting minutes or notes?

  Yes

  No

  N/A

Disciplinary Policy

• Is there one in place?

  Yes

  No

  N/A

• Description

Reward System

• Is there one in place?

  Yes

  No

  N/A

• Description

Workplace Audits

• Is there an audit system in place?

  Yes

  No

  N/A

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

  Workers Compensation Carrier

  Private Consultants

  In House Audits

  Other

• Description

Training

• Is there a program in place?

  Yes

  No

  N/A

• Description

Hazard Communication

• Is there a written program?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Have MSDS's been converted to SDS?

  Yes

  No

  N/A

• Are chemicals at the worksite labeled?

  Yes

  No

  N/A

• What chemicals and other hazard materials are commonly used on site?

Emergency Response

• Is there a written program?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Does management have annual fire drills for all shifts?

  Yes

  No

  N/A

• If fire drill are not performed, why not?

Fire Extinguishers

• Are they inspected annually?

  Yes

  No

  N/A

• Are they inspected monthly?

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• Are employees trained to use extinguishers?

  Yes

  No

  N/A

Exits

• Are all exits marked?

  Yes

  No

  N/A

• Are all exit paths equipped with proper emergency lighting?

  Yes

  No

  N/A

• Are work areas equipped with proper alarm systems?

  Yes

  No

  N/A

• Are they centrally located or local alarms?

  Central

  Local

Chemical Spills

• What is the largest chemical spill possible at the site?

• Are employees expected to clean the spill?

  Yes

  No

  N/A

• Are employees trained to clean up the spill?

  Yes

  No

  N/A

• Is the proper equipment available to the employees to properly clean up the spill?

  Yes

  No

  N/A

Medical Emergencies

• Is medical assistance located within 5 minutes of the site?

  Yes

  No

  N/A

• Are there employees that are dedicated first aid responders?

  Yes

  No

  N/A

• Are the first aid certified or trained?

  Yes

  No

  N/A

• Do those employees have an emergency care plan in place?

  Yes

  No

  N/A

Lockout/Tagout (LOTO)

• Is there a written program?

  Yes

  No

  N/A

• Is the program reviewed annually?

  Yes

  No

  N/A

• Are employees trained in LOTO?

  Yes

  No

  N/A

• Are there procedures for specific machines?

  Yes

  No

  N/A

• Which machines?

Respirator Program

• Is there a respirator program?

  Yes

  No

  N/A

• Is the program voluntary?

  Yes

  No - Mandatory

• Do employees where tight fitting respirators, two strap respirators or both!

  Tight Fitting

  Two Strap

  Both

• Employees must be provided appendix D, be medically evaluated and trained.

• Appendix D must be provided to the employees using the mask.

• Is there a written program?

  Yes

  No

  N/A

• Are employees trained?

  Yes

  No

  N/A

• Are employees fit tested?

  Yes

  No

  N/A

• Are employees medically evaluated?

  Yes

  No

  N/A

Fork Trucks

• Does the site use fork trucks?

  Yes

  No

  N/A

• How many?

• Propane or Electric

  Propane

  Electric

• Do employees preform maintenance of the fork truck(s)?

  Yes

  No

  N/A

• Are employees trained?

  Yes

  No

  N/A

• Are daily inspection preformed?

  Yes

  No

  N/A

• Have CO emissions checks been done?

  Yes

  No

  N/A

(Permit Required) Confined Spaces

• Are there spaces on site?

  Yes

  No

  N/A

• Locations

• What hazards are there?

  Yes

  No

  N/A

• Are spaces marked or labeled by signs?

  Yes

  No

  N/A

• Are permits in place for all spaces?

  Yes

  No

  N/A

• Are there alternative entry procedures?

  Yes

  No

  N/A

• Are the means to preform atmospheric monitoring present?

  Yes

  No

  N/A

• Four gas meter?

  Yes

  No

  N/A

• Is proper calibration completed?

  Yes

  No

  N/A

• What a hazard inspection completed during the visit?

  Yes

  No

  N/A

Slips, Trips and Falls

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Select Yes - Lose fall protection harness 29 CFR 1926.502(d)(17) Yes - Missing guardrail system 29 CFR 1926.501(b)(14) Yes - Missing midrail 29 CFR 1926.502(b)(2) Yes - Missing toprail 29 CFR 1926.501(b)(14) Yes - Floor hole cover missing "hole" or "cover" - 29 CFR 1926.502(i)(4) Yes - Roof warning lines were not flagged every 6 feet 29 CFR 1926.502(g)(3)(i) Yes - Point of access or egress has an elevation change greater then 19 inches 29 CFR 1926.1051(a) Yes - Personal fall protection systems damaged 29 CFR 1926.502(d)(21) No

  • Yes - Lose fall protection harness 29 CFR 1926.502(d)(17)
  • Yes - Missing guardrail system 29 CFR 1926.501(b)(14)
  • Yes - Missing midrail 29 CFR 1926.502(b)(2)
  • Yes - Missing toprail 29 CFR 1926.501(b)(14)
  • Yes - Floor hole cover missing "hole" or "cover" - 29 CFR 1926.502(i)(4)
  • Yes - Roof warning lines were not flagged every 6 feet 29 CFR 1926.502(g)(3)(i)
  • Yes - Point of access or egress has an elevation change greater then 19 inches 29 CFR 1926.1051(a)
  • Yes - Personal fall protection systems damaged 29 CFR 1926.502(d)(21)
  • No

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description Of Hazard

• Picture Of Hazard

  Media

Ladders

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Select Yes - Structural damage 29 CFR 1926.1053(b)(6) Yes - Employee using the top step 29 CFR 1926.1053(b)(13) Yes - Ladder is not secured when used for access 29 CFR 1926.1053(b)(8) Yes - General improper use 29 CFR 1926.1053(b)(4) Yes - Ladder is not extended 3 ft above the working surface when used for access 29 CFR 1926.1053(b)(1) No

  • Yes - Structural damage 29 CFR 1926.1053(b)(6)
  • Yes - Employee using the top step 29 CFR 1926.1053(b)(13)
  • Yes - Ladder is not secured when used for access 29 CFR 1926.1053(b)(8)
  • Yes - General improper use 29 CFR 1926.1053(b)(4)
  • Yes - Ladder is not extended 3 ft above the working surface when used for access 29 CFR 1926.1053(b)(1)
  • No

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description and Location of Hazard

• Picture Of Hazard

  Media

Electrical

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Select Yes - Cord fitting not providing proper strain relief 29 CFR 1926.405(g)(2)(iv) Yes - Ground prong missing 29 CFR 1926.404(f)(6) Yes - Fraying in cord 29 CFR 1926.416(e)(1) Yes - Knockout missing 29 CFR 1926.405(b)(1) Yes - Cord in potential pinch point and/or sharp edge 29 CFR 1926.405(a)(2)(ii)(I) Yes - Extension cord hung from staples or nails 29 CFR 1926.416(e)(2) Yes - Equipment listed and labeled for use in residential settings were available for use or in use 29 CFR 1926.403(b)(2) Yes - Temporary lighting missing cage(s) 29 CFR 1926.405(a)(2)(ii)(e) No

  • Yes - Cord fitting not providing proper strain relief 29 CFR 1926.405(g)(2)(iv)
  • Yes - Ground prong missing 29 CFR 1926.404(f)(6)
  • Yes - Fraying in cord 29 CFR 1926.416(e)(1)
  • Yes - Knockout missing 29 CFR 1926.405(b)(1)
  • Yes - Cord in potential pinch point and/or sharp edge 29 CFR 1926.405(a)(2)(ii)(I)
  • Yes - Extension cord hung from staples or nails 29 CFR 1926.416(e)(2)
  • Yes - Equipment listed and labeled for use in residential settings were available for use or in use 29 CFR 1926.403(b)(2)
  • Yes - Temporary lighting missing cage(s) 29 CFR 1926.405(a)(2)(ii)(e)
  • No

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description and Location of Hazard

• Picture Of Hazard

  Media

Scaffold/Aerial Lifts/Scissor Lifts

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Select Yes - Aerial Lift anti ejection protection 29 CFR 1926.453(b)(2)(v) Yes - Missing mud sill(s) 29 CFR 1926.451(c)(2) Yes - Casters not locked while working on mobile scaffold 29 CFR 1926.452(w)(2) Yes - Caster(s) were found damaged and not functional on Mobil scaffold 29 CFR 1926.451(f)(3) Yes - Midrail chain not connected while an employee is working in a scissor lift 29 CFR 1926.451(g)(1) Yes - Employee working 10 feet or more above the lower working level 29 CFR 1926.451(g)(1) Yes - Scaffold setup missing baseplates 29 CFR 1926.451(c)(2) Yes - Scaffold decking over hang did not meet the minimum 6 inch over hang 29 CFR 1926.451(b)(4) Yes - Casters on mobile scaffold were not properly pinned or otherwise secured 29 CFR 1926.453(w)(9) No

  • Yes - Aerial Lift anti ejection protection 29 CFR 1926.453(b)(2)(v)
  • Yes - Missing mud sill(s) 29 CFR 1926.451(c)(2)
  • Yes - Casters not locked while working on mobile scaffold 29 CFR 1926.452(w)(2)
  • Yes - Caster(s) were found damaged and not functional on Mobil scaffold 29 CFR 1926.451(f)(3)
  • Yes - Midrail chain not connected while an employee is working in a scissor lift 29 CFR 1926.451(g)(1)
  • Yes - Employee working 10 feet or more above the lower working level 29 CFR 1926.451(g)(1)
  • Yes - Scaffold setup missing baseplates 29 CFR 1926.451(c)(2)
  • Yes - Scaffold decking over hang did not meet the minimum 6 inch over hang 29 CFR 1926.451(b)(4)
  • Yes - Casters on mobile scaffold were not properly pinned or otherwise secured 29 CFR 1926.453(w)(9)
  • No

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description Location of Hazard

• Picture Of Hazard

  Media

Trenching/Excavations

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Yes - Spoil piles less then 2 ft back from the trench or excavation 1926.651(j)(2)

  Yes - All trenches and excavations must be sloped, benched, shored or boxed when deeper the 5 feet 29 CFR 1926.652(a)(1)(ii)

  Yes - Egress pints must be provided every 25 feet 29 CFR 1926.651(c)(2)

  No

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description and Location of Hazard

• Picture Of Hazard

  Media

HAZCOM/Eye Wash

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Yes - Container containing an unknown substance is not labeled 29 CFR 1926.1200(f)(6)

  Yes - A chemical was in use that required an eye wash within 10 seconds of unimpeded travel 29 CFR 1926.50(g)

  No

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description and Location of Hazard

• Picture Of Hazard

  Media

Material Handling

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Yes - A wire rope sling(s) was missing its load rating tag 29 CFR 1926.251(b)(1)

  Yes - A synthetic sling(s) was found damaged 29 CFR 1926.251(d)(6)(iii)

  Yes - A chain sling(s) was found with damaged or missing its self closing latches 29 CFR 19226.1425(c)(2)

  Yes - A u-bolt wire rope clip(s) were found applied so the "U" section was in contact with the dead end of the wire rope 29 CFR 1926.251(c)(5)(i)

  No

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description and Location of Hazard

• Picture Of Hazard

  Media

Compressed Gas Cylinders + Welding

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Yes - A compressed gas cylinde(s) was found unsecured 29 CFR 1926.350(a)(2)

  Yes - Cylinder missing proper labeling 29 CFR 1926.350(a)(12)

  No

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description and Location of Hazard

• Picture Of Hazard

  Media

Flammable Liquids and Fire Protection

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Select Yes - A flammable liquid dispensing unit was found unprotected from potential damage 29 CFR 1926.152(e)(4) Yes - Fire extinguisher not available within 50 ft of 5 gallons or more or flammable liquids or materials 29 CFR 1926.150(c)(1)(vi) Yes - Improper container for flammable liquids greater the 1 gallon Yes - No annual inspection of extinguisher 29 CFR 1926.150(c)(1)(viii) Yes - Improper amount of fire extinguishers, require one every 3000 square feet 1926.150(c)(1)(i) No

  • Yes - A flammable liquid dispensing unit was found unprotected from potential damage 29 CFR 1926.152(e)(4)
  • Yes - Fire extinguisher not available within 50 ft of 5 gallons or more or flammable liquids or materials 29 CFR 1926.150(c)(1)(vi)
  • Yes - Improper container for flammable liquids greater the 1 gallon
  • Yes - No annual inspection of extinguisher 29 CFR 1926.150(c)(1)(viii)
  • Yes - Improper amount of fire extinguishers, require one every 3000 square feet 1926.150(c)(1)(i)
  • No

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description and Location of Hazard

• Picture Of Hazard

  Media

Housekeeping/Emergency Egress/General Work Environment

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Yes - Missing exit signs 29 CFR 1926.34(b)

  Yes - Blocked exit route or egress route 29 CFR 1926.34(c)

  Yes - Block stairway 29 1926.25(a)

  Yes - Housekeeping 29 CFR 1926.25(a)

  No

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description and Location of Hazard

• Picture Of Hazard

  Media

Confined Spaces

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Yes - Missing exit signs 29 CFR 1926.34(b)

  Yes - Blocked exit route or egress route 29 CFR 1926.34(c)

  Yes - Block stairway 29 1926.25(a)

  Yes - Housekeeping 29 CFR 1926.25(a)

  No

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description and Location of Hazard

• Picture Of Hazard

  Media

Cranes

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Yes - Crane swing radius must be be clearly mark 29 CFR 1926.1424.(a)(2)(ii)

  No

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description and Location of Hazard

• Picture Of Hazard

  Media

PPE

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Yes - No eye or face protection 29 CFR 1926.(a)(1)

  Yes - No hard hats when necessary 29 CFR 1926.100(a)

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description and Location of Hazard

• Picture Of Hazard

  Media

Guarding

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Yes - Hand grinder missing guard 29 CFR 1926.300(b)(9)

  Yes - Table saw missing guard 29 CFR 1926.304(h)(1)

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description and Location of Hazard

• Picture Of Hazard

  Media

Laser Usage

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Yes - Laser was found in use without the proper signage in place to warn employees 39 CFR 1926.54(d)

• Hazard Type

  Yes - Laser was found in use without the proper signage in place to warn employees 39 CFR 1926.54(d)

• Instances

• Description and Location of Hazard

• Picture Of Hazard

  Media

Concrete and Masonry

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  Yes - Rebar was not protected from potential impalement 29 CFR 1926.701(b)

  No

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description and Location of Hazard

• Picture Of Hazard

  Media

Other

• Was there a hazard?

  Yes

  No

  N/A
Hazard

• Is the hazard considered one of the most common hazards found by WorkWISE NH consultants?

  No

• Hazard Type

  Imminent

  Serious

  Other-Than-Serious

• Instances

• Description and Location of Hazard

• Picture Of Hazard

  Media

• Consultant Signature

  Sign

• 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.