Title Page
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Date
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Job Name
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Job Number
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Prepared by
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Signature
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Location
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Employees Present
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Western States on site date OR back to site?
General Contractor
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General Contractor / Owner
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Job Contract
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Did you talk to the site superintendent?
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Name & Phone Number
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Did you visit the job trailer / office?
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Superintendent walked job site with you.
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GC requires all employees attend site specific orientation?
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Notes
Construction
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How far along is construction? Stage?
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Will the job site require a man-lift?
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Slab-Type
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All-Terrain
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Has the underground fire line been run and stubbed up into the building?
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Has it been flushed and WSFP been provided the flushing paperwork?
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Notes
Submittal / Permitting
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Has the project been designed?
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Has the design been submitted?
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Has the submitted design been approved?
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WSFP has pulled all required permits
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Notes
Material Handling
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Does contractor have a forklift on site?
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Is contractor willing to allow WSFP to use the forklift to unload material OR unload our material for us?
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Is there an established material lay-down area?
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If yes: location?
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Notes
Safety / Risk Management
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If any of the following are checked as "Yes," please notify your Safety Manager.
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Was the building built before 1980?
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Are there any asbestos or potentially asbestos containing materials? ASK GC!
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Is any part of WSFP scope to be completed in a confined space?
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Is any part of WSFP scope to be completed from a scaffold?
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Is any part of WSFP scope to be completed in an excavation or trench?
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Does any part of WSFP scope involve Hot Work? Use of torch or other open flame?
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Is WSFP required to develop a site specific safety plan?
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For the following questions, notify your safety manager if you need assistance or employees do not have necessary training.
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Are the GC provided fall protection measures adequate? Look at Guardrails, Lifelines (horizontal and vertical), Safety Nets, Warning Lines, Fall Protection Procedures, Controlled Access Zones, etc.
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Do all WSFP personnel working at this site have necessary training, including but not limited to: Basic 8, WSFP New Hire Orientation, OSHA 10/30, Lift Training (Boom, Scissor, Fork), First Aid/CPR, Confined Space, etc.
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Will there be any WSFP employees on this site with LESS THAN 1 YEAR work experience with WSFP?
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Notes
Additional Media / Notes
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Additional Notes
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Pictures
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Drawing, if needed