WV Dome Project

• Conducted on

  Date

• Prepared by

• Location
  Address

• Number of Employees on Site

  Yes

  No

  N/A

Hazard Communication

• SDS and Chemical lists maintained on site

  Pass

  Action Required

  N/A

• SDS and Chemical lists updated

  Pass

  Action Required

  N/A

• Proper identification labels on cans / portable containers

  Pass

  Action Required

  N/A

Housekeeping

• Work areas clean of excess construction debris

  Pass

  Action Required

  N/A

• Nails pulled from wood before handling

  Pass

  Action Required

  N/A

• Proper storage of materials, supplies and equipment (Gangbox, sea box, etc.)

  Pass

  Action Required

  N/A

• Proper walkway maintained

  Pass

  Action Required

  N/A

Job Site Requirements

• Emergency Action Plan Posted

  Pass

  Action Required

  N/A

• First aid kits / eye wash / bloodborne kits available and maintained

  Pass

  Action Required

  N/A

• OSHA (5 in 1) minimum wage, discrimination state posters are displayed

  Pass

  Action Required

  N/A

Public / Other Worker Protection

• Pedestrian signs, barriers, fences, gates, and flagging is setup

  Pass

  Action Required

  N/A

• Pedestrian walkways are protected from trip and slip hazards

  Pass

  Action Required

  N/A

• Open holes covered and secured and/or barricaded with fencing or guardrails

  Pass

  Action Required

  N/A

• Dust curtains are taped with doors and access areas

  Pass

  Action Required

  N/A

• Overhead protection (falling, flying debris, tool and equipment)

  Pass

  Action Required

  N/A

• Property glass, tile, flooring and vehicles protected

  Pass

  Action Required

  N/A

• Traffic controls maintained (signs, direction, barricades)

  Pass

  Action Required

  N/A

Safety Culture

• Project planning documents onsite and have been reviewed with employees

  Pass

  Action Required

  N/A

• Task planning completed for unidentified or new tasks

  Pass

  Action Required

  N/A

• Project is utilizing safety culture programs (i.e. Safety 24/7, Frontline Safety, Mentoring Programs)

  Pass

  Action Required

  N/A

Sanitation

• Proper means of disposal (dumpsters, trash cans)

  Pass

  Action Required

  N/A

• Proper number of toilets and wash-up facilities provided

  Pass

  Action Required

  N/A

Compressed Air and Gas Cylinder Safety

• Air compressors properly maintained and used

  Pass

  Action Required

  N/A

• All connections are double pinned with whip check installed

  Pass

  Action Required

  N/A

• Compressed air receiver tanks equipped with blow off valve

  Pass

  Action Required

  N/A

• Threaded connection for airlines 2" or greater

  Pass

  Action Required

  N/A

• OSHA Valves installed on 1/2" or greater inside diameter hose (3/4" outside diameter or greater)

  Pass

  Action Required

  N/A

• Compressed gas cylinders stored and secured vertically

  Pass

  Action Required

  N/A

• Cylinders have caps installed when not in use

  Pass

  Action Required

  N/A

• Cylinders have caps installed when not in use

  Pass

  Action Required

  N/A

• Flash back arrests installed at cylinder regulator

  Pass

  Action Required

  N/A

• Oxygen and fuel gases stored 20' apart or separated by fire proof wall

  Pass

  Action Required

  N/A

Electrical Safety

• Adequate lighting for work areas (guarded lenses)

  Pass

  Action Required

  N/A

• Assured grounding inspection or GFCI is in use

  Pass

  Action Required

  N/A

• Electric panel boxes have proper covers

  Pass

  Action Required

  N/A

• Extension cords are 12 gauge / 3 wire minimum

  Pass

  Action Required

  N/A

Fall Protection

• Anchor point of 5000 lbs per employee or engineered anchorage

  Pass

  Action Required

  N/A

• Floor and walkway openings protected

  Pass

  Action Required

  N/A

• Fall equipment inspections are completed

  Pass

  Action Required

  N/A

• ALL employees are maintaining 100% fall protection program

  Pass

  Action Required

  N/A

• Floor openings covered, clearly marked and secured

  Pass

  Action Required

  N/A

• Vertical and horizontal life lines properly used and inspected

  Pass

  Action Required

  N/A

• Handrails are properly constructed - top, middle and toe board

  Pass

  Action Required

  N/A

Fire Safety

• Equipment turned off while fueling

  Pass

  Action Required

  N/A

• Exit, stairs, and walkways are clear (36" Minimum walkway)

  Pass

  Action Required

  N/A

• Fire extinguishers are of adequate size and placement (10 lb min)

  Pass

  Action Required

  N/A

• Flammable storage is 20' from buildings

  Pass

  Action Required

  N/A

• Flammables and combustibles stored separately

  Pass

  Action Required

  N/A

• Fuel cans no larger than 5 gallons with flash arrestor / spring locks

  Pass

  Action Required

  N/A

• Fuel storage area contains signs / containment / > 20 lbs extinguisher

  Pass

  Action Required

  N/A

• No smoking signs posted (smoking areas clearly marked)

  Pass

  Action Required

  N/A

• Oily rags stored in proper container with self closing lid

  Pass

  Action Required

  N/A

• Welding / burning : No combustibles / fire extinguisher present

  Pass

  Action Required

  N/A

• Hot work permit in use (when required)

  Pass

  Action Required

  N/A

Hand Tools and Power Equipment

• Power equipment clean and free of damage

  Pass

  Action Required

  N/A

• Grinders used with guards and side handles at all times

  Pass

  Action Required

  N/A

• Hand tools maintained and free of damage

  Pass

  Action Required

  N/A

• Hand tools secured from falling (working at heights)

  Pass

  Action Required

  N/A

• Power tools are double insulated with proper grounding connection

  Pass

  Action Required

  N/A

• Running equipment not left unattended

  Pass

  Action Required

  N/A

• Sand pots: properly used, clean and free of damage

  Pass

  Action Required

  N/A

• Saws: properly used, clean and free of damage

  Pass

  Action Required

  N/A

Motorized Equipment (Forklift, Buggie, Skid Steer)

• Equipment inspection completed before use (daily)

  Pass

  Action Required

  N/A

• Lift is used within rated capacity

  Pass

  Action Required

  N/A

• Attachments inspected and manufactured for intended use

  Pass

  Action Required

  N/A

Mixing / Grouting / Gunite Equipment

• Dust containment's are established in public areas

  Pass

  Action Required

  N/A

• Employees are wearing correct PPE for identified tasks

  Pass

  Action Required

  N/A

• Equipment is shut down for cleaning where needed

  Pass

  Action Required

  N/A

• Machines are maintained and appear to be fully operational

  Pass

  Action Required

  N/A

• Material placement does not create tripping hazards

  Pass

  Action Required

  N/A

• Team lifting practices for bags (50 lbs or greater)

  Pass

  Action Required

  N/A

Personal Protective Equipment

• Hard hats are being worn properly and are in good condition

  Pass

  Action Required

  N/A

• Eye protection (Z-87.1+ and rated for task)

  Pass

  Action Required

  N/A

• Appropriate gloves for the identified task

  Pass

  Action Required

  N/A

• Hearing protection (noise levels greater than 85 dB)

  Pass

  Action Required

  N/A

• Work boots: Leather / safety toe (steel or composite)

  Pass

  Action Required

  N/A

• Reflective clothing / vests - as determined by project

  Pass

  Action Required

  N/A

Respiratory Protection

• All airborne (respiratory hazards) have been identified

  Pass

  Action Required

  N/A

• Employees are clean shaven when using respiratory protection

  Pass

  Action Required

  N/A

• Fitted respirator users trained, provided physicals, and fit tested

  Pass

  Action Required

  N/A

• Proper respiratory protection has been selected for hazards

  Pass

  Action Required

  N/A

• Respiratory cleaning / disinfection supplies provided

  Pass

  Action Required

  N/A

• Respirators are stored in protective bags when not in use

  Pass

  Action Required

  N/A

• Respirators are being worn properly

  Pass

  Action Required

  N/A

Structure Safety and Protection

• Has shoring been properly implemented and maintained

  Pass

  Action Required

  N/A

• Is loose and delaminated concrete removed prior to working

  Pass

  Action Required

  N/A

• Shoring is left in place until completion of proper cure time

  Pass

  Action Required

  N/A

• Shoring is placed around columns when concrete is removed

  Pass

  Action Required

  N/A

• Structure is capable of supporting construction equipment and debris

  Pass

  Action Required

  N/A

• Point loading of materials or debris on elevated decks is less than allotted weight

  Pass

  Action Required

  N/A

Scaffold and Ladder Access

• Ladder tip extends 36" beyond landing area

  Pass

  Action Required

  N/A

• Ladders are inspected daily and are in good condition

  Pass

  Action Required

  N/A

• Ladders are installed with 4:1 standard ratio

  Pass

  Action Required

  N/A

• Ladders are secured before work begins

  Pass

  Action Required

  N/A

• Ladders are non-conductive and have non-skid feet

  Pass

  Action Required

  N/A

• Scaffold has adequate cross bracing with positive locking device

  Pass

  Action Required

  N/A

• Scaffold modifications made by competent person only

  Pass

  Action Required

  N/A

• Scaffolding system is properly tagged and inspected

  Pass

  Action Required

  N/A

• Work decks are secured to scaffolding and free of debris

  Pass

  Action Required

  N/A

• Work decks are complete without spacing / openings

  Pass

  Action Required

  N/A

Storage

• Protected from vehicle and pedestrian traffic

  Pass

  Action Required

  N/A

• Secure area (fencing or other enclosure) off hours

  Pass

  Action Required

  N/A

• Equipment is barricaded while being operated

  Pass

  Action Required

  N/A

General Notes and Comments