| 100 |
WR |
NA |
Site PPE – Requirements: |
Yes |
No |
NA |
Administrative: |
Use |
Inc |
NA |
Check List (Using or Incomplete) |
| |
|
|
Hard Hats: 100% or When Required |
|
|
|
OSHA Partnership – Alliance – VPP |
|
|
|
Fall Protection: |
| |
|
|
Eye Protection |
|
|
|
Contract Agreements – In Written |
|
|
|
Fall Protect: Harn – Lany – Anchor |
| |
|
|
Respirator Protection |
|
|
|
Site Safety Plan – Safety Manual |
|
|
|
Training Records on Fall Prot. |
| |
|
|
Hearing Protection |
|
|
|
Safety Rules & Enforced |
|
|
|
Competent Per. – Inspect Equipt. |
| |
|
|
Steel Toe Shoes |
|
|
|
Jobsite Orientation |
|
|
|
Guardrailing |
| |
|
|
Traffic Vest |
|
|
|
Emergency Action Plan – Onsite |
|
|
|
Falling Object Protection |
| |
|
|
Other: |
|
|
|
First-Aid – CPR Responders |
|
|
|
Scaffold: Frame – Tube – Susp – Mobile |
| Yes |
No |
NA |
Hazard Assessment: |
|
|
|
Inspections – Daily - Weekly |
|
|
|
Competent Per. – Inspect – Traing |
| |
|
|
Weather Cond: Hot Cold Wind |
|
|
|
Safety Meetings – Daily - Weekly |
|
|
|
Lifts: Scissor – Aerial – Fork |
| |
|
|
Slip – Trip – Fall Hazards |
|
|
|
Report Near Misses |
|
|
|
Other: |
| |
|
|
Good Lighting |
Yes |
No |
NA |
Material Items “Onsite” |
|
|
|
Ladders: Step – Extension – Other |
| |
|
|
Falling Objects – Holes |
|
|
|
OSHA Poster |
|
|
|
Set up – Inspected – Train |
| |
|
|
Absorption (Chem – Bio – Radiation) |
|
|
|
300 Log: On-Site – HDQ. |
|
|
|
Excavation – Trenching: |
| |
|
|
Inhalation – Fume, Mist, Dust, Vapors |
|
|
|
300 summary (2/1-4/30) posted |
|
|
|
Competent Per. – Inspect – Traing |
| |
|
|
Violence |
|
|
|
Emerg. Alarm: Voice – Cell – Horn |
|
|
|
Utilities called & marked |
| |
|
|
Impalement Hazards (Nails – Rebar) |
|
|
|
Emergency Numbers Posted |
|
|
|
Protected: Box – Slope – Bench |
| |
|
|
Traffic: Street, Road, Parking Area |
|
|
|
First Aid Kit |
|
|
|
Electric: |
| |
|
|
Vibration – Ergonomics – Noise |
|
|
|
Bloodborne Path Kit |
|
|
|
Powerlines: Marked – Covered |
| Yes |
No |
NA |
Type of Work: Com – Resid. |
|
|
|
Eye Wash Station |
|
|
|
GFCI: Port – Wall – Breaker |
| |
|
|
Inside Outside |
|
|
|
Toilet Facilities |
|
|
|
Extention Cords – Temp. Lighting |
| |
|
|
Number of Floors: |
|
|
|
Drinking Water |
|
|
|
Panels: Covers – Secure – Marked |
| |
|
|
Shift Work: 1, 2, 3 |
|
|
|
Site Signage (Front) |
|
|
|
Worker Qualified – Lockout |
| Yes |
No |
NA |
Progress: Stage 1 – 2 – 3 – 4 – 5 |
|
|
|
Street Workzone and Sign Needed |
|
|
|
Tools & Equip:Hand – Power – Pn – Hyd |
| |
|
|
Demo – Site Clearing |
|
|
|
Material Safety Data Sheets |
|
|
|
Guards – Hose Clip – Insp. |
| |
|
|
Excavation – Trenching |
|
|
|
Co. Safety Manual – OSHA Book |
|
|
|
Cranes:Tower – Mobile – Hoist |
| |
|
|
Concrete – Rest – Form – Chipping |
Yes |
No |
# |
Sub-Contractor: |
|
|
|
Slings & Attach: Mark – Inspect |
| |
|
|
Steel Erection |
|
|
|
Number of Sub-Contractors Onsite |
|
|
|
Operator Qualified – Trained |
| |
|
|
Framing – Truss – Siding – Roofing |
|
|
|
Safety Person Onsite |
|
|
|
Confined Space:Type |
| |
|
|
HVAC – Electrical – Plumbing |
|
|
|
Competent Person Onsite |
|
|
|
Permit – Monitor – Train – Rescue |
| |
|
|
Drywall – Painting |
|
|
|
Co. Safety Manual – OSHA Book |
|
|
|
Workzone: Street – Road – Inter – Park |
| |
|
|
Glass – Windows – Trim – Doors |
|
|
|
Safety Meetings, Site Inspections |
|
|
|
Signage – Worker Vest – WZ Map |
| |
|
|
Landscape |
|
|
|
Safety Training – Workers |
|
|
|
Haz. Com: |
| Yes |
No |
NA |
Safety Training: |
|
|
|
Sub of Sub Notification to G.C. |
|
|
|
List – Prog – Label – MSDS – Traing |
| |
|
|
OSHA 30 Hr.- Emp Supv. Manage |
|
|
|
Fire Extinguishers – First Aid Kit |
|
|
|
Other: |
| |
|
|
OSHA 10 Hr.- Emp Supv. Manage |
|
|
|
MSDS Onsite |
|
|
|
Fire Hazard Area’s ID – Signage |
| |
|
|
Specific: |
Yes |
No |
NA |
Behavior Observed: |
|
|
|
Heavy Equipment – Vehicles |
| Yes |
No |
NA |
Site Condition: |
|
|
|
Jobsite Attitude – Good – Helpful |
|
|
|
Weld – Permit – Fire Extg – Watch |
| |
|
|
Housekeeping – Good |
|
|
|
PPE – Workers Using PPE Properly |
|
|
|
Concrete – Underground – Tunnel |
| |
|
|
Exits Paths – Maintained |
|
|
|
Reported items to the Company |
|
|
|
Blasting – Explosives – Qualified |
| |
|
|
Fire Extinguishers Provided |
|
|
|
Company Rep: |
|
|
|
Lead – Asbestos – Mold: Abated |
| |
|
|
|
|
|
|
|
|
|
|
|
| Due to the constantly changing nature of government regulations, conditions, and the human factors involved, no safety audit can possibly reveal all conditions existing at the audit site that may lead to injury, property damage, or fines. Furthermore, no safety audit can possibly render an opinion on conditions existing at the inspection site before or after the performance of the audit. The Company understands that it must also provide or conduct frequent and regular inspections on the job site. The audits performed by Safety Alliance LLC shall be used only to aid not relieve the company in complying with this requirement. Safety Alliance will have no authority to stop, correct or supervise employees but will inform company representative of any specific safety concerns known to it. This is considered a walk through inspection not a comprehesive safety inspection. This form may not be complete for your site. You will need to review and revise this form to your type of work. REVISED FORM: 8/6/08 |
| |
| |
| |
| |
| Contractor & Project: Supt.: Date: |
