Field Assessment Field Site Assessment 1Contact Information2Site Qualifications3General Information4Pre-Job Planning5Emergency Response6Training Certification7PPE8Housekeeping9Fall Protection Systems10Fall Protection on Rooftops11Working at Heights on Elevated Structures12Scaffolding13Excavation / Trenching / Boring14Confined Space15Fire Prevention16Hoisting & Rigging17Cranes18Mobile Elevating Working Platforms19Ladder Usage20Electrical Work21RF / EME22Hand and Power Tools23Hazard Communication24Heat Illness Prevention25Heavy Construction Equipment26Traffic Control27Concrete Construction28Assessment Review and Submit HiddenField Site Assessment Field Site Assessment Name First Last Date MM slash DD slash YYYY Company Email PhoneGeneral Contractor Supervisor Project Name Site # Lower Tier Contractors Has a job-specific hazard assesment (JSA/JHA/STA) been developed? Yes No Are fall protection systems being used? Yes No Is rooftop work being performed? Yes No Is tower work being performed? Yes No Is scaffolding being used? Yes No Is trenching, excavation and/or boring activities being performed? Yes No Is work being performed in a confined space? Yes No Are professionals performing hot work activities on site, (welding, cutting, grinding, or brazing)? Yes No Is any rigging taking place on site? Yes No Is a crane being used on site? Yes No Is a mobile elevating work platform being used on site? Yes No Are ladders being used on site? Yes No Is electrical work being performed? Yes No Do RF hazards exist on site? Yes No Are hand and power tools being used on site? Yes No Are hazardous substances being used and/or encountered by professionals on site? Yes No Is the ambient temperature over 85 degrees F? Yes No Is heavy equipment being used on site? Yes No Are work activities being performed on a public road or right of way? Yes No Are concrete and mason block activities being performed on site? Yes No GeneralIs there an NTP (Notice to Proceed) on site? Yes No N/A Do the dates on the NTP reflect the actual dates being worked on site? Yes No N/A Has the NOC been notified? Yes No N/A Is there a SARC (Site Aquisition Release to Construction) on site? Yes No N/A Is there a safety banner (4 in 1 sign) posted in a conspicuous area? Yes No N/A Is a jobsite safety binder on site? Yes No N/A Is the applicable safety program on site, (subcontractor safety program, customer safety program)? Yes No N/A A minimum of one 10 lb. ABC fire extinguisher is fully charged and readily available? Yes No N/A Fire Extinguisher has been inspected monthly and serviced annually? Yes No N/A Provide a photo/upload of the safety program. Pre-Job PlanningHas the JSA/JHA/STA been developed daily, reviewed and signed be all affected professionals? Yes No Does the JSA/JHA/STA covers all tasks and hazards associated to the scope of work being performed? Yes No N/I Have all hazards have been communicated to all professionals and subcontractors? Yes No N/A Is potable water available on site? Yes No N/A Are there are at least 2 professionals who possess current and valid CPR/1st Aid certifications? Yes No N/A Is there a properly stocked 1st Aid kit on site? Yes No N/A All methods of procedures (MOP) specific to a task/scope of work are readily available and accurate? Yes No N/A Provide a photo of each page of the JSA/JHA/STAProvide photo/photos of emergency action plan Emergency ResponseHas a site specific emergency action plan been developed and communicated to all professionals? Yes No N/A Are there at least 2 First Aid / CPR certified personnel on site? Yes No N/A Is there an adequate and properly stocked First Aid kit? Yes No N/A SDS’s are readily available for all applicable hazardous substances to which professionals are exposed? Yes No N/A Training CertificationAre training certifications readily available for all professionals on site? Yes No N/A Are all training certifications current and up-to-date for all professionals on site? Yes No N/A Are all employees on site OSHA 10/30 certified? Yes No N/A Personal Protective EquipmentAre professionals wearing applicable hardhats that meet the ANSI Z89 standard? Yes No N/A Are professionals wearing applicable safety glasses that meet the ANSI Z87 standard? Yes No N/A Are professionals wearing suitable footwear? Yes No N/A Are professionals using suitable face shields (when required)? Yes No N/A Are professionals wearing applicable gloves specific to the task? Yes No N/A Are professionals using suitable hearing protection when required? Yes No N/A Are professionals wearing suitable work clothing? Yes No N/A HousekeepingIs the work area maintained in a clean and orderly fashion? Yes No N/A Are walkways / aisleways clear and free from slip/trip hazards? Yes No N/A Are areas barricaded as required to prevent access by the public? Yes No N/A Are construction materials and tools secured as to prevent accidental displacement? Yes No N/A Are combustible and flammable materials controlled? Yes No N/A Fall Protection SystemsIs fall protection being used to prevent professionals from falling to lower levels in excess of 6’? Yes No N/A Is the fall protection system a warning line? Yes No N/A Is the warning line 15’ or > more from the unprotected edge? Yes No N/A Does the warning line have an MBS (Minimum Breaking Strength) of 500 # or >? Yes No N/A Is the warning line flagged or marked every 6’? Yes No N/A Is the warning line rigged not fewer than 39” and not more than 45” from the working surface? Yes No N/A Is the fall protection system a guardrail? Yes No N/A Is the guardrail constructed of wood or in an equally substantial manner from other materials? Yes No N/A Is the top rail between 42” and 45” in height? Yes No N/A Is the mid-rail placed halfway between the top rail and the floor? Yes No N/A Vertical posts are spaced at 8’ or closer intervals? Yes No N/A Is the guardrail capable of withstanding a force of at least 200 lbs. applied to the top rail? Yes No N/A Is the fall protection system a personal fall restraint system? Yes No N/A Does the fall restraint system keep the professional from falling to a lower level? Yes No N/A Is the anchor point capable of withstanding 1,000 lbs. or 4 times the intended load? Yes No N/A Does the personal fall restraint system have compatible connections? Yes No N/A The fall protection equipment has been inspected is deemed in good working order / condition and meets the latest revision of the ANSI/ASSE Z359 standard? Yes No N/A Is the fall protection system a personal fall arrest system? Yes No N/A Does the personal fall arrest system keep the professional from free falling 6’ or less and from contacting a lower level / structure? Yes No N/A Does the anchor point support 5,000 lbs.? Yes No N/A Does the personal fall arrest system have compatible connections? Yes No N/A Is there a rescue plan in place? Yes No N/A Is rescue equipment readily available? Yes No N/A The fall protection equipment has been inspected is deemed in good working order / condition and meets the latest revision of the ANSI/ASSE Z359 standard? Yes No N/A Provide file drop / upload photograph of the fall protection system being used to protect the professionals.* Fall Protection on RooftopsA rooftop control method of procedure has been submitted and accepted? Yes No N/A Are professionals protected from falling to lower levels more than 6’ by a parapet wall 42” high or greater? Yes No N/A Is there a site-specific rooftop control method of procedure readily available? Yes No N/A Are floor, roof openings and skylights guarded by railings and toe boards or by covers? Yes No N/A Are covers capable of supporting 400 lbs. or twice the weight of employees, equipment, and material, and be securely fastened? Yes No N/A Do covers bear a sign with minimum 1” letters stating – OPENING / HOLE – DO NOT REMOVE Yes No N/A Professionals within 6’ of any skylight are protected from falling through the skylight opening by any one of the following methods: guardrails, skylight screens, personal fall protection system, covers installed over the skylights? Yes No N/A Are professionals using control descent techniques to access the work location? Yes No N/A Is a control descent method of procedure readily available? Yes No N/A Are the professionals who are performing the control descent qualified? Yes No N/A Are both primary and secondary systems using suitable anchor points? Yes No N/A Are there qualified rescue personnel readily available? Yes No N/A Is the rescue equipment readily available? Yes No N/A Is there a rescue plan in place? Yes No N/A The fall protection equipment has been inspected is deemed in good working order / condition and meets the latest revision of the ANSI/ASSE Z359 standard? Yes No N/A Provide file drop / upload photograph of the general rooftop working area with the fall protection system being used to protect the professionals.* Working at Heights on Elevated StructuresAll professionals who are climbing and/or working at height possess current tower climber / rescue training certifications? Yes No N/A Authorized climbers are under the supervision of a competent climber? Yes No N/A A site-specific fall protection hazard assessment has been conducted? Yes No N/A A documented rescue plan is in place with the applicable rescue equipment on site and is readily available? Yes No N/A 2 competent rescuers are readily available and have the responsibility to implement the site-specific rescue plan? Yes No N/A The methods and equipment used for fall protection are compliant with applicable standards? Yes No N/A The fall protection equipment has been inspected is deemed in good working order / condition and meets the latest revision of the ANSI/ASSE Z359 standard? Yes No N/A Tower/elevated structure does not have an active bird’s nest? Yes No N/A ScaffoldingIs a competent person on site? Yes No N/A Professionals who are working on the scaffold possess current and valid scaffold user certifications? Yes No N/A Has the scaffold been inspected prior to professionals working on the scaffold? Yes No N/A Does the scaffold bear the appropriate tag? Yes No N/A Scaffolds that exceed 36’ in height have a DOSH (Department of Occupational Safety and Health) permit? Yes No N/A The scaffold design and construction is in accordance with the manufacturer’s recommendations? Yes No N/A Ladders, horizontal members, and stairways provide safe and unobstructed access to all working platforms? Yes No N/A Ladders are securely attached to the scaffold? Yes No N/A Ladders extend 3’ above the platform? Yes No N/A Scaffolds are tied off with a double-looped No. 12 iron wire or a single-looped No. 10 iron wire or equivalent? Yes No N/A The ties are at intervals not to exceed 30 feet horizontally? Yes No N/A There are ties at the free ends of the scaffold when the scaffold platform height is 3 times the base depth? Yes No N/A Ties for subsequent levels are installed at 26’ intervals vertically, with the last tie no further from the top than 4 times the base depth? Yes No N/A Platforms are fully planked (without gaps greater than 1”) and cover the entire space between scaffold uprights? Yes No N/A The space between the platform and the building (structure) does not exceed 16”? Yes No N/A Overhead protection is provided when professionals are working overhead or when passing below, (toe boards / canopies / netting)? Yes No N/A The planking overhangs the ledger or support between 6” and 18”? Yes No N/A Guardrails are installed on all open sides and ends of platforms that are 7 ½ ‘or higher? Yes No N/A Provide file drop / upload photograph of the overall scaffold* Drop files here or Select files Accepted file types: jpg, png, gif, pdf, heic, jpeg, Max. file size: 50 MB. Excavation / Trenching / BoringIs a competent person on site? Yes No N/A Has a Utility Avoidance Plan (UAP) been developed? Yes No N/A Is the UAP readily available and being adhered to? Yes No N/A Has the 811-regional center (or equivalent) been notified? Yes No N/A A positive response from all known owners/operators of subsurface installations has been received? Yes No N/A Is there current “dig” ticket readily available and/or on site? Yes No N/A The exact locations of all known underground utilities have been determined by safe and acceptable means (potholing)? Yes No N/A Is the excavation / trench 5’ or deeper? Yes No N/A Are professionals performing work in the trench / excavation? Yes No N/A Is there a DOSH permit readily available? Yes No N/A Are professionals protected from cave-ins by an appropriate protective system, (shoring / benching / sloping / trench box)? Yes No N/A Standard shoring, sloping and benching are used as specified in regulation illustrations or according to tabulated data? Yes No N/A Has a competent person inspected the excavation / trench, adjacent areas and protective systems prior to the start of work, throughout the shift and daily for potential cave-ins, failures, hazardous atmospheres or other hazards? Yes No N/A An excavation / trench permit has been completed and is readily available? Yes No N/A Are professionals protected from falling materials by scaling, installation of protective barriers, or other methods? Yes No N/A Professionals are protected from excavated or other material by keeping such material 2’ from the excavation edge or by using barrier devices? Yes No N/A Excavations or trenches beneath the level of underground utilities, adjacent foundations, retaining walls or other structures are supported by additional bracing? Yes No N/A Ladders or other safe access are provided within 25’ of a work area in trenches 4’ or deeper? Yes No N/A Are barriers erected around excavations? All wells, pits, shafts and caissons are covered or barricaded, or if temporary, backfilled when work is completed? Yes No N/A Excavations / trenches 4’ or deeper which have the potential to contain a hazardous atmosphere have been tested with a 4 in 1 gas monitor? Yes No N/A Provide file drop / upload photograph of the general excavation / trench / boring activities.* Confined SpaceWill professionals be working in a confined space? Yes No N/A (A confined space must contain the following 3 elements: 1. large enough to bodily enter; 2. limited access and egress; and 3. not designed for continuous human occupancy)Has a confined space assessment been developed and readily available? Yes No N/A Professionals who are working in the confined space possess current and valid confined space awareness certifications? Yes No N/A Does the confined space assessment deem the space to be a non-permit space? Yes No N/A Does the confined space assessment deem the space to be a permit space? Yes No N/A Has a confined space permit been completed and readily available? Yes No N/A The space is being purged / ventilated with appropriate ventilation equipment? Yes No N/A Has the permit entry team been identified with roles & responsibilities established and is being executed? Yes No N/A Does the permit team possess current and valid permit required confined space training? Yes No N/A Is the atmosphere being monitored for safe entry where no hazardous atmosphere exists? Yes No N/A The gas monitor is a 4 in 1 gas monitor and it is within the calibration date? Yes No N/A A documented rescue plan is in place with the applicable rescue equipment on site and is readily available? Yes No N/A Does the confined space contain proper signage and the signage is posted at the entry point? Yes No N/A Are there safeguards in place to prevent unauthorized entry into the space? Yes No N/A Provide file drop / upload photograph of the general confined space.* Fire PreventionHas a hot work activity method of procedure been developed and readily available? Yes No N/A Has the hot work activity method of procedure been submitted and accepted? Yes No N/A Does the hot work activity method of procedure include a hot work permit? Yes No N/A Suitable fire extinguishers are provided and readily available? Yes No N/A All flammable / combustible materials have been removed in the work area? Yes No N/A Welding blankets are approved for their intended use and are being used? Yes No N/A Welders are wearing appropriate PPE, (non-flammable gloves, appropriate foot protection, leather aprons and shirts that have sleeves and collars, helmets, hoods and face shields suitable for head protection and suitable eye protection)? Yes No N/A Screens are in place to protect the eyes of non-welders from flash burns and ultraviolet light rays? Yes No N/A Are professionals gas welding? Yes No N/A Are the fuel gas and oxygen hoses distinguished from each other? Yes No N/A Are gas cylinders protected from all heat sources? Yes No N/A Acetylene and fuel gas cylinders are stored and used with valve ends up? Yes No N/A All gas cylinders in service are securely held in substantial fixed or portable racks, or placed so they will not fall or be knocked over? Yes No N/A Are professionals arc welding? Yes No N/A Are the cables being used in poor condition? Yes No N/A Is the arc welding frames or cutting machines grounded? Yes No N/A Is defective equipment being used? Yes No N/A Provide file drop / upload photograph of the general hot work activities.*Provide file drop / upload photograph of the fire prevention system being used.* Hoisting & RiggingAre applicable rigging plans developed and readily available (Class I, Class II, Class III or Class IV)? Yes No N/A Has the rigging plan been submitted and accepted? Yes No N/A Is a competent rigger on site who possesses a current and valid competent rigger certification? Yes No N/A A qualified signal person is on site and permitted to give signals? Yes No N/A The methods and equipment used for rigging are compliant with applicable standards, (ASME B30, ANSI/ASSE A10.48)? Yes No N/A The rigging equipment has been inspected, is deemed in good working order / condition and meets the latest revision of the ASME B30 standard? Yes No N/A The rigging equipment, (blocks, shackles, slings, rope and hoists) bears legible capacity specifications? Yes No N/A Control access zones / exclusion zones / drop zones are established and being maintained while overhead hoisting activities are taking place? Yes No N/A Are professionals using a capstan hoist? Yes No N/A Capstan hoist operators are qualified? Yes No N/A The capstan hoist is being used with the rope locking device? Yes No N/A The capstan hoist is configured per manufacturer specifications and has not been altered or modified? Yes No N/A The anchorage used for the capstan hoist is appropriate for the capacity of the hoist and the maximum expected load to be lifted? Yes No N/A Load control is being maintained (recommended synthetic rope wraps to ensure control of the load)? Yes No N/A The rope wraps are installed on the drum with the load side of the rope on the inside of the drum closest to the motor? Yes No N/A The pull side of the rope will be on the outside of the drum furthest away from the motor? Yes No N/A The excess rope is properly managed, so it doesn’t get tangled with other objects or the operator’s feet? Yes No N/A Provide file drop / upload photograph of the general rigging equipment set up.* CranesHas a lift plan been developed and readily available? Yes No N/A Has the lift plan been submitted and accepted? Yes No N/A Does the lift involve a suspended personnel platform? Yes No N/A This is a critical lift. Has a critical lift plan been developed and is it readily available? Yes No N/A Has the critical lift plan been submitted and accepted? Yes No N/A The suspended personnel platform checklist has been completed? Yes No N/A A pre-lift meeting has been conducted with all involved professionals? Yes No N/A A test and trial lift of the empty suspended personnel platform has been completed? Yes No N/A The suspended personnel platform has a capacity marking? Yes No N/A There is direct communication between the crane operator and the suspended personnel? Yes No N/A The crane operator remains at the controls while the personnel are suspended? Yes No N/A The methods and equipment used for fall protection are compliant with applicable regulations? Yes No N/A The fall protection equipment has been inspected, is deemed in good working order / condition and meets the latest revision of the ANSI/ASSE Z359 standard? Yes No N/A During lifting operations, will any part of the equipment, load line, or load (including rigging and lifting accessories) get closer than 20 feet to a power line up to 350 kV? Yes No N/A This is a critical lift. Has a critical lift plan been developed and is it readily available? Yes No N/A Has the critical lift plan been submitted and accepted? Yes No N/A Have all precautionary and control measures been implemented on site during lifting operations within 20 feet of power lines? Yes No N/A Does the crane operator possess a current and valid certification of competency / license for the specific type of crane that they are operating? Yes No N/A A complete range of the manufacturer’s equipment rated capacities are readily available? Yes No N/A Is the equipment being operated within its rated capacity? Yes No N/A Block and ball not damaged, free to rotate? Yes No N/A Hook and ball assemblies and load blocks are marked with their rated capacity and weight? Yes No N/A Hooks are equipped with latches? Yes No N/A Rigging equipment inspected before use, legible tags, and no signs of damage? Yes No N/A Hooks and latches are free from deformation, cracks, excessive wear or damage from chemicals or heat? Yes No N/A The rigging equipment is not loaded in excess of its recommended safe working load? Yes No N/A An accessible fire extinguisher is on the equipment and up to date? Yes No N/A The operator cab windows are free from significant cracks, breaks, or other deficiencies that would hamper the operator’s view? Yes No N/A Ground conditions are firm, drained, and graded to a sufficient extent so that, in conjunction (if necessary) with the use of supporting materials, the equipment manufacturer’s specifications for adequate support and degree of level of the equipment are met? Yes No N/A Is there a control line, warning line, railing or similar barrier to mark the swing radius hazards? Yes No N/A Only professionals essential to the operation are permitted in the fall zone/ working under the load? Yes No N/A Qualified signal persons are provided and giving signals to the operator? Yes No N/A The outriggers or stabilizers are fully extended or, if manufacturer procedures permit, deployed as specified in the load chart? Yes No N/A Outrigger float(s) secured with pad pin and proper ground support in place? Yes No N/A Is the rigging work being done by a qualified rigger? Yes No N/A The crane has a valid annual certification of inspection and is readily available? Yes No N/A The crane has a valid quadrennial certification of inspection and is readily available? Yes No N/A Provide at least 3 overall photos of the crane.* Mobile Elevating Working PlatformsWill professionals transfer out of the mobile elevating working platform? Yes No N/A Has a method of procedure been developed and readily available? Yes No N/A Has the method of procedure been submitted and accepted? Yes No N/A A documented rescue plan is in place and readily available? Yes No N/A Will professionals be operating the mobile elevating working platform in close proximity, (10 feet or less) to energized electrical lines? Yes No N/A Has the voltage of the power line been identified by the utility owner/operator? Yes No N/A Has a method of procedure been developed and readily available? Yes No N/A Has the method of procedure been submitted and accepted? Yes No N/A Professionals operating the mobile elevating working platform possess valid and current certifications for the equipment being operated? Yes No N/A A pre-use inspection of the mobile elevating working platform and worksite has been conducted? Yes No N/A Are professionals standing firmly on the floor of the basket? Yes No N/A Planks, ladders or other means are not allowed for professionals to gain greater heights? Yes No N/A Professionals who are working from the mobile elevating working platform are using a fall protection system and attached to the manufacturer’s recommended anchor point? Yes No N/A The mobile elevating working platform is being operated within the manufacturer’s recommended safety envelope / rated capacity? Yes No N/A Is there a control line, warning line, or similar barrier to mark the swing radius hazards of the mobile elevating working platform? Yes No N/A The mobile elevating working platform is being operated under wind speeds of 29 MPH? Yes No N/A The mobile elevating working platform is being operated within the manufacturer’s intended design and use? Yes No N/A Provide file drop / upload photograph of the general mobile elevating working platform set up.*Provide file drop / upload photograph of the general working activities from the mobile elevating working platform.* Ladder UsageHave ladders been inspected for visible defects? Yes No N/A Ladders with defects such as broken or missing steps, rungs, cleats, safety feet, side rails or other defects are not being used and have been taken out of service? Yes No N/A Are ladders maintained in good condition with legible labels? Yes No N/A Portable ladders are not being overloaded when used? Yes No N/A The base of the ladder is placed on a secure level footing and erected at a 4:1 ratio? Yes No N/A Ladders are not being used on slippery surfaces? Yes No N/A The ladder is placed as to prevent slipping, or it is tied, blocked, held or otherwise secured to prevent slipping? Yes No N/A The ladder side rails are extended to at least 3’ above the landing unless handholds are provided? Yes No N/A Extension ladders are erected so that the top section is above and resting on the bottom section with the rung locks engaged? Yes No N/A Ladders are not placed in passageways, doorways, driveways or any location where they may be displaced unless protected by barricades or guards? Yes No N/A The professional climbs and works with the body near the middle of the step or rung and does not overreach from this position? Yes No N/A To avoid overreaching, the professional descends and re-positions the ladder? Yes No N/A Professionals do not carry equipment or materials, which prevent the safe use of ladders? Yes No N/A Professionals face the ladder when climbing or descending and maintain 3 points of contact with the ladder? Yes No N/A Professionals do not stand and work on the top 3 rungs of a single or extension ladder? Yes No N/A Professionals do not sit, kneel, step, or stand on the pail shelf, top cap or the step below the top cap of a step ladder? Yes No N/A The ladder is suitable for the task (i.e., extension ladder vs. step ladder)? Yes No N/A Ladders are not tied together to create longer sections unless they are designed for such use? Yes No N/A Metal ladders are not being used? Yes No N/A Multi-purpose ladders are not being used? Yes No N/A Provide file drop / upload photograph of the general ladder usage of professionals.* Electrical WorkAre energized electrical circuits in an electrically safe working condition? Yes No N/A Is LOTO in place? Yes No N/A Is the LOTO procedure executed appropriately? Yes No N/A Only qualified electrical workers are working on electrical equipment or systems of 50 volts or greater? Yes No N/A Appropriate arc flash protection level PPE is being used? Yes No N/A Insulated tools are being used? Yes No N/A Covers or barriers are installed on boxes, fittings and enclosures to prevent accidental contact with live parts? Yes No N/A If flexible cords are being used in place of permanent wiring methods for temporary work, the cords are equipped with an attachment plug and energized from an approved receptacle? Yes No N/A Flexible cords are of a Type S? Yes No N/A Flexible cords have a ground? Yes No N/A Flexible cords are routed to prevent tripping hazards? Yes No N/A Flexible cords are in good condition and free of damage? Yes No N/A Flexible cords are not placed through doorways, holes in walls, direct contact with steel, or fastened by nails? Yes No N/A Does each receptacle have a grounding contact that is connected to an equipment grounding conductor? Yes No N/A A GFCI is being used on site? Yes No N/A If GFCI’s are not being used, is an assured equipment grounding conductor program in place? Yes No N/A RF / EMEAn RF / EME assessment has been developed and is readily available? Yes No N/A Known RF /EME hazards and exposures have been identified and communicated to all affected professionals? Yes No N/A Appropriate control measures are in place and being executed, (transmitters powered down to acceptable levels, warning line systems, maintaining safe distances from transmitters)? Yes No N/A All professionals possess current and valid RF / EME safety awareness certifications? Yes No N/A Appropriate signage is posted warning professionals of known RF / EME hazards? Yes No N/A RF monitors are on site, functioning appropriately, turned on and within the calibration period? Yes No N/A Hand and Power ToolsAre tool lanyards being used when applicable? Yes No N/A Are corded tools properly grounded? Yes No N/A Are corded tools double insulated? Yes No N/A Are hand and power tools maintained in proper working order? Yes No N/A Are power tool handles and guards being utilized when necessary ? Yes No N/A Are GFCI (Ground Fault Circuit Interrupters) being utilized? Yes No N/A Are extension and other electrical cords in serviceable condition? Yes No N/A Hazard CommunicationDo professionals on site possess current and valid “Hazard Communication” training certifications? Yes No N/A SDS’s are readily available for all applicable hazardous substances to which professionals are exposed? Yes No N/A Labels and other forms of warning are legible and on containers of hazardous chemicals? Yes No N/A Have all known hazardous substances been identified prior to the commencement of working activities? Yes No N/A Have all known hazardous substances been abated from the working environment, (lead/asbestos/bird feces)? Yes No N/A Heat Illness PreventionDo professionals on site possess current and valid “Heat Illness Prevention” training certifications? Yes No N/A Is there a written heat illness prevention program readily available? Yes No N/A Is there sufficient amounts of fresh, pure, and suitably cool potable water for all professionals on site? Yes No N/A During hot weather, (temperature > 95 degrees F) is the potable water cooler than the ambient temperature? Yes No N/A Is shade provided to professionals during breaks and preventative cool down rest periods? Yes No N/A Is there an effective emergency response plan in place for the jobsite? Yes No N/A Heavy Construction EquipmentProfessionals who operate heavy equipment are qualified? Yes No N/A Vehicles and systems have been checked for proper operation at the start of each shift? Yes No N/A Rollover protection and seat belts are installed? Yes No N/A Vehicles are equipped with an automatic backup alarm that sounds immediately on backing? Yes No N/A Vehicles are equipped with a manually operated warning device? Yes No N/A Loads on vehicles are secured from displacement? Yes No N/A Professionals who are working around heavy equipment and heavy equipment operations are wearing high visibility apparel manufactured to the ANSI/ISEA standards? Yes No N/A Provide file drop / upload photograph of the general heavy equipment usage by professionals.* Traffic ControlWorksite traffic controls and placement of warning signs conform to the traffic control plan identified with the encroachment permit? Yes No N/A The traffic control plan is on site and readily available? Yes No N/A Wherever mobile equipment operation encroaches on the public right of way, a system of traffic control is being used? Yes No N/A When barricades and warning signs cannot control moving traffic, flaggers are being utilized? Yes No N/A Professionals (on foot), exposed to vehicular traffic are wearing high visibility safety apparel manufactured to the ANSI/ISEA standards? Yes No N/A Provide file drop / upload photograph of the general traffic control activities on site.* Drop files here or Select files Accepted file types: jpg, png, gif, pdf, heic, jpeg, Max. file size: 50 MB. Concrete ConstructionAre professionals wearing the appropriate protective clothing and gloves to prevent burns, rashes, and skin irritations from exposure to cement dust or wet concrete? Yes No N/A Are professionals protected from inhaling concrete dust during operations such as concrete cutting, drilling, grinding, or sandblasting? Yes No N/A Are professionals protected from impalement by rebar or other objects? Yes No N/A Concrete pumping equipment and placing booms are set-up and operating according to manufacturer’s guidelines? Yes No N/A Equipment has been inspected by a qualified operator prior to daily use and is documented? Yes No N/A Masonry walls more than 8’ high are braced to prevent overturning or collapse or are adequately supported through its design or construction method? Yes No N/A Has a limited access zone (LAZ) been established for masonry walls? Yes No N/A The LAZ has been established on the unscaffolded side? Yes No N/A The width of the LAZ is equal to the height of the wall to be constructed plus 4’ and runs the entire length of the wall? Yes No N/A Only authorized professionals are able to enter the LAZ? Yes No N/A Provide file drop / upload photograph of the general concrete construction activities on site.* Assessment ReviewProvide 5 overall site photos.*Detail mitigation measures for any deficiencies found on site*CommentsConsent I agree that all answers provided are accurate as of the posting of this survey.HiddenIP Address HiddenDate MM slash DD slash YYYY Δ
