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Field: Erection/Finishing/Sealant
Field: Erection/Finishing/Sealant
Date
Total Score
Total Percent Score
Location
Albany
Grand Forks
Rosemount
Wells
Wells (Field)
Denver
Section 1: Safety Administration & Leadership
N/A Number Section 1
Score
Percent Score
Safety Meetings
Weekly Toolbox Talk held
*
Pass
Fail
Not Applicable
N/A
N/A
Monthly mass safety meeting
*
Pass
Fail
Not Applicable
N/A
na
Morning RAP sessions held at board
*
Pass
Fail
Not Applicable
N/A
na
Accident Prevention
Pre-planning for tools/equipment
*
Pass
Fail
Not Applicable
N/A
na
Auditing of tools & equipment
*
Pass
Fail
Not Applicable
N/A
na
CAP items addressed in 5 days
*
Pass
Fail
Not Applicable
N/A
na
Incident Management
Incidents reported
*
Pass
Fail
Not Applicable
N/A
na
Investigated & reviewed with employees
*
Pass
Fail
Not Applicable
N/A
na
Corrective action taken
*
Pass
Fail
Not Applicable
N/A
na
Training
New hires received orientation & mentoring
*
Pass
Fail
Not Applicable
N/A
na
Employees are trained in area orientation & safety plan
*
Pass
Fail
Not Applicable
N/A
na
Policy Enforcement
All safety rules, safe working procedures, and written programs are enforced
*
Pass
Fail
Not Applicable
N/A
na
Comments
N/A Number Section 2
Section 2: Main OSHA & RMP Programs
Score
Percent Score
Cranes
Lift plan available
*
Pass
Fail
Not Applicable
N/A
na
Lift plan
*
Pass
Fail
Not Applicable
N/A
na
Operator CCO certified
*
Pass
Fail
Not Applicable
N/A
na
Inspections performed
*
Pass
Fail
Not Applicable
N/A
na
Hand signals posted
*
Pass
Fail
Not Applicable
N/A
na
Power lines evaluated/addressed
*
Pass
Fail
Not Applicable
N/A
na
Qualified signalman utilized
*
Pass
Fail
Not Applicable
N/A
na
Crane pad is suitable
*
Pass
Fail
Not Applicable
N/A
na
Rigging
Annual Inspection
*
Pass
Fail
Not Applicable
N/A
na
Rigging capacity tags
*
Pass
Fail
Not Applicable
N/A
na
Qualified riggers utilized
*
Pass
Fail
Not Applicable
N/A
na
Pick points in good condition
*
Pass
Fail
Not Applicable
N/A
na
Hazard Communication
Haz-com program available
*
Pass
Fail
Not Applicable
N/A
na
Chemical inventory complete
*
Pass
Fail
Not Applicable
N/A
na
Training for hazardous chemical in place
*
Pass
Fail
Not Applicable
N/A
na
PPE
PPE hazard assessment performed
*
Pass
Fail
Not Applicable
N/A
na
PPE is effective
*
Pass
Fail
Not Applicable
N/A
na
PPE is available
*
Pass
Fail
Not Applicable
N/A
na
Employees trained on PPE
*
Pass
Fail
Not Applicable
N/A
na
Work Plans and JHA's
Appropriate plans in place
*
Pass
Fail
Not Applicable
N/A
na
Plans are effective
*
Pass
Fail
Not Applicable
N/A
na
Employee's trained on the plans
*
Pass
Fail
Not Applicable
N/A
na
Fall Protection
Site plan available
*
Pass
Fail
Not Applicable
N/A
na
Site plan effective
*
Pass
Fail
Not Applicable
N/A
na
Annual equipment inspections performed
*
Pass
Fail
Not Applicable
N/A
na
Employee's trained
*
Pass
Fail
Not Applicable
N/A
na
Stability/Bracing Plan
Plan created
*
Pass
Fail
Not Applicable
N/A
na
Plan effective
*
Pass
Fail
Not Applicable
N/A
na
Requirements communicated to crew
*
Pass
Fail
Not Applicable
N/A
na
Welding/grouting on pace
*
Pass
Fail
Not Applicable
N/A
na
Comments
Section 3: Tools, Material Handling, & Specific Equipment
Score
Percent Score
N/A Number Section 3
Hand Tools
Inspected before use
*
Pass
Fail
Not Applicable
N/A
na
In safe condition
*
Pass
Fail
Not Applicable
N/A
na
No structural repairs
*
Pass
Fail
Not Applicable
N/A
na
No homemade tools
*
Pass
Fail
Not Applicable
N/A
na
Right for the job
*
Pass
Fail
Not Applicable
N/A
na
Electric Tools
Inspected before use
*
Pass
Fail
Not Applicable
N/A
na
In safe condition
*
Pass
Fail
Not Applicable
N/A
na
Guards in place
*
Pass
Fail
Not Applicable
N/A
na
Extension cords
*
Pass
Fail
Not Applicable
N/A
na
Employees trained
*
Pass
Fail
Not Applicable
N/A
na
Welding/Cutting
Inspected before use
*
Pass
Fail
Not Applicable
N/A
na
In safe condition
*
Pass
Fail
Not Applicable
N/A
na
Combustible material removed
*
Pass
Fail
Not Applicable
N/A
na
Flashback arresters installed
*
Pass
Fail
Not Applicable
N/A
na
Power Washers
Inspected before use
*
Pass
Fail
Not Applicable
N/A
na
In safe condition
*
Pass
Fail
Not Applicable
N/A
na
Machine guards in place
*
Pass
Fail
Not Applicable
N/A
na
Employee's trained
*
Pass
Fail
Not Applicable
N/A
na
Grout Mixers
Inspected before use
*
Pass
Fail
Not Applicable
N/A
na
In safe condition
*
Pass
Fail
Not Applicable
N/A
na
Machine guards in place
*
Pass
Fail
Not Applicable
N/A
na
Employee's trained
*
Pass
Fail
Not Applicable
N/A
na
Suspended Scaffolds
Inspected before use
*
Pass
Fail
Not Applicable
N/A
na
In safe condition
*
Pass
Fail
Not Applicable
N/A
na
Installed properly
*
Pass
Fail
Not Applicable
N/A
na
4 wraps on drum
*
Pass
Fail
Not Applicable
N/A
na
Employee's trained
*
Pass
Fail
Not Applicable
N/A
na
Independent lifeline
*
Pass
Fail
Not Applicable
N/A
na
Power supply correct, restrained, & protected
*
Pass
Fail
Not Applicable
N/A
na
Cable reaches lowest landing
*
Pass
Fail
Not Applicable
N/A
na
Ladder Safety
Inspected before use
*
Pass
Fail
Not Applicable
N/A
na
In safe condition
*
Pass
Fail
Not Applicable
N/A
na
Provided type is adequate
*
Pass
Fail
Not Applicable
N/A
na
Employee's trained
*
Pass
Fail
Not Applicable
N/A
na
Aerial Lifts
Inspected before use
*
Pass
Fail
Not Applicable
N/A
na
In safe condition
*
Pass
Fail
Not Applicable
N/A
na
Retractables
*
Pass
Fail
Not Applicable
N/A
na
Level conditions
*
Pass
Fail
Not Applicable
N/A
na
Employee's trained
*
Pass
Fail
Not Applicable
N/A
na
Comments
Section 4 People and Behaviors
Section 4 N/A
Score
Percentage Score
Fall Procedures
Plan followed
*
Pass
Fail
Not Applicable
N/A
na
CAZ set up correctly
*
Pass
Fail
Not Applicable
N/A
na
Fall protection used unloading product
*
Pass
Fail
Not Applicable
N/A
na
Daily inspection
*
Pass
Fail
Not Applicable
N/A
na
6' tie-off followed/anytime outside the CAZ
*
Pass
Fail
Not Applicable
N/A
na
Floor/wall openings protected
*
Pass
Fail
Not Applicable
N/A
na
Equipment used properly
*
Pass
Fail
Not Applicable
N/A
na
Rigging
Daily inspection
*
Pass
Fail
Not Applicable
N/A
na
Safety latches in place
*
Pass
Fail
Not Applicable
N/A
na
No defective rigging used
*
Pass
Fail
Not Applicable
N/A
na
Configuration good
*
Pass
Fail
Not Applicable
N/A
na
Rigging clear
*
Pass
Fail
Not Applicable
N/A
na
Haz-com Procedures
Proper containers being used
*
Pass
Fail
Not Applicable
N/A
na
Containers properly labeled
*
Pass
Fail
Not Applicable
N/A
na
Chemicals stored properly
*
Pass
Fail
Not Applicable
N/A
na
PPE Procedures
Employees wearing appropriate PPE
*
Pass
Fail
Not Applicable
N/A
na
Head
*
Pass
Fail
Not Applicable
N/A
na
Eyes/Face
*
Pass
Fail
Not Applicable
N/A
na
Ears
*
Pass
Fail
Not Applicable
N/A
na
Lungs
*
Pass
Fail
Not Applicable
N/A
na
Hands/Arms
*
Pass
Fail
Not Applicable
N/A
na
Body
*
Pass
Fail
Not Applicable
N/A
na
Feet
*
Pass
Fail
Not Applicable
N/A
na
Stability/Bracing Plan
Plan followed
*
Pass
Fail
Not Applicable
N/A
na
Correct type/# of shores used
*
Pass
Fail
Not Applicable
N/A
na
Proper shims/bearing pads used
*
Pass
Fail
Not Applicable
N/A
na
Removal procedures
*
Pass
Fail
Not Applicable
N/A
na
Crane Procedures
Lift plan followed
*
Pass
Fail
Not Applicable
N/A
na
Radio test
*
Pass
Fail
Not Applicable
N/A
na
Load weights checked
*
Pass
Fail
Not Applicable
N/A
na
Swing radius flagged
*
Pass
Fail
Not Applicable
N/A
na
Daily inspection verified
*
Pass
Fail
Not Applicable
N/A
na
Work Plans/JHA's
Plans are followed
*
Pass
Fail
Not Applicable
N/A
na
Tools, Material Handling & Specific Equipment
Right tool used for the job
*
Pass
Fail
Not Applicable
N/A
na
Gas cylinders stored properly
*
Pass
Fail
Not Applicable
N/A
na
Fire watch performed after hot work
*
Pass
Fail
Not Applicable
N/A
na
Control zones established for washing
*
Pass
Fail
Not Applicable
N/A
na
Grout material contained/stored properly
*
Pass
Fail
Not Applicable
N/A
na
Ladder position
*
Pass
Fail
Not Applicable
N/A
na
Ladder secured
*
Pass
Fail
Not Applicable
N/A
na
Tied off over 6' on ladder
*
Pass
Fail
Not Applicable
N/A
na
Aerial access policy followed
*
Pass
Fail
Not Applicable
N/A
na
Red tag policy followed
*
Pass
Fail
Not Applicable
N/A
na
Employee Actions
Striking Against
*
Pass
Fail
Not Applicable
N/A
na
Struck by Objects
*
Pass
Fail
Not Applicable
N/A
na
Caught On/In/Between
*
Pass
Fail
Not Applicable
N/A
na
Falling
*
Pass
Fail
Not Applicable
N/A
na
Contact Temp. Extreme
*
Pass
Fail
Not Applicable
N/A
na
Contacting Electrical Current
*
Pass
Fail
Not Applicable
N/A
na
Inhaling
*
Pass
Fail
Not Applicable
N/A
na
Absorbing
*
Pass
Fail
Not Applicable
N/A
na
Overexertion
*
Pass
Fail
Not Applicable
N/A
na
Awkward Body Positions
*
Pass
Fail
Not Applicable
N/A
na
Comments
Section 5: Environment
Score
Score Percentage
N/A Number
Housekeeping
Housekeeping expectations set, known, and followed
*
Pass
Fail
Not Applicable
N/A
na
No trip/slip hazards
*
Pass
Fail
Not Applicable
N/A
na
Spill kits available
*
Pass
Fail
Not Applicable
N/A
na
Air Quality
Vacuums assisted tools used
*
Pass
Fail
Not Applicable
N/A
na
CAZ used when needed
*
Pass
Fail
Not Applicable
N/A
na
Respirator program followed
*
Pass
Fail
Not Applicable
N/A
na
Job Site Conditions
Trucking access
*
Pass
Fail
Not Applicable
N/A
na
Weather - wind, lighting issues, ice
*
Pass
Fail
Not Applicable
N/A
na
Trades at safe distance/area (overhead loads)
*
Pass
Fail
Not Applicable
N/A
na
Emergency Action
Fire extinguishers
*
Pass
Fail
Not Applicable
N/A
na
Emergency action plan
*
Pass
Fail
Not Applicable
N/A
na
Emergency facility identified/communicated
*
Pass
Fail
Not Applicable
N/A
na
First aid kit
*
Pass
Fail
Not Applicable
N/A
na
Material Storage
Securely stacked in defined area
*
Pass
Fail
Not Applicable
N/A
na
Ergonomic access to materials
*
Pass
Fail
Not Applicable
N/A
na
Safe lifting practices observed
*
Pass
Fail
Not Applicable
N/A
na
Comments
Section 6: Miscellaneous Items, Observations, & Conditions
Comments
