Unsafe SeverityLowMediumHighLife Threat

Category Sub-CategoryAdministration Average

Accountability Plan UtilizedAddress Displayed On PerimeterAdequate 1st Aid KitsAdequate Eyewash StationsAnnual Program EvaluationCompetent Persons ListCoord With Local FDCompetent person ID'ed/presentDART/TRC/DBO2 Goals MetDaily Stretch & FlexEmerg Mgmt MeetingEmerg Mgmt PlanNew Empl Orientations heldCompetent person ID'ed/presentDocument pre-const mtgsDrug Testing programIncentive/Recognition ProgramSafety manualSTA submitted each tradeSub Toolbox MeetingsMSDS manualOSHA 10hr card OSHA 10/30 hour cardJHA submitted each tradeEmerg Numbers PostedWkly JHA/PTP submittedEmerg Plan Sent To Ops CenterEmployee InvolvementFile System Estab/MaintEmergency Muster Point PostedFirst-Aid/CPR On SiteHigh-Hazard Planning MeetingIncident Investigation ProgramKnox-Box On SiteMap To Medical FacilityMoisture Control PlanVisitor sign-in form/waiverVisitor hard hat availableVerification of Training

Updated Precon ChecklistSupt Daily Inspection CompletedSubcontractor Safety MeetingsState/Fed (Eng/Sp)/WC postersSite Spec Safety Manual AcceptSite Orientations ConductedFreq/reg safety inspectionsForeman/PM Safety MeetingsOSHA 300 Log Posted as ReqdToolBox talks Submitted WeeklyDaily Safety Inspections DocumentedMonthly Mass Safety MeetingMonthly Mgmt Safety MeetingMonthly Reporting Up-To-DateMSDS Manual CurrentOrientation Program documentedPost-Incident Review HeldPre-Con Safety MeetingProject Safety BoardProject-Specific HASP ReviewedPTP's Reviewed/ApprovedReturn to Work ProgramSafety Inspections CompletedSafety Recognition ProgramSafety Related CommunicationTool Box Talks DocumentedVisitor PPE availableIFE Banners PostedOSHA Posters / OSHA 300 LogSafety meetings

i SHEMS on projectSHMP on ProjectState / Fed posters (Eng/Sp)Visitor sign-in formWorkers OrientatedVisitor Release Form

Program Management Visitor PPE AvailableVisitor Sign-In Log MaintainedWeekly Safety Meeting Held

Bookcases, Shelves, Cabinets Bookcases and shelves not overloadeBookcases and cabinets secured againHeavy storage shelves secured to walFile drawers closed when not in use

PreCon/Proj Start-up Site Spec Safety Manual AcceptWeekly JHA submittedUpdated Precon ChecklistMSDS ManualOSHA 10Hr Employee on Site

Emergency ContactEnrolled in Wrap-Up(Y,N,NA)Competent PersonsContract SignedCertificate of Ins in place

Medical / Emergency Eye wash 1st aid kitEmergency action planCPR/First Aid Trained EmployeesEmergency Numbers PostedEyewash (ANSI Approved) ProvidedEmergency procs suppliesEmergency numbers postedEye washMap to medical facilityPerson with 1st Aid/CPR on siteCoordination w/EMSEmrg Action Plan posted/commOccupational Clinic estabExit SignsLight Duty Program in placeEmergency Action Plan practiced, do

i Physician Panel for projectTeam contact numbersEmergency Action Plan practiced, do1st aid kitEmergency action planEye wash Emergency numbers postedMap to medical facility1st Aid/CPR on siteTeam contact numbersPerson with 1st Aid/CPR on site

Healthcare bio hazard removalCeiling tiles replaceddust free beyond workhazardous material inspectionexits unobstructedhot work notificationI.C.R.A. Implementedno transporting dustSmoke partition compliantPre task planceiling permitinspection of adjacent areas

Tack mats cleanuninterrupted fire systemsnegative air confirmationNew Employee orientationno flammables in buildingFire stopping installed

Medical & First Aid CPR/First Aid Trained EmployeesFirst Aid Kits ProvidedEmergency Numbers PostedEyewash (ANSI Approved) Provided

Heat Illness Prevention Access to shadeAccess to waterEmployee and Supervisory trainingWritten procedures including emerge

Material Handling/Storage/Disposal Accessways Kept ClearNo Suspended Overhead LoadsControl Loads/Tag Lines

Planning Adequate ResourcesAdequate Steps ListedCompleted and on FileSub Imp Plan (PEP)

i Controls IdentifiedCrew ParticipationActive pre-task planningWeekly toolbox meetingsDaily Pre Task CompletedHazards IdentifiedPosted in work areaPre Task MeetingsProper Methods UsedReviewed & AuditedScheduled ActivityRisk Communication

Asbestos AverageArea Air Monitoring ConductedContractor License ValidCritical Barriers EstablishedDaily Log PostedDanger Signs PostedDecon EstablishedDumpster SecuredEmergency Response PlanFire Extinguisher PresentFire-Retardent Poly UsedHarvard Disposal FacilityHEPA Machine Cert. AvailableMADEP Notification Posted

Manometer PresentMSDS Manual AvailablePersonal Air Samples PostedWork Plan SubmittedWorker Licenses Posted

Concrete & Masonry Adequate bracingConcrete pump operationsForm work drawings onsiteLimited access zoneRebar capsRotating parts guardedWashout pits/boxes

Caught between Access w/ in 25' & @ 4' deepCompetent person presentDaily inspect by competent persHigh Visibility Vest WornUnderground Utility IDPerimeter prot/barricadeSloped, benched, or shoredWater entering excavationSpoil 2' from edgeExcav > 20' engineeredSurface encumbrances removed

Struck by/Pinch Point Hazards Are ground personnel easily visible tCan equipment and machinery be shutEmployees in work zone protected frProper methods for material handlingProtection from moving machinery aWork zone job hazard analysis and tra

Confined Space AverageAdequate Ventilation ProvidedRescue Plan/Emerg #'s PostedAtmospheric conditionsComm / secure area / signageEntry super/monitor/entrantHarness / extraction equipElectrical / fire preventionRescue plan/emerg #'s/mapRegular insp / air monitorHarness / extraction equipPermit completed/postedRespiratory equipmentSfty person/rescue equip/PPETraining documentationVentilationAtmospheric Conditions Tested

Communications/Area SecureEntry Supervisor/Monitor PresentReg. Testing of Atmos ConditionsRescue Equip Readily AvailableResp Equip UsedSafety Person/Rescue Equip AvailSigned Permit Present at SpaceTraining Documentation ProvidedPre-Task Plan CompletedCompetent person presentConfined Space InventoryPermit Posted/CompletedProper PPE In UsePre-Entry Monitoring ConductedMonitor Calibrated/In UseRescue Plan/EquipmentLO/TO Required/CompletedEntry Team Trained

Control Of Hazardous Energy AveragePre-Task Plan CompletedCompetent Person PresentEmployees TrainedLocks Keyed DifferentlyTags Used/CompletedEnergized Work ProcedureShutdown/Disruption PermitZero Energy Confirmed

Demolition AveragePre-Task Plan CompletedCompetent Person PresentEngineering Survey/Demo PlanHazardous Materials SurveyPre-Demo Checklist/WalkthruUtilities Clearly ID'd/ProtectedDebris Removal Each DayDrop zone area(thru floors..)barricadFire Protection AddressedSystems Drained/Locked OutAccess Controlled/RestrictedDust ControlFall Protection In UseHousekeeping/Access MaintainedFlamm/Comb Materials Removed

Electrical AverageBlanks and plugs installedCircuits labeledCircuits labeledElect Hot Work ProceduresCords in good conditionEquipment firmly mounted

Ext eqp in weatherproof enclElec Rooms/Panels SecuredGenerators groundedLO/TO proceduresNFPA 70 E for Energized workProper use temp pwr bxsQuarterly cord insp currentEnergized Work ProcedureTemp lghts installed/guardedCords elevated above the wrk surf whProper use temp power boxesGFCI's usedExt. cords, elec equip, tools damage fGFCI tested before useGFCI receptacles present, functioningEmerg Lighting Below GradePower Feed Locations ID'dProper Temporary LightingSignage PresentTemporary Lighting (Sufficient)Temporary Lighting PresentTemporary Electric SupportedCord Strain Relief FunctioningCords protected from damageElectrical Room RestrictedEquipment properly groundedGFCI's inspectedGFCI's used/suppliedLights & cages @ proper heightPanels labeled properlyCords protected from trafficElectrical room protectedEnergized parts protectedLock Out/Tag OutConductive surfaces/GroundingOverhead/Underground cable protectGFCI Protection UsedTemporary Power Strain ReliefKnock-outs Covered/Protected

Electrical Safety, Chairs, Chemical Products, Step Stools, Ladde Are all light fixtures adequate and fu

Chairs in good mechanical condition (

Chemical products properly used, sto

Electrical cords and plugs in good con

Is the Breaker Panel accessible with L

Coffee Machines Secured and not clos

Is Clear Access (36?) provided to Elect

Paper shredder guarded

Equipment properly grounded (3 pron

Kitchen Area Clean

Safe step stools and ladders properl

Coffee Machines Secured and not clos

Electrical outlets not overloaded

Extension cords not substituted for

Paper cutter equipped with guard/ bl

Unobstructed air movement and ventEnvironmental Average

Concrete cut wet & vacuumedAdequate ventilationDust control measuresDiesel Exhaust/IdlingFenceline Dust MonitoringErosion ctrl measures maint/adeqNoise control measuresSpill containment adequateRegular air sampling SWPPPlan followedSWPPPlan on fileContainers labeledHaz material properly storedMoisture Control Plan in PlacePolicy posters posted on siteHAZWOPER TrainingDEP/EPA ComplianceNoise MonitoringNuisance dustFueling Procedures FollowedOdors/VaporsPest ControlNuisance dust controlledSatelite Accumulation AreaSilica Control Plan in PlaceSoil Mgmt./LSP on SiteSPCC Program in PlaceClean Air LetterSpill Kit Available

SWPPP in PlaceAsbestos/lead/mold/silicaHazardous Mat'l Rpt ReceivedWater Mgmt-Follow-up Track FormWater Mgmt-Incident Rpt FormWater Mgmt-Matls Insp ChecklistHealth Hazard CtrlDewatering Pollution PlanStorm Water

Kitchen Area Kitchen Area CleanCoffee Machines Secured and not closFire Extinguisher in Kitchen Area

Scissor / Aerial Lifts AveragePre-Task Plan CompletedCompetent Person PresentPre-Entry Inspection CompletedDaily Inspections DocumentedFall Protection In UseEquipment loaded properlyGate Or Chain SecuredSurface Free Of Holes/FlatOperators TrainedOperator trainingHarness while in liftsInspections Annual/Preshift doc'sOperator certificate/licenseSafe work dist from pwr linesHarness while in aerial liftsOperating on flat surfaceEquip used in proper mannerArea Below ProtectedOperator trained docProper operating procedure usedRated lift capacity observedSafe work distancesNothing to increase heightSurface free of holes

Forklift Operator IdentificationMax load posted on equipEquipment inspected dailyOperator trained

Rigging Chain/Wire Ropes/Synthetic Slings-IDDefective Rigging RemovedAlloyed Chain UseRigging Properly Stored/MaintainedPositive Latching Device PresentRigging Inspected By Comp. Person

Cranes And Hoisting Equipment Average20 ft from powerline/deenergized3rd party Annual Inspection currentAssembly/Disassembly director appoiCrane LevelMult Lift Rigging ProcedureCrane supported/Blocked per ground Crew trained in hazardsDaily/Mnthly/Annual Rigging inspectioElev/Hoist capacity postedFall zone restricted/barricadedFire extinguisher in craneGilbane Crane lift plan on fileMfr Assembly/Disassembly procedureOperational aids workingOperator Certif. on fileLoad chart postedMfr procedures/Manual in craneOutriggers extended per mfr reqtsWeight of load verifiedAnti-Two Block DevicePersonal Fall protection usedPersonnel basket testedPre/Post assembly inspection conducPreshift/Mthly Equip inspections on fiQualified riggers assignedQualified signal persons assignedRigging inspected/rated10' Or More From Overhead LinesCrane Leveled On Firm SurfaceProper Sized CribbingNo Overhead LoadsSafety devices workingUnderground hazards identified/comMass. Hoisting LicenseAnnual inspection currentAnti Two Block deviceBellman certifiedBellman identifiedBoom angle indicatorCrane supported and levelDaily Crane Lift PlanDaily inspections currentSwing radius barricadedTag lines usedCrit Pick Pln for two-crane

Monthly inspection currentRigger qualifiedSafety latches usedOperator appears competentOperator manual in craneOperator training records on file.3Pty Annual Inspection CurrentRig insp/rated/ratedAnti Two Block InstalledBoom angle indicatorCert or verify trainingCrane supported and levelDaily inspections currentFire Ext in Cab of CraneLift plan on fileLoad chart postedLoad indicator on craneLoads properly securedMeans of communicationOperator appears competentPath of Overhead Loads Verif'dPwr Line Clearance AppropRig insp/ratedCrit Pick Pln for loads >75%Safety latches operable

General Rigging/Hoisting Come-Alongs inspected /ratedChain Falls inspected /ratedAnchorage / Structure will support loCapacity tags attached/legibleRatchet/Hydraulic Jacks inspected /rRiggers trained/certifiedRollers inspected /ratedSafety latches functioningWinches/Tuggers inspected and propSignalperson trained/certifiedRigging inspected/ratedProper use of riggingProper rigging planDesignated rigging/Lifting pointsWinches/Tuggers inspected and prop

Pressurized Equip & Systems 6 Month Inspect. by Qual. PersonConfined Space free of Gas Cylinders

Cranes & Hoisting Equipment Swing Radius ProtectedTag lines usedWeight of load verifiedSignal person ID'd & on-siteOperator manual in crane

Outrig extend/cribbingMeans of communication

Personnel/Material Hoists All tie-ins secureBase enclosure per standardsCar doors functioning properlyDaily equip inspections compltDrop test verifiedInspection per regional req'tsLanding gates in place all levlsOperator trained/documentedOverhead protection in placeProper signage cars & landings

Work Platforms Access Ladder or Equiv ProvidedBase Plates/Mudsills UsedPlanking Overlapped 12"/SecuredWork PlatformsPlanks Extend > 6" but < 12"Scaffold Properly Cross-BracedMobile Scaffold Height < 3X BaseScaffold Tied when 4X base exceededScaffolds Plumb/LevelWorking Levels Fully Planked

Hand Safety Correct gloves for taskEyes on taskGlove per MSDS/chemicalGloves in good conditionGood grips on toolsGuards/barriers in placeHand not placed in unseen locationHands not in Pinch PointsHands off loadHands placed out of line of fireNo jewelry/snag hazardsSTA -includes hand hazards and contrNo Wet/ slippery/oily conditionsNot handling Sharp/jagged edgesProper fit of glove

STA Quality Control steps being followedCrew knowledgeable of hazards and cHazard control steps clearly listed foJob tasks clearly identifiedSTA references rescue plan, emergenSTA reviewed as conditions changeSTA reviewed by supervisorSTA signed by all crew members prior

STA matches work being performedSTA prepared at the work locationSTA includes specific hazards for each

Hand And Power Tools AveragePre-Task Plan CompletedCords In Good ConditionGround Prong In PlaceGuards In PlaceAuto Chain Brake, Chain SawAuto Shut Off Abrasive Blast NozzleChain Saw Not Above ShoulderAssur Equip. Grnd?g/Current colorCord in good conditionDouble Insulated toolGround prong in placeProper tool for the jobLaser in use signagePowder charge disposalSecure air hose couplingsTool in good conditionPneumatic Tool LashingPort Circ Saw Guard not ShimedQualified Operator(Explosive-ActuateInformation Label On ToolProper Tool For The JobStrain Relief FunctioningEmergency Shut-Off SwitchGuards in place

ES - Heavy Equipment AveragePre-Task Plan CompletedCompetent Person PresentPre-Entry Insp DocumentedEmployees TrainedFlagman IdentifiedBack-Up Alarms FunctioningSeat Belts In UseHoisting LicensesGlass free of obstructionsHorn functioningStrobe Lights

Motorized Equipment Back up alarm functioningGlass free of obstructionsRollover protectionTraining/licenses on fileForklift ForksLoad ChartEquip condition/inspectionFlagman used if applicable

Fire ext. chg'd/presentPre shilft/Mthly insp./doc'sROPSState lic. operator if appl.Operator appears competentTraining docs availableHorn functioningSeat belts used

Machinery/ Mechanized Equip Reverse Alarms WorkingAHA Developed per SurveyAnnual/Quad Tests Maint. (Crane)Anti Two Block DeviceFire Extingquishers PresentOperator Qualified/LicensedTrained/Authorized Forklift OperatorAt Controls While Load SuspendedCrane-Manuel/Load Chart/Log BookCritical Lift Plan Prepared (AHA)Daily Equipment Inspections

Ladders / Stairs AveragePre-Task Plan CompletedLandings and treads filledCompetent person presentExtend 3' Above Landing3' above landingLadder req?d type/capacityLadders in good conditionSafe work dist from hazdClear of debris/materials

i Job-blt ldrs const properlyJob-built ladders securedAccess break >19"Ladder openings protectedRails at stairs/landingsLadders securedStep ladders not used for accessStep ladders being used as intendedTied at the top or properly footedStepladders fully extendedSafe Access Break > 19"Extension Ladder 4:1 PitchInspected for defectsJob-Mades Built ProperlyLadders Secured In PlaceRailing at stairs/landingsProper Use Of Ladder

Type 1A Ladders In UseGate/Offset @ Ladder AccessTop/Bottom Of Ladders ClearSafe Work Dist From HazardsStair/Handrails PresentLandings And Stair Treads FilledStairs IlluminatedSlip trip exposure elim

Hand & Power Tools AveragePre-Task Plan CompletedAuto Shut Off/Safety SwitchesWhip-Checks usedCompetent Person PresentPersonnel In Area ProtectedOperator Trained/DocumentationTools Inspected DailyHand tool in good cond with no defecTool is double insulated or groundedCord in good conditionGuards/safety switches are in placeThe tool appropriate for the jobGround prong in placeGuards in placeInformation label on tool

i Proper tool for the jobPowder Actuated ToolsShots properly discardedTool in good conditionSpent Caps Properly Disposed

Hand And Power Tools Tool Guards in Place/FunctioningPowder actuated cert

Excavations AveragePre-Task Plan CompletedCompetent Person PresentCompetent person identifiedOther materials including equipment 1-call/as-builts usedPerimeter prot/barricade> 4' with Access every 25'>5 Protected Shoring/Shield/Box/SloEmployees not in Trench WaterInspec/Doc by CP as ReqManuf. data on shoringExcav permit completed/doc?sMaterial Set Back 2'Max Slope 34 (1-1/2 to 1)Protected From Water

Protected with BarricadesSupport System Tab Data OnsiteUtilities Located/Marked Prior toSloped, shielded, benched, or shoredSpoil min 2' from edgeSurface traffic exposure controledWater entering excavationAccess with 25'Daily inspections docExcavation PermitFall Protection @ 6?-0Surface encumbrancesPre-Task PlanTrench Permit ObtainedAs-Builts PresentUtilities MarkedUtilities Protected/SupportedDaily Inspections DocumentedTrench Box CertificationSloped/Shored Properly4' Depth - Safe Access>6 - Fall Protection InstalledAtmospheric HazardsPerimeter Protection/BarricadesSoil Classified/TestedSpoils 2' From EdgeSurface Encumbrances SupportedSurface Traffic ExposureWater Entering ExcavationAccess w/ in 25' & @ 4' deepDaily inspect by competent persExcav > 20' engineeredHigh Visibility Vest WornSloped, benched, or shoredSpoil 2' from edgeSurface encumbrances removedUnderground Utility IDBridge or Guardrail for CrossingAccess within 25'

Fall Protection AveragePre-Task Plan CompletedAnchorage points eng'rd/doc'sCAZ in placeCompetent Person PresentWorkers Trained/DocumGuardrail Removal PermitEquipment Insp/FunctioningExt/int guardrails

Fall rescue plan & equip avlHarness and lanyard insp/doc'sHarness/lanyard training/doc'sStair/ramp/walkway protToeboards installed Falling Object ProtectionFloor/Wall Openings ProtectedFloor Covers Adeq/Sec/MarkedToeboards PresentCAZ Guardrails/SignageHoist Areas ProtectedDebris Chutes ProtectedSafe Ladder Use/AccessArrested fall/Free/fall distance identiDemonstration of trainingFall rescue planRescue Provisions In PlaceEmp tied off - no lower level strike?Daily inspection of equipmentFloor/wall opening protectedRoof edge protectedFall protection at 6' (4' in WashingtonVertical lifelineHoriz lifelines are engineeredGood access to extinguishers?Port fire ext. distributed/tagged/curr

i Proper anchorage pointsRetractable(Yo-Yo's) inspectedSafety harness and lanyard inspectedFloor Covers Secured and LabeledFall protection at 6' (4' in WashingtonToe boards installedFall protection at 6' (4' in Washington

i Proper anchorage pointsRetractable(Yo-Yo's) inspectedSafety harness and lanyard inspectedExt/interior guardrailsHorizontal lifelines designIdentified on Pre-Task PlanTask Specific Fall Protection PlanProper anchorage pointsSafety harness and lanyard inspectedFall protection at 6' (4' in WashingtonProper anchorage pointsRetractable(Yo-Yo's) inspectedSafety harness and lanyard inspected

Fall protection at 6' (4' in WashingtonPrecast Conc. provided/in placeProper anchorage pointsRetractable(Yo-Yo's) inspectedResidential provided/in place

i Safety harness and lanyard inspectedFall protection at 6' (4' in WashingtonProper PFAS In UseStair/Ramp/Walkway ProtectedImpalement ProtectionDeflection <2"Ext/int guardrail w/ toe boardsFall protection at 6'Fall protection planFlr covrs adeq,secure,labelHarness & lanyard inspected

Walking Surfaces Cords not stretched across aisles or Aisles correctly established and clearCarpet is secure and free of tears, luNo tripping hazards in evidenceFloors dry - not slippery

Stairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire Ex Stair treads in good condition

Adequate lighting in stairways, aisle

Last Fire Drill ConductedBathrooms Clean

Emergency exit doors clearly marked

Are all fire alarms functioning proper

Emergency Exits Signs Illuminated

Emergency Phone Numbers Visible and

Evacuation Routes Visible

First Aid Kits Available and Fully Stoc

Handrails installed and in good condi

Maps to Hospital and /or Medical Facili

Fire extinguishers accessible and full

Halls kept clear of equipment and sup

Stairways clear - not clutteredFloor & Walls Holes & Openings Covers Labeled/Secured

Floor/Roof Opening Guarded/CovereSafe Access & Fall Protection Ladder Clear of Doors/Passageways

Personal Fall Arrest Systems100% Tie Off (Double Lanyards)Guardrails Provided Meet Req.4:1 Pitch (vertical-horizontal)5000 # AchorageLifeline used by Single EmployeeLoose tools not present on ladderAccessway Min. 18"Accessway Overhead ProtectionLadders Extend 3' above LandingProtect from Falls 6ft or GreaterSafety Nets InspectedLadders Inspected for DefectsLadders Secured(top/bottom/inter)Ladders Top/top Step not usedLadders used for intended useHarness & lanyard properly wornLeading Edge provided/in placeStair/ramp/walkway protectd

Fire Protection AverageExt charged/inspected/taggedHot Work monitoredProp signs in store areasSCCI hot work permitAdequate Ventilation ProvidedLPG storage & useSecondary containmentStandpipe installedPre-Task Plan CompletedFire Prot/Prev ProgramHot Work Permit PostedShutdown/Disruption PermitTemp heaters Standpipes installed/avail for FDSmokingInterior struct. 1hr ratedHydrants/Water supplyHot work permitsFlamm Liq storage/use/disposalFD Connect marked/unobstructedEvac Plan Posted Each Floor

Emergency Vehicle AccessExt charged and inspectedLocal jurisdictionExt Charged/InspectedExt Mounted/Signed ProperlyFire Suppression Equip AvailFire Watch PresentProper Signs In Storage AreaProper Liquid/Gas StorageProper Comb. Material StorageNo Propane Stored IndoorsProper Fuel Containers UsedExt's charged and inspectedHot work permitProper signs in storage areasProper Storage for Fuel Containers

i Ext's charged and inspectedFire watch when applicableHot work permitProper signs in storage areasProper Storage for Fuel ContainersTarps Flame RetardantProper Temp Heat/Permit

Fire Prevention and Protection - Hot Work Operations AveragePre-Task Plan CompletedCompetent Person PresentFlamm/Comb Materials RemovedBottles Upright/Capped/SecuredCG Cylinders Stored Properly20lb Ext PresentFlash Arrest At Torch/RegWelding Screens ProvidedGauges Working ProperlyEquipment Inspected DailyLeads In Good ConditionProper PPE In UseTorch Hoses Good ConditionWeld Machine VentilatedHot Work Permit PostedFire Watch PresentHoses/Leads Prot From DamageLead Terminals Covered

Fire Prevention/Protection Activities Rqrd. Hot Work PermitFire Exting Present (20-B:C)Fire Extinguisher TrainingFire Exting Provided/InspectedApproved Fuel Containers/Trucks

Welding / Cutting Bottles upright/cap/securedFire ext presentReverse Flow Check Valve at Torch an

Valves Closed/Gas Supply SecureCylinder IDFlash arrest at regulatorsOx/Ac cyl sep by 20' in storgWelding bootsComb. Mat. Screened from SlagEquipment Inspected DailyNo Splices/Repaired Insulation 10ft. Welding/Cutting Machine GroundedWorker,Watchers,Public ProtectedCylinders upright/cap/securedFlashback arrestor presentProper storage of cylindersTorch hoses good condWelding leads in good conditionWelding operation ventilatedFlash arrest on torch/guageFlash protection availableGauges working properlyAreas below wrk area prop ctrl and pHot Work Permit

i Leads in good conditionApprop PPE for welded material?Fire Ext immedialtey accessibleCables&Hoses Clear of Ladders,etc.Compatible Fire Extinguisher AccessibLeads Unattended Equip Shut downWelding PPE UsedWelding/Cutting/Heating, VentilatedWrk area properly ventilatedProp PPE in useProper storage of hosesTorch hoses good conditionWeld machine ventilated

Hazard Communications AveragePre-Task Plan CompletedCompetent Person PresentCopy of programInventory listReadily availableEmployees trainedMSDS' (site specific)Chemical Use Auth FormEmployees trainedMSDS Readily availableProper labels on containers

Proper Labels On ContainersHigh Hazard Programs Asbestos awareness program

Back Injury Prev ProgramConfined Space ProgramSafe Ladder ProgramCorporate Fall ProgramCrane & Lift ProgramElectrical Hot Work ProgramElectrical LO/TO ProgramEnvironmental ProgramExcavation & Trenching ProgFire Protection ProgramLead Awareness ProgramTraffic Control ProgramWelding Cutting Program

Housekeeping AverageClear Access to Bldg/SiteCords/Hoses On Floor/WalkwayProper Material StorageSlip/Trip/Fall HazardsMaterials secured against weatherCords/hoses off ground / protected Walkways ClearTools, materials and equipment storeDesignated employee parkingImpalement protectionExits Clear/Egress Routes PostedExterior Access Points ProvidedFire Alarm/Suppression ActiveSCCI Housekeep policy appliedTemp Walls & Signage in PlaceRoadway around proj clearAccess & Egress Walkways clearFloor Sweep being usedSlip, trip, fall hazardsTrash in protected contAdeq numb of port. toiletsPortable toilets clean/maintProper use of "CAZ" idSanitary cleaner availableWork areas clear of debris

Work Environment Safety Employees work areas are clean, ordeTrash Cans Empty and not OverloadeAre work areas free of rodents, insec

Employees are not engaged in ergonom

Employees are not engaged in unsafe acEmployees work areas are adequately

P.P.E. AverageHierarchy Of Controls UtilizedHigh Visibility clothing wornRespiratorsGlasses / face shieldsSafety GlassesExposure To Contam AssessedDanger Tape/Sign AppropriateCaution Tape/Sign AppropriateFace shieldsHigh visibility vestProper protective clothingV rated or F.R. Clothing wornEye/Face ProtectionHand ProtectionMetatarsal protectionHard HatsHearing ProtectionRebar capsReflective VestFoot protection are being worn?Proper hand prot are used when req?Face shield are used when required?Hard hats are being worn?Foot ProtectionSafety glasses are being worn?Proper ClothingSfty vests/high viz attire being worn?GlovesHearing prot being worn when req?Respirators are used when requiredHigh-Vis Reflective VestProper face/eye protectionSafety Glasses/side shieldsWork BootsRespiratory Protection

PPE Eye and Face ProtectionFall Arrest, Restrain, PositioningGlovesSafety Workboots/Metatarsal Prot.PPE Training for EmployeesFall Arrest, Restrain, PositioningGlovesHead Protection

High Visibility ApparelElectrical PPEProper Clothing-Pants,Shirts,etc

Noise Monitoring 50 FootLot Line

Respiratory Med Evaluation docMed questionnaire completedProper respirator usedWorkers properly fit testedVoluntary use Appendix DProper Training doc?

Signs/Tags/Labels/Signals/Traff Contr Approved Traffic Control PlanHaul/Access Roads Approved

Sanitation Toilets ProvidedCool Water ProvidedDrink Water Disp-No Cross Contam

Site / Public Protection AverageTraffic Control Plan SubmittedWalkways ClearOverhead Protection In PlacePublic Warning SignagePed Crosswalk AppropriateAdequate LightingAccess RestrictedPolice Detail PresentWalkways Delineated/ProtectedExcavations protectedSite fencesCompany rep presentConstruction Mgt PlanSCCI Public protection signageSecurity system in placeBarricades installed properlySite FencingFalling object protectionHand Wash Impalement Protection

i Perimeter fencesPublic protection signageRestroomsTraffic Control planStreet closure identified

Steel Erection Anchorage points meet reqControlled Decking Zone UsedFall Protection Training ProvRigger/Connector Training ProvMult lift/rig/con training

Deck Turnover Proced followedFall Protection at Heights >6'Mult lift proced utilizedStruct flooring requirements2 bolts per connectionAdequate site conditionsAnchor bolts certificationDecking securedErector notif of modificationFalling object protectionProper anch of colmns/beamProper erection planFall pro training providedSite layout / sequence planWritten approv conc strengthConcrete @ 75%Falling Object Protection ProvProper anchorage pointsSite Layout/Sequence Plan ProvCDZ training / utilizedCertified or Qualified RiggerLoads not swung over the public/wor

Concrete/Masonry/Steel Erection Fall Prot. for Masonry > 6'Impalement Hazards ControlledFall Prot. for Steel Erectors > 6'Safety latches on Hooks OperableRigging Insp. Daily by Qual. RiggerDocumentation of concrete strengthApprv'd Steel Erect Start FormCritical Pick ChecklistEmergency crane use

i Fall Protection PlanRigging Inspected Daily & MonthlySteel Erection Checklist on fileStructural flooring requirements

Scaffolds AveragePre-Task Plan CompletedTagging system in useWheels locked, as applicableScaffold fall protection planSCCI Mast Climber Plcy in placeProper Height to base ratioScaffold engineering planPump jacks erected properlySafe work dist from pwr lines

Inspected daily by comp personProp secured to structureAdequate Debris ContainmentOutriggers used, as applicableGuardrails in place @ 6'Competent Person PresentErection/Dismantling Fall ProtGuardrails InstalledInspected daily and is taggedPlank in good cond,no cracks/damagSill, plates, jacks installedFalling Object ProtectionMast-Climber Proc SubmittedDaily Inspection Cond/DocuAccess To Scaffold AppropriateInitial Inspection Condu/DocuBracing And Pins In PlaceCompatible Components UsedFully PlankedProper Loading Of MaterialsSills, Plates, Jacks InstalledGuardrail in place @ 6'Bracing and pins in placeCompatible components usedProperly secured to structureCompetent person doing Daily InspecDaily Pre-Task PlanVertical Safety lines protected / secuGuardrail & Toe Boards Inspected dailyClimbing mast scaffoldDaily scaftag inspect. sysGrdrls instll on Baker at 4'Platforms fully plankedScaffold-grade plank usedSills,plates,jacks installedSurface in safe conditionWheels locked/securedSwing scaffolds Users trained/doc?sFall Protection PlanProper access to platformsProper loading of materialsSafe work distancesSills,plates,jacks installed

i Surface in safe conditionSwing staging erected properly

Wheels LockedDaily Inspection of ScaffoldsProper Fall ProtectionSurface In Safe Condition

CodeLMHLT

CombinedAdministrationAverageAdministrationAccountability Plan UtilizedAdministrationAddress Displayed On PerimeterAdministrationAdequate 1st Aid KitsAdministrationAdequate Eyewash StationsAdministrationAnnual Program EvaluationAdministrationCompetent Persons ListAdministrationCoord With Local FDAdministrationCompetent person ID'ed/presentAdministrationDART/TRC/DBO2 Goals MetAdministrationDaily Stretch & FlexAdministrationEmerg Mgmt MeetingAdministrationEmerg Mgmt PlanAdministrationNew Empl Orientations heldAdministrationCompetent person ID'ed/presentAdministrationDocument pre-const mtgsAdministrationDrug Testing programAdministrationIncentive/Recognition ProgramAdministrationSafety manualAdministrationSTA submitted each tradeAdministrationSub Toolbox MeetingsAdministrationMSDS manualAdministrationOSHA 10hr card AdministrationOSHA 10/30 hour cardAdministrationJHA submitted each tradeAdministrationEmerg Numbers PostedAdministrationWkly JHA/PTP submittedAdministrationEmerg Plan Sent To Ops CenterAdministrationEmployee InvolvementAdministrationFile System Estab/MaintAdministrationEmergency Muster Point PostedAdministrationFirst-Aid/CPR On SiteAdministrationHigh-Hazard Planning MeetingAdministrationIncident Investigation ProgramAdministrationKnox-Box On SiteAdministrationMap To Medical FacilityAdministrationMoisture Control PlanAdministrationVisitor sign-in form/waiverAdministrationVisitor hard hat availableAdministrationVerification of Training

AdministrationUpdated Precon ChecklistAdministrationSupt Daily Inspection CompletedAdministrationSubcontractor Safety MeetingsAdministrationState/Fed (Eng/Sp)/WC postersAdministrationSite Spec Safety Manual AcceptAdministrationSite Orientations ConductedAdministrationFreq/reg safety inspectionsAdministrationForeman/PM Safety MeetingsAdministrationOSHA 300 Log Posted as ReqdAdministrationToolBox talks Submitted WeeklyAdministrationDaily Safety Inspections DocumentedAdministrationMonthly Mass Safety MeetingAdministrationMonthly Mgmt Safety MeetingAdministrationMonthly Reporting Up-To-DateAdministrationMSDS Manual CurrentAdministrationOrientation Program documentedAdministrationPost-Incident Review HeldAdministrationPre-Con Safety MeetingAdministrationProject Safety BoardAdministrationProject-Specific HASP ReviewedAdministrationPTP's Reviewed/ApprovedAdministrationReturn to Work ProgramAdministrationSafety Inspections CompletedAdministrationSafety Recognition ProgramAdministrationSafety Related CommunicationAdministrationTool Box Talks DocumentedAdministrationVisitor PPE availableAdministrationIFE Banners PostedAdministrationOSHA Posters / OSHA 300 LogAdministrationSafety meetingsAdministrationSHEMS on projectAdministrationSHMP on ProjectAdministrationState / Fed posters (Eng/Sp)AdministrationVisitor sign-in formAdministrationWorkers OrientatedAdministrationVisitor Release FormProgram ManagementVisitor PPE AvailableProgram ManagementVisitor Sign-In Log MaintainedProgram ManagementWeekly Safety Meeting HeldBookcases, Shelves, CabinetsBookcases and shelves not overloadedBookcases, Shelves, CabinetsBookcases and cabinets secured against tippingBookcases, Shelves, CabinetsHeavy storage shelves secured to wallBookcases, Shelves, CabinetsFile drawers closed when not in usePreCon/Proj Start-upSite Spec Safety Manual AcceptPreCon/Proj Start-upWeekly JHA submittedPreCon/Proj Start-upUpdated Precon ChecklistPreCon/Proj Start-upMSDS ManualPreCon/Proj Start-upOSHA 10Hr Employee on Site

PreCon/Proj Start-upEmergency ContactPreCon/Proj Start-upEnrolled in Wrap-Up(Y,N,NA)PreCon/Proj Start-upCompetent PersonsPreCon/Proj Start-upContract SignedPreCon/Proj Start-upCertificate of Ins in placeMedical / EmergencyEye wash Medical / Emergency1st aid kitMedical / EmergencyEmergency action planMedical / EmergencyCPR/First Aid Trained EmployeesMedical / EmergencyEmergency Numbers PostedMedical / EmergencyEyewash (ANSI Approved) ProvidedMedical / EmergencyEmergency procs suppliesMedical / EmergencyEmergency numbers postedMedical / EmergencyEye washMedical / EmergencyMap to medical facilityMedical / EmergencyPerson with 1st Aid/CPR on siteMedical / EmergencyCoordination w/EMSMedical / EmergencyEmrg Action Plan posted/commMedical / EmergencyOccupational Clinic estabMedical / EmergencyExit SignsMedical / EmergencyLight Duty Program in placeMedical / EmergencyEmergency Action Plan practiced, doc and reviewedMedical / EmergencyPhysician Panel for projectMedical / EmergencyTeam contact numbersMedical / EmergencyEmergency Action Plan practiced, doc and reviewedMedical / Emergency1st aid kitMedical / EmergencyEmergency action planMedical / EmergencyEye wash Medical / EmergencyEmergency numbers postedMedical / EmergencyMap to medical facilityMedical / Emergency1st Aid/CPR on siteMedical / EmergencyTeam contact numbersMedical / EmergencyPerson with 1st Aid/CPR on siteHealthcarebio hazard removalHealthcareCeiling tiles replacedHealthcaredust free beyond workHealthcarehazardous material inspectionHealthcareexits unobstructedHealthcarehot work notificationHealthcareI.C.R.A. ImplementedHealthcareno transporting dustHealthcareSmoke partition compliantHealthcarePre task planHealthcareceiling permitHealthcareinspection of adjacent areas

HealthcareTack mats cleanHealthcareuninterrupted fire systemsHealthcarenegative air confirmationHealthcareNew Employee orientationHealthcareno flammables in buildingHealthcareFire stopping installedMedical & First AidCPR/First Aid Trained EmployeesMedical & First AidFirst Aid Kits ProvidedMedical & First AidEmergency Numbers PostedMedical & First AidEyewash (ANSI Approved) ProvidedHeat Illness PreventionAccess to shadeHeat Illness PreventionAccess to waterHeat Illness PreventionEmployee and Supervisory trainingHeat Illness PreventionWritten procedures including emergency responseMaterial Handling/Storage/DisposalAccessways Kept ClearMaterial Handling/Storage/DisposalNo Suspended Overhead LoadsMaterial Handling/Storage/DisposalControl Loads/Tag LinesPlanningAdequate ResourcesPlanningAdequate Steps ListedPlanningCompleted and on FilePlanningSub Imp Plan (PEP)PlanningControls IdentifiedPlanningCrew ParticipationPlanningActive pre-task planningPlanningWeekly toolbox meetingsPlanningDaily Pre Task CompletedPlanningHazards IdentifiedPlanningPosted in work areaPlanningPre Task MeetingsPlanningProper Methods UsedPlanningReviewed & AuditedPlanningScheduled ActivityPlanningRisk CommunicationAsbestosAverageAsbestosArea Air Monitoring ConductedAsbestosContractor License ValidAsbestosCritical Barriers EstablishedAsbestosDaily Log PostedAsbestosDanger Signs PostedAsbestosDecon EstablishedAsbestosDumpster SecuredAsbestosEmergency Response PlanAsbestosFire Extinguisher PresentAsbestosFire-Retardent Poly UsedAsbestosHarvard Disposal FacilityAsbestosHEPA Machine Cert. AvailableAsbestosMADEP Notification Posted

AsbestosManometer PresentAsbestosMSDS Manual AvailableAsbestosPersonal Air Samples PostedAsbestosWork Plan SubmittedAsbestosWorker Licenses PostedConcrete & MasonryAdequate bracingConcrete & MasonryConcrete pump operationsConcrete & MasonryForm work drawings onsiteConcrete & MasonryLimited access zoneConcrete & MasonryRebar capsConcrete & MasonryRotating parts guardedConcrete & MasonryWashout pits/boxesCaught betweenAccess w/ in 25' & @ 4' deepCaught betweenCompetent person presentCaught betweenDaily inspect by competent persCaught betweenHigh Visibility Vest WornCaught betweenUnderground Utility IDCaught betweenPerimeter prot/barricadeCaught betweenSloped, benched, or shoredCaught betweenWater entering excavationCaught betweenSpoil 2' from edgeCaught betweenExcav > 20' engineeredCaught betweenSurface encumbrances removed

Struck by/Pinch Point HazardsAre ground personnel easily visible to equipment and vehicle operators

Struck by/Pinch Point HazardsCan equipment and machinery be shut off quickly in an emergencyStruck by/Pinch Point HazardsEmployees in work zone protected from vehicles and equipmentStruck by/Pinch Point HazardsProper methods for material handling and riggingStruck by/Pinch Point HazardsProtection from moving machinery and equipmentStruck by/Pinch Point HazardsWork zone job hazard analysis and trainingConfined SpaceAverageConfined SpaceAdequate Ventilation ProvidedConfined SpaceRescue Plan/Emerg #'s PostedConfined SpaceAtmospheric conditionsConfined SpaceComm / secure area / signageConfined SpaceEntry super/monitor/entrantConfined SpaceHarness / extraction equipConfined SpaceElectrical / fire preventionConfined SpaceRescue plan/emerg #'s/mapConfined SpaceRegular insp / air monitorConfined SpaceHarness / extraction equipConfined SpacePermit completed/postedConfined SpaceRespiratory equipmentConfined SpaceSfty person/rescue equip/PPEConfined SpaceTraining documentationConfined SpaceVentilationConfined SpaceAtmospheric Conditions Tested

Confined SpaceCommunications/Area SecureConfined SpaceEntry Supervisor/Monitor PresentConfined SpaceReg. Testing of Atmos ConditionsConfined SpaceRescue Equip Readily AvailableConfined SpaceResp Equip UsedConfined SpaceSafety Person/Rescue Equip AvailConfined SpaceSigned Permit Present at SpaceConfined SpaceTraining Documentation ProvidedConfined SpacePre-Task Plan CompletedConfined SpaceCompetent person presentConfined SpaceConfined Space InventoryConfined SpacePermit Posted/CompletedConfined SpaceProper PPE In UseConfined SpacePre-Entry Monitoring ConductedConfined SpaceMonitor Calibrated/In UseConfined SpaceRescue Plan/EquipmentConfined SpaceLO/TO Required/CompletedConfined SpaceEntry Team TrainedControl Of Hazardous EnergyAverageControl Of Hazardous EnergyPre-Task Plan CompletedControl Of Hazardous EnergyCompetent Person PresentControl Of Hazardous EnergyEmployees TrainedControl Of Hazardous EnergyLocks Keyed DifferentlyControl Of Hazardous EnergyTags Used/CompletedControl Of Hazardous EnergyEnergized Work ProcedureControl Of Hazardous EnergyShutdown/Disruption PermitControl Of Hazardous EnergyZero Energy ConfirmedAverageDemolitionPre-Task Plan CompletedDemolitionCompetent Person PresentDemolitionEngineering Survey/Demo PlanDemolitionHazardous Materials SurveyDemolitionPre-Demo Checklist/WalkthruDemolitionUtilities Clearly ID'd/ProtectedDemolitionDebris Removal Each DayDemolitionDrop zone area(thru floors..)barricaded/signed?DemolitionFire Protection AddressedDemolitionSystems Drained/Locked OutDemolitionAccess Controlled/RestrictedDemolitionDust ControlDemolitionFall Protection In UseDemolitionHousekeeping/Access MaintainedDemolitionFlamm/Comb Materials RemovedElectricalAverageElectricalBlanks and plugs installedElectricalCircuits labeledElectricalCircuits labeledElectricalElect Hot Work ProceduresElectricalCords in good conditionElectricalEquipment firmly mounted

ElectricalExt eqp in weatherproof enclElectricalElec Rooms/Panels SecuredElectricalGenerators groundedElectricalLO/TO proceduresElectricalNFPA 70 E for Energized workElectricalProper use temp pwr bxsElectricalQuarterly cord insp currentElectricalEnergized Work ProcedureElectricalTemp lghts installed/guardedElectricalCords elevated above the wrk surf when practical?ElectricalProper use temp power boxesElectricalGFCI's usedElectricalExt. cords, elec equip, tools damage free, insp?ElectricalGFCI tested before useElectricalGFCI receptacles present, functioning & testedElectricalEmerg Lighting Below GradeElectricalPower Feed Locations ID'dElectricalProper Temporary LightingElectricalSignage PresentElectricalTemporary Lighting (Sufficient)ElectricalTemporary Lighting PresentElectricalTemporary Electric SupportedElectricalCord Strain Relief FunctioningElectricalCords protected from damageElectricalElectrical Room RestrictedElectricalEquipment properly groundedElectricalGFCI's inspectedElectricalGFCI's used/suppliedElectricalLights & cages @ proper heightElectricalPanels labeled properlyElectricalCords protected from trafficElectricalElectrical room protectedElectricalEnergized parts protectedElectricalLock Out/Tag OutElectricalConductive surfaces/GroundingElectricalOverhead/Underground cable protectionElectricalGFCI Protection UsedElectricalTemporary Power Strain ReliefElectricalKnock-outs Covered/ProtectedElectrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementAre all light fixtures adequate and functioning properlyElectrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementChairs in good mechanical condition (springs/casters)Electrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementChemical products properly used, stored and labeledElectrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementElectrical cords and plugs in good conditionElectrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementIs the Breaker Panel accessible with Labels identifying the function of each switchElectrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementCoffee Machines Secured and not close to edge of counter

Electrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementPaper shredder guarded

Electrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementKitchen Area Clean

EnvironmentalAverageEnvironmentalConcrete cut wet & vacuumedEnvironmentalAdequate ventilationEnvironmentalDust control measuresEnvironmentalDiesel Exhaust/IdlingEnvironmentalFenceline Dust MonitoringEnvironmentalErosion ctrl measures maint/adeqEnvironmentalNoise control measuresEnvironmentalSpill containment adequateEnvironmentalRegular air sampling EnvironmentalSWPPPlan followedEnvironmentalSWPPPlan on fileEnvironmentalContainers labeledEnvironmentalHaz material properly storedEnvironmentalMoisture Control Plan in PlaceEnvironmentalPolicy posters posted on siteEnvironmentalHAZWOPER TrainingEnvironmentalDEP/EPA ComplianceEnvironmentalNoise MonitoringEnvironmentalNuisance dustEnvironmentalFueling Procedures FollowedEnvironmentalOdors/VaporsEnvironmentalPest ControlEnvironmentalNuisance dust controlledEnvironmentalSatelite Accumulation AreaEnvironmentalSilica Control Plan in PlaceEnvironmentalSoil Mgmt./LSP on SiteEnvironmentalSPCC Program in PlaceEnvironmentalClean Air LetterEnvironmentalSpill Kit Available

Electrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementIs Clear Access (36?) provided to Electrical Panels

Electrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementEquipment properly grounded (3 pronged plugs)

Electrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementSafe step stools and ladders properly used when neededElectrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementCoffee Machines Secured and not close to edge of counterElectrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementElectrical outlets not overloadedElectrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementExtension cords not substituted for permanent wiringElectrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementPaper cutter equipped with guard/ blade spring functioningElectrical Safety, Chairs, Chemical Products, Step Stools, Ladders, Air MovementUnobstructed air movement and vents

EnvironmentalSWPPP in PlaceEnvironmentalAsbestos/lead/mold/silicaEnvironmentalHazardous Mat'l Rpt ReceivedEnvironmentalWater Mgmt-Follow-up Track FormEnvironmentalWater Mgmt-Incident Rpt FormEnvironmentalWater Mgmt-Matls Insp ChecklistEnvironmentalHealth Hazard CtrlEnvironmentalDewatering Pollution PlanEnvironmentalStorm WaterKitchen AreaKitchen Area CleanKitchen AreaCoffee Machines Secured and not close to edge of counterKitchen AreaFire Extinguisher in Kitchen AreaScissor / Aerial LiftsAverageScissor / Aerial LiftsPre-Task Plan CompletedScissor / Aerial LiftsCompetent Person PresentScissor / Aerial LiftsPre-Entry Inspection CompletedScissor / Aerial LiftsDaily Inspections DocumentedScissor / Aerial LiftsFall Protection In UseScissor / Aerial LiftsEquipment loaded properlyScissor / Aerial LiftsGate Or Chain SecuredScissor / Aerial LiftsSurface Free Of Holes/FlatScissor / Aerial LiftsOperators TrainedScissor / Aerial LiftsOperator trainingScissor / Aerial LiftsHarness while in liftsScissor / Aerial LiftsInspections Annual/Preshift doc'sScissor / Aerial LiftsOperator certificate/licenseScissor / Aerial LiftsSafe work dist from pwr linesScissor / Aerial LiftsHarness while in aerial liftsScissor / Aerial LiftsOperating on flat surfaceScissor / Aerial LiftsEquip used in proper mannerScissor / Aerial LiftsArea Below ProtectedScissor / Aerial LiftsOperator trained docScissor / Aerial LiftsProper operating procedure usedScissor / Aerial LiftsRated lift capacity observedScissor / Aerial LiftsSafe work distancesScissor / Aerial LiftsNothing to increase heightScissor / Aerial LiftsSurface free of holesForkliftOperator IdentificationForkliftMax load posted on equipForkliftEquipment inspected dailyForkliftOperator trainedRiggingChain/Wire Ropes/Synthetic Slings-ID TagsRiggingDefective Rigging RemovedRiggingAlloyed Chain UseRiggingRigging Properly Stored/MaintainedRiggingPositive Latching Device PresentRiggingRigging Inspected By Comp. Person

Cranes And Hoisting EquipmentAverageCranes And Hoisting Equipment20 ft from powerline/deenergizedCranes And Hoisting Equipment3rd party Annual Inspection currentCranes And Hoisting EquipmentAssembly/Disassembly director appointedCranes And Hoisting EquipmentCrane LevelCranes And Hoisting EquipmentMult Lift Rigging ProcedureCranes And Hoisting EquipmentCrane supported/Blocked per ground conditionsCranes And Hoisting EquipmentCrew trained in hazardsCranes And Hoisting EquipmentDaily/Mnthly/Annual Rigging inspections on fileCranes And Hoisting EquipmentElev/Hoist capacity postedCranes And Hoisting EquipmentFall zone restricted/barricadedCranes And Hoisting EquipmentFire extinguisher in craneCranes And Hoisting EquipmentGilbane Crane lift plan on fileCranes And Hoisting EquipmentMfr Assembly/Disassembly procedures followedCranes And Hoisting EquipmentOperational aids workingCranes And Hoisting EquipmentOperator Certif. on fileCranes And Hoisting EquipmentLoad chart postedCranes And Hoisting EquipmentMfr procedures/Manual in craneCranes And Hoisting EquipmentOutriggers extended per mfr reqtsCranes And Hoisting EquipmentWeight of load verifiedCranes And Hoisting EquipmentAnti-Two Block DeviceCranes And Hoisting EquipmentPersonal Fall protection usedCranes And Hoisting EquipmentPersonnel basket testedCranes And Hoisting EquipmentPre/Post assembly inspection conductedCranes And Hoisting EquipmentPreshift/Mthly Equip inspections on fileCranes And Hoisting EquipmentQualified riggers assignedCranes And Hoisting EquipmentQualified signal persons assignedCranes And Hoisting EquipmentRigging inspected/ratedCranes And Hoisting Equipment10' Or More From Overhead LinesCranes And Hoisting EquipmentCrane Leveled On Firm SurfaceCranes And Hoisting EquipmentProper Sized CribbingCranes And Hoisting EquipmentNo Overhead LoadsCranes And Hoisting EquipmentSafety devices workingCranes And Hoisting EquipmentUnderground hazards identified/communicatedCranes And Hoisting EquipmentMass. Hoisting LicenseCranes And Hoisting EquipmentAnnual inspection currentCranes And Hoisting EquipmentAnti Two Block deviceCranes And Hoisting EquipmentBellman certifiedCranes And Hoisting EquipmentBellman identifiedCranes And Hoisting EquipmentBoom angle indicatorCranes And Hoisting EquipmentCrane supported and levelCranes And Hoisting EquipmentDaily Crane Lift PlanCranes And Hoisting EquipmentDaily inspections currentCranes And Hoisting EquipmentSwing radius barricadedCranes And Hoisting EquipmentTag lines usedCranes And Hoisting EquipmentCrit Pick Pln for two-crane

Cranes And Hoisting EquipmentMonthly inspection currentCranes And Hoisting EquipmentRigger qualifiedCranes And Hoisting EquipmentSafety latches usedCranes And Hoisting EquipmentOperator appears competentCranes And Hoisting EquipmentOperator manual in craneCranes And Hoisting EquipmentOperator training records on file.Cranes And Hoisting Equipment3Pty Annual Inspection CurrentCranes And Hoisting EquipmentRig insp/rated/ratedCranes And Hoisting EquipmentAnti Two Block InstalledCranes And Hoisting EquipmentBoom angle indicatorCranes And Hoisting EquipmentCert or verify trainingCranes And Hoisting EquipmentCrane supported and levelCranes And Hoisting EquipmentDaily inspections currentCranes And Hoisting EquipmentFire Ext in Cab of CraneCranes And Hoisting EquipmentLift plan on fileCranes And Hoisting EquipmentLoad chart postedCranes And Hoisting EquipmentLoad indicator on craneCranes And Hoisting EquipmentLoads properly securedCranes And Hoisting EquipmentMeans of communicationCranes And Hoisting EquipmentOperator appears competentCranes And Hoisting EquipmentPath of Overhead Loads Verif'dCranes And Hoisting EquipmentPwr Line Clearance AppropCranes And Hoisting EquipmentRig insp/ratedCranes And Hoisting EquipmentCrit Pick Pln for loads >75%Cranes And Hoisting EquipmentSafety latches operableGeneral Rigging/HoistingCome-Alongs inspected /ratedGeneral Rigging/HoistingChain Falls inspected /ratedGeneral Rigging/HoistingAnchorage / Structure will support loadGeneral Rigging/HoistingCapacity tags attached/legibleGeneral Rigging/HoistingRatchet/Hydraulic Jacks inspected /ratedGeneral Rigging/HoistingRiggers trained/certifiedGeneral Rigging/HoistingRollers inspected /ratedGeneral Rigging/HoistingSafety latches functioningGeneral Rigging/HoistingWinches/Tuggers inspected and properly mountedGeneral Rigging/HoistingSignalperson trained/certifiedGeneral Rigging/HoistingRigging inspected/ratedGeneral Rigging/HoistingProper use of riggingGeneral Rigging/HoistingProper rigging planGeneral Rigging/HoistingDesignated rigging/Lifting pointsGeneral Rigging/HoistingWinches/Tuggers inspected and properly mountedPressurized Equip & Systems6 Month Inspect. by Qual. PersonPressurized Equip & SystemsConfined Space free of Gas CylindersCranes & Hoisting EquipmentSwing Radius ProtectedCranes & Hoisting EquipmentTag lines usedCranes & Hoisting EquipmentWeight of load verifiedCranes And Hoisting EquipmentSignal person ID'd & on-siteCranes And Hoisting EquipmentOperator manual in crane

Cranes And Hoisting EquipmentOutrig extend/cribbingCranes And Hoisting EquipmentMeans of communicationPersonnel/Material HoistsAll tie-ins securePersonnel/Material HoistsBase enclosure per standardsPersonnel/Material HoistsCar doors functioning properlyPersonnel/Material HoistsDaily equip inspections compltPersonnel/Material HoistsDrop test verifiedPersonnel/Material HoistsInspection per regional req'tsPersonnel/Material HoistsLanding gates in place all levlsPersonnel/Material HoistsOperator trained/documentedPersonnel/Material HoistsOverhead protection in placePersonnel/Material HoistsProper signage cars & landingsWork PlatformsAccess Ladder or Equiv ProvidedWork PlatformsBase Plates/Mudsills UsedWork PlatformsPlanking Overlapped 12"/SecuredWork PlatformsWork PlatformsWork PlatformsPlanks Extend > 6" but < 12"Work PlatformsScaffold Properly Cross-BracedWork PlatformsMobile Scaffold Height < 3X BaseWork PlatformsScaffold Tied when 4X base exceededWork PlatformsScaffolds Plumb/LevelWork PlatformsWorking Levels Fully PlankedHand SafetyCorrect gloves for taskHand SafetyEyes on taskHand SafetyGlove per MSDS/chemicalHand SafetyGloves in good conditionHand SafetyGood grips on toolsHand SafetyGuards/barriers in placeHand SafetyHand not placed in unseen locationHand SafetyHands not in Pinch PointsHand SafetyHands off loadHand SafetyHands placed out of line of fireHand SafetyNo jewelry/snag hazardsHand SafetySTA -includes hand hazards and controlsHand SafetyNo Wet/ slippery/oily conditionsHand SafetyNot handling Sharp/jagged edgesHand SafetyProper fit of gloveSTA QualityControl steps being followedSTA QualityCrew knowledgeable of hazards and controlsSTA QualityHazard control steps clearly listed for each hazardSTA QualityJob tasks clearly identifiedSTA QualitySTA references rescue plan, emergency #'s, evacuation map/Assembly AreaSTA QualitySTA reviewed as conditions changeSTA QualitySTA reviewed by supervisorSTA QualitySTA signed by all crew members prior to beginning work

STA QualitySTA matches work being performedSTA QualitySTA prepared at the work locationSTA QualitySTA includes specific hazards for each taskHand And Power ToolsAverageHand And Power ToolsPre-Task Plan CompletedHand And Power ToolsCords In Good ConditionHand And Power ToolsGround Prong In PlaceHand And Power ToolsGuards In PlaceHand And Power ToolsAuto Chain Brake, Chain SawHand And Power ToolsAuto Shut Off Abrasive Blast NozzleHand And Power ToolsChain Saw Not Above ShoulderHand And Power ToolsAssur Equip. Grnd?g/Current colorHand And Power ToolsCord in good conditionHand And Power ToolsDouble Insulated toolHand And Power ToolsGround prong in placeHand And Power ToolsProper tool for the jobHand And Power ToolsLaser in use signageHand And Power ToolsPowder charge disposalHand And Power ToolsSecure air hose couplingsHand And Power ToolsTool in good conditionHand And Power ToolsPneumatic Tool LashingHand And Power ToolsPort Circ Saw Guard not ShimedHand And Power ToolsQualified Operator(Explosive-Actuated)Hand And Power ToolsInformation Label On ToolHand And Power ToolsProper Tool For The JobHand And Power ToolsStrain Relief FunctioningHand And Power ToolsEmergency Shut-Off SwitchHand And Power ToolsGuards in placeES - Heavy EquipmentAverageES - Heavy EquipmentPre-Task Plan CompletedES - Heavy EquipmentCompetent Person PresentES - Heavy EquipmentPre-Entry Insp DocumentedES - Heavy EquipmentEmployees TrainedES - Heavy EquipmentFlagman IdentifiedES - Heavy EquipmentBack-Up Alarms FunctioningES - Heavy EquipmentSeat Belts In UseES - Heavy EquipmentHoisting LicensesES - Heavy EquipmentGlass free of obstructionsES - Heavy EquipmentHorn functioningES - Heavy EquipmentStrobe LightsMotorized EquipmentBack up alarm functioningMotorized EquipmentGlass free of obstructionsMotorized EquipmentRollover protectionMotorized EquipmentTraining/licenses on fileMotorized EquipmentForklift ForksMotorized EquipmentLoad ChartMotorized EquipmentEquip condition/inspectionMotorized EquipmentFlagman used if applicable

Motorized EquipmentFire ext. chg'd/presentMotorized EquipmentPre shilft/Mthly insp./doc'sMotorized EquipmentROPSMotorized EquipmentState lic. operator if appl.Motorized EquipmentOperator appears competentMotorized EquipmentTraining docs availableMotorized EquipmentHorn functioningMotorized EquipmentSeat belts usedMachinery/ Mechanized EquipReverse Alarms WorkingMachinery/ Mechanized EquipAHA Developed per SurveyMachinery/ Mechanized EquipAnnual/Quad Tests Maint. (Crane)Machinery/ Mechanized EquipAnti Two Block DeviceMachinery/ Mechanized EquipFire Extingquishers PresentMachinery/ Mechanized EquipOperator Qualified/LicensedMachinery/ Mechanized EquipTrained/Authorized Forklift OperatorMachinery/ Mechanized EquipAt Controls While Load SuspendedMachinery/ Mechanized EquipCrane-Manuel/Load Chart/Log BookMachinery/ Mechanized EquipCritical Lift Plan Prepared (AHA)Machinery/ Mechanized EquipDaily Equipment InspectionsLadders / StairsAverageLadders / StairsPre-Task Plan CompletedLadders / StairsLandings and treads filledLadders / StairsCompetent person presentLadders / StairsExtend 3' Above LandingLadders / Stairs3' above landingLadders / StairsLadder req?d type/capacityLadders / StairsLadders in good conditionLadders / StairsSafe work dist from hazdLadders / StairsClear of debris/materialsLadders / StairsJob-blt ldrs const properlyLadders / StairsJob-built ladders securedLadders / StairsAccess break >19"Ladders / StairsLadder openings protectedLadders / StairsRails at stairs/landingsLadders / StairsLadders securedLadders / StairsStep ladders not used for accessLadders / StairsStep ladders being used as intendedLadders / StairsTied at the top or properly footedLadders / StairsStepladders fully extendedLadders / StairsSafe Access Break > 19"Ladders / StairsExtension Ladder 4:1 PitchLadders / StairsInspected for defectsLadders / StairsJob-Mades Built ProperlyLadders / StairsLadders Secured In PlaceLadders / StairsRailing at stairs/landingsLadders / StairsProper Use Of Ladder

Ladders / StairsType 1A Ladders In UseLadders / StairsGate/Offset @ Ladder AccessLadders / StairsTop/Bottom Of Ladders ClearLadders / StairsSafe Work Dist From HazardsLadders / StairsStair/Handrails PresentLadders / StairsLandings And Stair Treads FilledLadders / StairsStairs IlluminatedLadders / StairsSlip trip exposure elimHand & Power ToolsAverageHand & Power ToolsPre-Task Plan CompletedHand & Power ToolsAuto Shut Off/Safety SwitchesHand & Power ToolsWhip-Checks usedHand & Power ToolsCompetent Person PresentHand & Power ToolsPersonnel In Area ProtectedHand & Power ToolsOperator Trained/DocumentationHand & Power ToolsTools Inspected DailyHand & Power ToolsHand tool in good cond with no defectsHand & Power ToolsTool is double insulated or groundedHand & Power ToolsCord in good conditionHand & Power ToolsGuards/safety switches are in placeHand & Power ToolsThe tool appropriate for the jobHand & Power ToolsGround prong in placeHand & Power ToolsGuards in placeHand & Power ToolsInformation label on toolHand & Power ToolsProper tool for the jobHand & Power ToolsPowder Actuated ToolsHand & Power ToolsShots properly discardedHand & Power ToolsTool in good conditionHand & Power ToolsSpent Caps Properly DisposedHand And Power ToolsTool Guards in Place/FunctioningHand And Power ToolsPowder actuated certExcavationsAverageExcavationsPre-Task Plan CompletedExcavationsCompetent Person PresentExcavationsCompetent person identifiedExcavationsOther materials including equipment min. 2" from edgeExcavations1-call/as-builts usedExcavationsPerimeter prot/barricadeExcavations> 4' with Access every 25'Excavations>5 Protected Shoring/Shield/Box/SlopeExcavationsEmployees not in Trench WaterExcavationsInspec/Doc by CP as ReqExcavationsManuf. data on shoringExcavationsExcav permit completed/doc?sExcavationsMaterial Set Back 2'ExcavationsMax Slope 34 (1-1/2 to 1)ExcavationsProtected From Water

ExcavationsProtected with BarricadesExcavationsSupport System Tab Data OnsiteExcavationsUtilities Located/Marked Prior toExcavationsSloped, shielded, benched, or shoredExcavationsSpoil min 2' from edgeExcavationsSurface traffic exposure controledExcavationsWater entering excavationExcavationsAccess with 25'ExcavationsDaily inspections docExcavationsExcavation PermitExcavationsFall Protection @ 6?-0ExcavationsSurface encumbrancesExcavationsPre-Task PlanExcavationsTrench Permit ObtainedExcavationsAs-Builts PresentExcavationsUtilities MarkedExcavationsUtilities Protected/SupportedExcavationsDaily Inspections DocumentedExcavationsTrench Box CertificationExcavationsSloped/Shored ProperlyExcavations4' Depth - Safe AccessExcavations>6 - Fall Protection InstalledExcavationsAtmospheric HazardsExcavationsPerimeter Protection/BarricadesExcavationsSoil Classified/TestedExcavationsSpoils 2' From EdgeExcavationsSurface Encumbrances SupportedExcavationsSurface Traffic ExposureExcavationsWater Entering ExcavationExcavationsAccess w/ in 25' & @ 4' deepExcavationsDaily inspect by competent persExcavationsExcav > 20' engineeredExcavationsHigh Visibility Vest WornExcavationsSloped, benched, or shoredExcavationsSpoil 2' from edgeExcavationsSurface encumbrances removedExcavationsUnderground Utility IDExcavationsBridge or Guardrail for CrossingExcavationsAccess within 25'Fall ProtectionAverageFall ProtectionPre-Task Plan CompletedFall ProtectionAnchorage points eng'rd/doc'sFall ProtectionCAZ in placeFall ProtectionCompetent Person PresentFall ProtectionWorkers Trained/DocumFall ProtectionGuardrail Removal PermitFall ProtectionEquipment Insp/FunctioningFall ProtectionExt/int guardrails

Fall ProtectionFall rescue plan & equip avlFall ProtectionHarness and lanyard insp/doc'sFall ProtectionHarness/lanyard training/doc'sFall ProtectionStair/ramp/walkway protFall ProtectionToeboards installed Fall ProtectionFalling Object ProtectionFall ProtectionFloor/Wall Openings ProtectedFall ProtectionFloor Covers Adeq/Sec/MarkedFall ProtectionToeboards PresentFall ProtectionCAZ Guardrails/SignageFall ProtectionHoist Areas ProtectedFall ProtectionDebris Chutes ProtectedFall ProtectionSafe Ladder Use/AccessFall ProtectionArrested fall/Free/fall distance identifiedFall ProtectionDemonstration of trainingFall ProtectionFall rescue planFall ProtectionRescue Provisions In PlaceFall ProtectionEmp tied off - no lower level strike?Fall ProtectionDaily inspection of equipmentFall ProtectionFloor/wall opening protectedFall ProtectionRoof edge protectedFall ProtectionFall protection at 6' (4' in Washington)Fall ProtectionVertical lifelineFall ProtectionHoriz lifelines are engineeredFall ProtectionGood access to extinguishers?Fall ProtectionPort fire ext. distributed/tagged/current?Fall ProtectionProper anchorage pointsFall ProtectionRetractable(Yo-Yo's) inspectedFall ProtectionSafety harness and lanyard inspectedFall ProtectionFloor Covers Secured and LabeledFall ProtectionFall protection at 6' (4' in Washington)Fall ProtectionToe boards installedFall ProtectionFall protection at 6' (4' in Washington)Fall ProtectionProper anchorage pointsFall ProtectionRetractable(Yo-Yo's) inspectedFall ProtectionSafety harness and lanyard inspectedFall ProtectionExt/interior guardrailsFall ProtectionHorizontal lifelines designFall ProtectionIdentified on Pre-Task PlanFall ProtectionTask Specific Fall Protection PlanFall ProtectionProper anchorage pointsFall ProtectionSafety harness and lanyard inspectedFall ProtectionFall protection at 6' (4' in Washington)Fall ProtectionProper anchorage pointsFall ProtectionRetractable(Yo-Yo's) inspectedFall ProtectionSafety harness and lanyard inspected

Fall ProtectionFall protection at 6' (4' in Washington)Fall ProtectionPrecast Conc. provided/in placeFall ProtectionProper anchorage pointsFall ProtectionRetractable(Yo-Yo's) inspectedFall ProtectionResidential provided/in placeFall ProtectionSafety harness and lanyard inspectedFall ProtectionFall protection at 6' (4' in Washington)Fall ProtectionProper PFAS In UseFall ProtectionStair/Ramp/Walkway ProtectedFall ProtectionImpalement ProtectionFall ProtectionDeflection <2"Fall ProtectionExt/int guardrail w/ toe boardsFall ProtectionFall protection at 6'Fall ProtectionFall protection planFall ProtectionFlr covrs adeq,secure,labelFall ProtectionHarness & lanyard inspectedWalking SurfacesCords not stretched across aisles or under carpetsWalking SurfacesAisles correctly established and clearWalking SurfacesCarpet is secure and free of tears, lumps or loose piecesWalking SurfacesNo tripping hazards in evidenceWalking SurfacesFloors dry - not slippery

Stairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire ExtinguishersStair treads in good condition

Stairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire ExtinguishersLast Fire Drill ConductedStairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire ExtinguishersBathrooms Clean

Stairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire ExtinguishersEvacuation Routes Visible

Stairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire ExtinguishersAdequate lighting in stairways, aisles and storage rooms

Stairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire ExtinguishersEmergency exit doors clearly marked and accessibleStairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire ExtinguishersAre all fire alarms functioning properly and tested annuallyStairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire ExtinguishersEmergency Exits Signs IlluminatedStairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire ExtinguishersEmergency Phone Numbers Visible and at all phone stations

Stairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire ExtinguishersFirst Aid Kits Available and Fully StockedStairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire ExtinguishersHandrails installed and in good conditionStairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire ExtinguishersMaps to Hospital and /or Medical Facility by First Aid KitStairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire ExtinguishersFire extinguishers accessible and fully chargedStairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire ExtinguishersHalls kept clear of equipment and supplies

Stairways, Aisles, Storage Rooms, Halls, Emergency Exits, Fire ExtinguishersStairways clear - not clutteredFloor & Walls Holes & OpeningsCovers Labeled/SecuredFloor & Walls Holes & OpeningsFloor/Roof Opening Guarded/CoveredSafe Access & Fall ProtectionLadder Clear of Doors/PassagewaysSafe Access & Fall ProtectionPersonal Fall Arrest SystemsSafe Access & Fall Protection100% Tie Off (Double Lanyards)Safe Access & Fall ProtectionGuardrails Provided Meet Req.Safe Access & Fall Protection4:1 Pitch (vertical-horizontal)Safe Access & Fall Protection5000 # AchorageSafe Access & Fall ProtectionLifeline used by Single EmployeeSafe Access & Fall ProtectionLoose tools not present on ladderSafe Access & Fall ProtectionAccessway Min. 18"Safe Access & Fall ProtectionAccessway Overhead ProtectionSafe Access & Fall ProtectionLadders Extend 3' above LandingSafe Access & Fall ProtectionProtect from Falls 6ft or GreaterSafe Access & Fall ProtectionSafety Nets InspectedSafe Access & Fall ProtectionLadders Inspected for DefectsSafe Access & Fall ProtectionLadders Secured(top/bottom/inter)Safe Access & Fall ProtectionLadders Top/top Step not usedSafe Access & Fall ProtectionLadders used for intended useFall ProtectionHarness & lanyard properly wornFall ProtectionLeading Edge provided/in placeFall ProtectionStair/ramp/walkway protectdFire ProtectionAverageFire ProtectionExt charged/inspected/taggedFire ProtectionHot Work monitoredFire ProtectionProp signs in store areasFire ProtectionSCCI hot work permitFire ProtectionAdequate Ventilation ProvidedFire ProtectionLPG storage & useFire ProtectionSecondary containmentFire ProtectionStandpipe installedFire ProtectionPre-Task Plan CompletedFire ProtectionFire Prot/Prev ProgramFire ProtectionHot Work Permit PostedFire ProtectionShutdown/Disruption PermitFire ProtectionTemp heaters Fire ProtectionStandpipes installed/avail for FDFire ProtectionSmokingFire ProtectionInterior struct. 1hr ratedFire ProtectionHydrants/Water supplyFire ProtectionHot work permitsFire ProtectionFlamm Liq storage/use/disposalFire ProtectionFD Connect marked/unobstructedFire ProtectionEvac Plan Posted Each Floor

Fire ProtectionEmergency Vehicle AccessFire ProtectionExt charged and inspectedFire ProtectionLocal jurisdictionFire ProtectionExt Charged/InspectedFire ProtectionExt Mounted/Signed ProperlyFire ProtectionFire Suppression Equip AvailFire ProtectionFire Watch PresentFire ProtectionProper Signs In Storage AreaFire ProtectionProper Liquid/Gas StorageFire ProtectionProper Comb. Material StorageFire ProtectionNo Propane Stored IndoorsFire ProtectionProper Fuel Containers UsedFire ProtectionExt's charged and inspectedFire ProtectionHot work permitFire ProtectionProper signs in storage areasFire ProtectionProper Storage for Fuel ContainersFire ProtectionExt's charged and inspectedFire ProtectionFire watch when applicableFire ProtectionHot work permitFire ProtectionProper signs in storage areasFire ProtectionProper Storage for Fuel ContainersFire ProtectionTarps Flame RetardantFire ProtectionProper Temp Heat/PermitFire Prevention and Protection - Hot Work OperationsAverageFire Prevention and Protection - Hot Work OperationsPre-Task Plan CompletedFire Prevention and Protection - Hot Work OperationsCompetent Person PresentFire Prevention and Protection - Hot Work OperationsFlamm/Comb Materials RemovedFire Prevention and Protection - Hot Work OperationsBottles Upright/Capped/SecuredFire Prevention and Protection - Hot Work OperationsCG Cylinders Stored ProperlyFire Prevention and Protection - Hot Work Operations20lb Ext PresentFire Prevention and Protection - Hot Work OperationsFlash Arrest At Torch/RegFire Prevention and Protection - Hot Work OperationsWelding Screens ProvidedFire Prevention and Protection - Hot Work OperationsGauges Working ProperlyFire Prevention and Protection - Hot Work OperationsEquipment Inspected DailyFire Prevention and Protection - Hot Work OperationsLeads In Good ConditionFire Prevention and Protection - Hot Work OperationsProper PPE In UseFire Prevention and Protection - Hot Work OperationsTorch Hoses Good ConditionFire Prevention and Protection - Hot Work OperationsWeld Machine VentilatedFire Prevention and Protection - Hot Work OperationsHot Work Permit PostedFire Prevention and Protection - Hot Work OperationsFire Watch PresentFire Prevention and Protection - Hot Work OperationsHoses/Leads Prot From DamageFire Prevention and Protection - Hot Work OperationsLead Terminals CoveredFire Prevention/ProtectionActivities Rqrd. Hot Work PermitFire Prevention/ProtectionFire Exting Present (20-B:C)Fire Prevention/ProtectionFire Extinguisher TrainingFire Prevention/ProtectionFire Exting Provided/InspectedFire Prevention/ProtectionApproved Fuel Containers/TrucksWelding / CuttingBottles upright/cap/securedWelding / CuttingFire ext presentWelding / CuttingReverse Flow Check Valve at Torch and Reg.

Welding / CuttingValves Closed/Gas Supply SecureWelding / CuttingCylinder IDWelding / CuttingFlash arrest at regulatorsWelding / CuttingOx/Ac cyl sep by 20' in storgWelding / CuttingWelding bootsWelding / CuttingComb. Mat. Screened from SlagWelding / CuttingEquipment Inspected DailyWelding / CuttingNo Splices/Repaired Insulation 10ft. Rod HolderWelding / CuttingWelding/Cutting Machine GroundedWelding / CuttingWorker,Watchers,Public ProtectedWelding / CuttingCylinders upright/cap/securedWelding / CuttingFlashback arrestor presentWelding / CuttingProper storage of cylindersWelding / CuttingTorch hoses good condWelding / CuttingWelding leads in good conditionWelding / CuttingWelding operation ventilatedWelding / CuttingFlash arrest on torch/guageWelding / CuttingFlash protection availableWelding / CuttingGauges working properlyWelding / CuttingAreas below wrk area prop ctrl and protWelding / CuttingHot Work PermitWelding / CuttingLeads in good conditionWelding / CuttingApprop PPE for welded material?Welding / CuttingFire Ext immedialtey accessibleWelding / CuttingCables&Hoses Clear of Ladders,etc.Welding / CuttingCompatible Fire Extinguisher AccessibleWelding / CuttingLeads Unattended Equip Shut downWelding / CuttingWelding PPE UsedWelding / CuttingWelding/Cutting/Heating, VentilatedWelding / CuttingWrk area properly ventilatedWelding / CuttingProp PPE in useWelding / CuttingProper storage of hosesWelding / CuttingTorch hoses good conditionWelding / CuttingWeld machine ventilatedHazard CommunicationsAverageHazard CommunicationsPre-Task Plan CompletedHazard CommunicationsCompetent Person PresentHazard CommunicationsCopy of programHazard CommunicationsInventory listHazard CommunicationsReadily availableHazard CommunicationsEmployees trainedHazard CommunicationsMSDS' (site specific)Hazard CommunicationsChemical Use Auth FormHazard CommunicationsEmployees trainedHazard CommunicationsMSDS Readily availableHazard CommunicationsProper labels on containers

Hazard CommunicationsProper Labels On ContainersHigh Hazard ProgramsAsbestos awareness programHigh Hazard ProgramsBack Injury Prev ProgramHigh Hazard ProgramsConfined Space ProgramHigh Hazard ProgramsSafe Ladder ProgramHigh Hazard ProgramsCorporate Fall ProgramHigh Hazard ProgramsCrane & Lift ProgramHigh Hazard ProgramsElectrical Hot Work ProgramHigh Hazard ProgramsElectrical LO/TO ProgramHigh Hazard ProgramsEnvironmental ProgramHigh Hazard ProgramsExcavation & Trenching ProgHigh Hazard ProgramsFire Protection ProgramHigh Hazard ProgramsLead Awareness ProgramHigh Hazard ProgramsTraffic Control ProgramHigh Hazard ProgramsWelding Cutting ProgramHousekeepingAverageHousekeepingClear Access to Bldg/SiteHousekeepingCords/Hoses On Floor/WalkwayHousekeepingProper Material StorageHousekeepingSlip/Trip/Fall HazardsHousekeepingMaterials secured against weatherHousekeepingCords/hoses off ground / protected HousekeepingWalkways ClearHousekeepingTools, materials and equipment stored, stacked and stableHousekeepingDesignated employee parkingHousekeepingImpalement protectionHousekeepingExits Clear/Egress Routes PostedHousekeepingExterior Access Points ProvidedHousekeepingFire Alarm/Suppression ActiveHousekeepingSCCI Housekeep policy appliedHousekeepingTemp Walls & Signage in PlaceHousekeepingRoadway around proj clearHousekeepingAccess & Egress Walkways clearHousekeepingFloor Sweep being usedHousekeepingSlip, trip, fall hazardsHousekeepingTrash in protected contHousekeepingAdeq numb of port. toiletsHousekeepingPortable toilets clean/maintHousekeepingProper use of "CAZ" idHousekeepingSanitary cleaner availableHousekeepingWork areas clear of debrisWork Environment SafetyEmployees work areas are clean, orderly and don?t present a hazardWork Environment SafetyTrash Cans Empty and not OverloadedWork Environment SafetyAre work areas free of rodents, insects and verminWork Environment SafetyEmployees are not engaged in ergonomic hazards, e.g. awkward posture, prolonged repetitive motion, contact stress, etc.

Work Environment SafetyEmployees work areas are adequately illuminated.P.P.E.AverageP.P.E.Hierarchy Of Controls UtilizedP.P.E.High Visibility clothing wornP.P.E.RespiratorsP.P.E.Glasses / face shieldsP.P.E.Safety GlassesP.P.E.Exposure To Contam AssessedP.P.E.Danger Tape/Sign AppropriateP.P.E.Caution Tape/Sign AppropriateP.P.E.Face shieldsP.P.E.High visibility vestP.P.E.Proper protective clothingP.P.E.V rated or F.R. Clothing wornP.P.E.Eye/Face ProtectionP.P.E.Hand ProtectionP.P.E.Metatarsal protectionP.P.E.Hard HatsP.P.E.Hearing ProtectionP.P.E.Rebar capsP.P.E.Reflective VestP.P.E.Foot protection are being worn?P.P.E.Proper hand prot are used when req?P.P.E.Face shield are used when required?P.P.E.Hard hats are being worn?P.P.E.Foot ProtectionP.P.E.Safety glasses are being worn?P.P.E.Proper ClothingP.P.E.Sfty vests/high viz attire being worn?P.P.E.GlovesP.P.E.Hearing prot being worn when req?P.P.E.Respirators are used when requiredP.P.E.High-Vis Reflective VestP.P.E.Proper face/eye protectionP.P.E.Safety Glasses/side shieldsP.P.E.Work BootsP.P.E.Respiratory ProtectionPPEEye and Face ProtectionPPEFall Arrest, Restrain, PositioningPPEGlovesPPESafety Workboots/Metatarsal Prot.PPEPPE Training for EmployeesPPEFall Arrest, Restrain, PositioningPPEGlovesPPEHead Protection

Work Environment SafetyEmployees are not engaged in unsafe acts, e.g. using chairs as stepstools, using multiple extension cords,

PPEHigh Visibility ApparelPPEElectrical PPEPPEProper Clothing-Pants,Shirts,etcNoise Monitoring50 FootNoise MonitoringLot LineRespiratoryMed Evaluation docRespiratoryMed questionnaire completedRespiratoryProper respirator usedRespiratoryWorkers properly fit testedRespiratoryVoluntary use Appendix DRespiratoryProper Training doc?Signs/Tags/Labels/Signals/Traff ContrApproved Traffic Control PlanSigns/Tags/Labels/Signals/Traff ContrHaul/Access Roads ApprovedSanitationToilets ProvidedSanitationCool Water ProvidedSanitationDrink Water Disp-No Cross ContamSite / Public ProtectionAverageSite / Public ProtectionTraffic Control Plan SubmittedSite / Public ProtectionWalkways ClearSite / Public ProtectionOverhead Protection In PlaceSite / Public ProtectionPublic Warning SignageSite / Public ProtectionPed Crosswalk AppropriateSite / Public ProtectionAdequate LightingSite / Public ProtectionAccess RestrictedSite / Public ProtectionPolice Detail PresentSite / Public ProtectionWalkways Delineated/ProtectedSite / Public ProtectionExcavations protectedSite / Public ProtectionSite fencesSite / Public ProtectionCompany rep presentSite / Public ProtectionConstruction Mgt PlanSite / Public ProtectionSCCI Public protection signageSite / Public ProtectionSecurity system in placeSite / Public ProtectionBarricades installed properlySite / Public ProtectionSite FencingSite / Public ProtectionFalling object protectionSite / Public ProtectionHand Wash Site / Public ProtectionImpalement ProtectionSite / Public ProtectionPerimeter fencesSite / Public ProtectionPublic protection signageSite / Public ProtectionRestroomsSite / Public ProtectionTraffic Control planSite / Public ProtectionStreet closure identifiedSteel ErectionAnchorage points meet reqSteel ErectionControlled Decking Zone UsedSteel ErectionFall Protection Training ProvSteel ErectionRigger/Connector Training ProvSteel ErectionMult lift/rig/con training

Steel ErectionDeck Turnover Proced followedSteel ErectionFall Protection at Heights >6'Steel ErectionMult lift proced utilizedSteel ErectionStruct flooring requirementsSteel Erection2 bolts per connectionSteel ErectionAdequate site conditionsSteel ErectionAnchor bolts certificationSteel ErectionDecking securedSteel ErectionErector notif of modificationSteel ErectionFalling object protectionSteel ErectionProper anch of colmns/beamSteel ErectionProper erection planSteel ErectionFall pro training providedSteel ErectionSite layout / sequence planSteel ErectionWritten approv conc strengthSteel ErectionConcrete @ 75%Steel ErectionFalling Object Protection ProvSteel ErectionProper anchorage pointsSteel ErectionSite Layout/Sequence Plan ProvSteel ErectionCDZ training / utilizedSteel ErectionCertified or Qualified RiggerSteel ErectionLoads not swung over the public/workersConcrete/Masonry/Steel ErectionFall Prot. for Masonry > 6'Concrete/Masonry/Steel ErectionImpalement Hazards ControlledConcrete/Masonry/Steel ErectionFall Prot. for Steel Erectors > 6'Concrete/Masonry/Steel ErectionSafety latches on Hooks OperableConcrete/Masonry/Steel ErectionRigging Insp. Daily by Qual. RiggerSteel ErectionDocumentation of concrete strengthSteel ErectionApprv'd Steel Erect Start FormSteel ErectionCritical Pick ChecklistSteel ErectionEmergency crane useSteel ErectionFall Protection PlanSteel ErectionRigging Inspected Daily & MonthlySteel ErectionSteel Erection Checklist on fileSteel ErectionStructural flooring requirementsScaffoldsAverageScaffoldsPre-Task Plan CompletedScaffoldsTagging system in useScaffoldsWheels locked, as applicableScaffoldsScaffold fall protection planScaffoldsSCCI Mast Climber Plcy in placeScaffoldsProper Height to base ratioScaffoldsScaffold engineering planScaffoldsPump jacks erected properlyScaffoldsSafe work dist from pwr lines

ScaffoldsInspected daily by comp personScaffoldsProp secured to structureScaffoldsAdequate Debris ContainmentScaffoldsOutriggers used, as applicableScaffoldsGuardrails in place @ 6'ScaffoldsCompetent Person PresentScaffoldsErection/Dismantling Fall ProtScaffoldsGuardrails InstalledScaffoldsInspected daily and is taggedScaffoldsPlank in good cond,no cracks/damageScaffoldsSill, plates, jacks installedScaffoldsFalling Object ProtectionScaffoldsMast-Climber Proc SubmittedScaffoldsDaily Inspection Cond/DocuScaffoldsAccess To Scaffold AppropriateScaffoldsInitial Inspection Condu/DocuScaffoldsBracing And Pins In PlaceScaffoldsCompatible Components UsedScaffoldsFully PlankedScaffoldsProper Loading Of MaterialsScaffoldsSills, Plates, Jacks InstalledScaffoldsGuardrail in place @ 6'ScaffoldsBracing and pins in placeScaffoldsCompatible components usedScaffoldsProperly secured to structureScaffoldsCompetent person doing Daily InspectionsScaffoldsDaily Pre-Task PlanScaffoldsVertical Safety lines protected / securedScaffoldsGuardrail & Toe Boards ScaffoldsInspected dailyScaffoldsClimbing mast scaffoldScaffoldsDaily scaftag inspect. sysScaffoldsGrdrls instll on Baker at 4'ScaffoldsPlatforms fully plankedScaffoldsScaffold-grade plank usedScaffoldsSills,plates,jacks installedScaffoldsSurface in safe conditionScaffoldsWheels locked/securedScaffoldsSwing scaffolds ScaffoldsUsers trained/doc?sScaffoldsFall Protection PlanScaffoldsProper access to platformsScaffoldsProper loading of materialsScaffoldsSafe work distancesScaffoldsSills,plates,jacks installedScaffoldsSurface in safe conditionScaffoldsSwing staging erected properly

ScaffoldsWheels LockedScaffoldsDaily Inspection of ScaffoldsScaffoldsProper Fall ProtectionScaffoldsSurface In Safe Condition

Weight135

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Project name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / Stairs

Project name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / Stairs

Project name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / Stairs

Project name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Ladders / StairsProject name Contractor name Medical / EmergencyProject name Contractor name Medical / EmergencyProject name Contractor name Medical / EmergencyProject name Contractor name Medical / EmergencyProject name Contractor name Medical / EmergencyProject name Contractor name Medical / EmergencyProject name Contractor name Medical / EmergencyProject name Contractor name Medical / EmergencyProject name Contractor name Medical / EmergencyProject name Contractor name Motorized EquipmentProject name Contractor name Motorized EquipmentProject name Contractor name Motorized EquipmentProject name Contractor name Motorized EquipmentProject name Contractor name Motorized Equipment

Project name Contractor name Motorized EquipmentProject name Contractor name Motorized EquipmentProject name Contractor name Motorized EquipmentProject name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name P.P.E.Project name Contractor name Scaffolds

Project name Contractor name ScaffoldsProject name Contractor name ScaffoldsProject name Contractor name ScaffoldsProject name Contractor name ScaffoldsProject name Contractor name ScaffoldsProject name Contractor name ScaffoldsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial Lifts

Project name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial Lifts

Project name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial Lifts

Project name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial Lifts

Project name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Scissor / Aerial LiftsProject name Contractor name Site / Public ProtectionProject name Contractor name STA QualityProject name Contractor name STA QualityProject name Contractor name STA QualityProject name Contractor name STA QualityProject name Contractor name STA QualityProject name Contractor name STA QualityProject name Contractor name STA QualityProject name Contractor name STA QualityProject name Contractor name STA QualityProject name Contractor name STA QualityProject name Contractor name STA QualityProject name Contractor name STA QualityProject name Contractor name STA QualityProject name Contractor name STA QualityProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / CuttingProject name Contractor name Welding / Cutting

Sub-Category Inspection Date InspectorCompetent person ID'ed/present Date Inspector nameCompetent person ID'ed/present Date Inspector nameDocument pre-const mtgs Date Inspector nameDocument pre-const mtgs Date Inspector nameDrug Testing program Date Inspector nameDrug Testing program Date Inspector nameDrug Testing program Date Inspector nameDrug Testing program Date Inspector nameFreq/reg safety inspections Date Inspector nameFreq/reg safety inspections Date Inspector nameIncentive/Recognition Program Date Inspector nameJHA submitted each trade Date Inspector nameJHA submitted each trade Date Inspector nameNew Empl Orientations held Date Inspector nameNew Empl Orientations held Date Inspector nameNew Empl Orientations held Date Inspector nameSafety meetings Date Inspector nameSTA submitted each trade Date Inspector nameSub Toolbox Meetings Date Inspector nameVisitor PPE available Date Inspector nameVisitor PPE available Date Inspector nameVisitor sign-in form Date Inspector nameVisitor sign-in form Date Inspector nameCircuits labeled Date Inspector nameCords in good condition Date Inspector nameCords in good condition Date Inspector nameCords in good condition Date Inspector nameCords in good condition Date Inspector nameCords in good condition Date Inspector nameCords in good condition Date Inspector nameCords in good condition Date Inspector nameCords in good condition Date Inspector nameCords in good condition Date Inspector nameCords in good condition Date Inspector nameCords in good condition Date Inspector nameCords in good condition Date Inspector nameCords protected from traffic Date Inspector nameCords protected from traffic Date Inspector nameCords protected from traffic Date Inspector nameCords protected from traffic Date Inspector nameCords protected from traffic Date Inspector nameCords protected from traffic Date Inspector nameCords protected from traffic Date Inspector nameElect Hot Work Procedures Date Inspector nameElectrical room protected Date Inspector nameElectrical room protected Date Inspector name

Electrical room protected Date Inspector nameElectrical room protected Date Inspector nameElectrical room protected Date Inspector nameElectrical room protected Date Inspector nameElectrical room protected Date Inspector nameElectrical room protected Date Inspector nameEnergized parts protected Date Inspector nameEnergized parts protected Date Inspector nameEnergized parts protected Date Inspector nameEquipment firmly mounted Date Inspector nameEquipment firmly mounted Date Inspector nameGFCI's used Date Inspector nameGFCI's used Date Inspector nameLO/TO procedures Date Inspector nameLO/TO procedures Date Inspector nameProper use temp pwr bxs Date Inspector nameProper use temp pwr bxs Date Inspector nameProper use temp pwr bxs Date Inspector nameProper use temp pwr bxs Date Inspector nameProper use temp pwr bxs Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector nameQuarterly cord insp current Date Inspector name

Quarterly cord insp current Date Inspector nameSignage present Date Inspector nameTemp lghts installed/guarded Date Inspector nameTemp lghts installed/guarded Date Inspector nameTemp lghts installed/guarded Date Inspector nameTemp lghts installed/guarded Date Inspector nameTemp lghts installed/guarded Date Inspector nameTemp lghts installed/guarded Date Inspector nameTemp lghts installed/guarded Date Inspector nameTemp lghts installed/guarded Date Inspector nameTemp lghts installed/guarded Date Inspector nameAdequate ventilation Date Inspector nameAdequate ventilation Date Inspector nameAdequate ventilation Date Inspector nameDust control measures Date Inspector nameFall protection at 6' Date Inspector nameFall protection at 6' Date Inspector nameFall protection plan Date Inspector nameFall protection plan Date Inspector nameHarness and lanyard insp/doc's Date Inspector nameEmergency vehicle access Date Inspector nameExt charged and inspected Date Inspector nameExt charged and inspected Date Inspector nameExt charged and inspected Date Inspector nameExt charged and inspected Date Inspector nameExt charged and inspected Date Inspector nameExt charged and inspected Date Inspector nameFire suppression equip avail Date Inspector nameFire watch when applicable Date Inspector nameHot work permits Date Inspector nameHydrants/Water supply Date Inspector nameSmoking Date Inspector nameTemp heaters Date Inspector nameProper use of rigging Date Inspector nameSofteners used Date Inspector nameAssur Equip. Grnd?g/Current color Date Inspector nameAssur Equip. Grnd?g/Current color Date Inspector nameAssur Equip. Grnd?g/Current color Date Inspector nameCord in good condition Date Inspector nameCord in good condition Date Inspector nameCord in good condition Date Inspector nameCord in good condition Date Inspector nameCord in good condition Date Inspector nameCord in good condition Date Inspector nameDouble Insulated tool Date Inspector nameDouble Insulated tool Date Inspector nameDouble Insulated tool Date Inspector nameDouble Insulated tool Date Inspector name

Ground prong in place Date Inspector nameGround prong in place Date Inspector nameGround prong in place Date Inspector nameGuards in place Date Inspector nameGuards in place Date Inspector nameGuards in place Date Inspector nameGuards in place Date Inspector nameInformation label on tool Date Inspector namePowder actuated cert Date Inspector nameProper tool for the job Date Inspector nameProper tool for the job Date Inspector nameProper tool for the job Date Inspector nameProper tool for the job Date Inspector nameProper tool for the job Date Inspector nameTool in good condition Date Inspector nameTool in good condition Date Inspector nameTool in good condition Date Inspector nameTool in good condition Date Inspector nameTool in good condition Date Inspector nameTool in good condition Date Inspector nameTool in good condition Date Inspector nameEyes on task Date Inspector nameEyes on task Date Inspector nameEyes on task Date Inspector nameEyes on task Date Inspector nameEyes on task Date Inspector nameGloves in good condition Date Inspector nameGloves in good condition Date Inspector nameGloves in good condition Date Inspector nameGloves in good condition Date Inspector nameGloves in good condition Date Inspector nameGloves in good condition Date Inspector nameGood grips on tools Date Inspector nameHands off load Date Inspector nameHands off load Date Inspector nameProper fit of glove Date Inspector nameProper fit of glove Date Inspector nameProper fit of glove Date Inspector nameProper fit of glove Date Inspector nameProper fit of glove Date Inspector nameAdeq numb of port. toilets Date Inspector nameAdeq numb of port. toilets Date Inspector nameAdeq numb of port. toilets Date Inspector nameAdeq numb of port. toilets Date Inspector nameClear access to bldg/site Date Inspector namePortable toilets clean/maint Date Inspector namePortable toilets clean/maint Date Inspector namePortable toilets clean/maint Date Inspector name

Portable toilets clean/maint Date Inspector namePortable toilets clean/maint Date Inspector namePortable toilets clean/maint Date Inspector namePortable toilets clean/maint Date Inspector nameProper material storage Date Inspector nameProper material storage Date Inspector nameRoadway around proj clear Date Inspector nameSanitary cleaner available Date Inspector nameSanitary cleaner available Date Inspector nameSanitary cleaner available Date Inspector nameSlip, trip, fall hazards Date Inspector nameSlip, trip, fall hazards Date Inspector nameTrash in protected cont Date Inspector nameTrash in protected cont Date Inspector nameTrash in protected cont Date Inspector nameTrash in protected cont Date Inspector nameTrash in protected cont Date Inspector nameTrash in protected cont Date Inspector nameTrash in protected cont Date Inspector nameTrash in protected cont Date Inspector nameWalkways clear Date Inspector nameWalkways clear Date Inspector nameWalkways clear Date Inspector nameWalkways clear Date Inspector nameWalkways clear Date Inspector nameWork areas clear of debris Date Inspector nameWork areas clear of debris Date Inspector nameWork areas clear of debris Date Inspector nameWork areas clear of debris Date Inspector nameWork areas clear of debris Date Inspector nameWork areas clear of debris Date Inspector nameWork areas clear of debris Date Inspector nameWork areas clear of debris Date Inspector nameClear of debris/materials Date Inspector nameClear of debris/materials Date Inspector nameClear of debris/materials Date Inspector nameClear of debris/materials Date Inspector nameClear of debris/materials Date Inspector nameClear of debris/materials Date Inspector nameClear of debris/materials Date Inspector nameClear of debris/materials Date Inspector nameClear of debris/materials Date Inspector nameClear of debris/materials Date Inspector nameClear of debris/materials Date Inspector nameClear of debris/materials Date Inspector nameClear of debris/materials Date Inspector nameClear of debris/materials Date Inspector nameClear of debris/materials Date Inspector name

Clear of debris/materials Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector name

Inspected for defects Date Inspector nameInspected for defects Date Inspector nameInspected for defects Date Inspector nameJob-blt ldrs const properly Date Inspector nameJob-blt ldrs const properly Date Inspector nameJob-blt ldrs const properly Date Inspector nameLadder req?d type/capacity Date Inspector nameLadder req?d type/capacity Date Inspector nameLadder req?d type/capacity Date Inspector nameLadder req?d type/capacity Date Inspector nameLadder req?d type/capacity Date Inspector nameLadder req?d type/capacity Date Inspector nameLadder req?d type/capacity Date Inspector nameLadder req?d type/capacity Date Inspector nameLadder req?d type/capacity Date Inspector nameLadder req?d type/capacity Date Inspector nameLadder req?d type/capacity Date Inspector nameLadder req?d type/capacity Date Inspector nameLadder req?d type/capacity Date Inspector nameLadder req?d type/capacity Date Inspector nameLadder req?d type/capacity Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector name

Ladders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders in good condition Date Inspector nameLadders secured Date Inspector nameLandings and treads filled Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector name

Proper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameProper use of ladder Date Inspector nameRails at stairs/landings Date Inspector nameSafe work dist from hazd Date Inspector nameSafe work dist from hazd Date Inspector nameSafe work dist from hazd Date Inspector nameSafe work dist from hazd Date Inspector nameSafe work dist from hazd Date Inspector nameSafe work dist from hazd Date Inspector nameSafe work dist from hazd Date Inspector nameSafe work dist from hazd Date Inspector nameSlip trip exposure elim Date Inspector nameSlip trip exposure elim Date Inspector nameSlip trip exposure elim Date Inspector nameSlip trip exposure elim Date Inspector nameSlip trip exposure elim Date Inspector nameSlip trip exposure elim Date Inspector nameSlip trip exposure elim Date Inspector nameSlip trip exposure elim Date Inspector nameSlip trip exposure elim Date Inspector nameStairs illuminated Date Inspector name1st aid kit Date Inspector name1st aid kit Date Inspector name1st Aid/CPR on site Date Inspector nameExit Signs Date Inspector nameExit Signs Date Inspector nameEye wash Date Inspector nameLight Duty Program in place Date Inspector nameMap to medical facility Date Inspector nameOccupational Clinic estab Date Inspector nameFire ext. chg'd/present Date Inspector nameFire ext. chg'd/present Date Inspector nameFire ext. chg'd/present Date Inspector nameFire ext. chg'd/present Date Inspector nameHorn functioning Date Inspector name

Horn functioning Date Inspector nameHorn functioning Date Inspector nameHorn functioning Date Inspector nameFace shields Date Inspector nameHearing protection Date Inspector nameHearing protection Date Inspector nameHearing protection Date Inspector nameProper protective clothing Date Inspector nameProper protective clothing Date Inspector nameProper protective clothing Date Inspector nameProper protective clothing Date Inspector nameProper protective clothing Date Inspector nameProper protective clothing Date Inspector nameProper protective clothing Date Inspector nameRespirators Date Inspector nameRespirators Date Inspector nameRespirators Date Inspector nameRespirators Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameSafety Glasses Date Inspector nameV rated or F.R. Clothing worn Date Inspector nameCompetent person present Date Inspector name

Guardrails in place @ 6' Date Inspector nameGuardrails in place @ 6' Date Inspector nameProper loading of materials Date Inspector nameSafe work distances Date Inspector nameSurface in safe condition Date Inspector nameWheels locked/secured Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameEquipment loaded properly Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector name

Gate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameGate or chain secured Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameHarness while in lifts Date Inspector nameInspections Annual/Preshift doc's Date Inspector nameInspections Annual/Preshift doc's Date Inspector nameInspections Annual/Preshift doc's Date Inspector nameInspections Annual/Preshift doc's Date Inspector nameInspections Annual/Preshift doc's Date Inspector nameInspections Annual/Preshift doc's Date Inspector nameInspections Annual/Preshift doc's Date Inspector nameInspections Annual/Preshift doc's Date Inspector nameInspections Annual/Preshift doc's Date Inspector nameInspections Annual/Preshift doc's Date Inspector nameInspections Annual/Preshift doc's Date Inspector nameInspections Annual/Preshift doc's Date Inspector nameInspections Annual/Preshift doc's Date Inspector nameInspections Annual/Preshift doc's Date Inspector nameInspections Annual/Preshift doc's Date Inspector name

Inspections Annual/Preshift doc's Date Inspector nameInspections Annual/Preshift doc's Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameNothing to increase height Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperating on flat surface Date Inspector nameOperator certificate/license Date Inspector nameOperator certificate/license Date Inspector nameOperator certificate/license Date Inspector nameOperator certificate/license Date Inspector nameOperator certificate/license Date Inspector nameOperator certificate/license Date Inspector nameOperator certificate/license Date Inspector name

Operator certificate/license Date Inspector nameOperator certificate/license Date Inspector nameOperator certificate/license Date Inspector nameOperator certificate/license Date Inspector nameOperator certificate/license Date Inspector nameOperator certificate/license Date Inspector nameOperator certificate/license Date Inspector nameOperator certificate/license Date Inspector nameOperator certificate/license Date Inspector nameOperator certificate/license Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameOperator training Date Inspector nameSafe work distances Date Inspector nameSafe work distances Date Inspector nameSafe work distances Date Inspector nameSafe work distances Date Inspector nameSafe work distances Date Inspector nameSafe work distances Date Inspector nameSafe work distances Date Inspector nameSafe work distances Date Inspector nameSafe work distances Date Inspector nameSafe work distances Date Inspector nameSafe work distances Date Inspector nameSafe work distances Date Inspector nameSafe work distances Date Inspector nameSafe work distances Date Inspector nameSafe work distances Date Inspector nameSurface free of holes Date Inspector nameSurface free of holes Date Inspector nameSurface free of holes Date Inspector nameSurface free of holes Date Inspector nameSurface free of holes Date Inspector nameSurface free of holes Date Inspector name

Surface free of holes Date Inspector nameSurface free of holes Date Inspector nameSurface free of holes Date Inspector nameSurface free of holes Date Inspector nameSurface free of holes Date Inspector nameSurface free of holes Date Inspector nameSurface free of holes Date Inspector nameSurface free of holes Date Inspector nameSurface free of holes Date Inspector nameSurface free of holes Date Inspector nameAdequate lighting Date Inspector nameControl steps being followed Date Inspector nameCrew knowledgeable of hazards and controls Date Inspector nameCrew knowledgeable of hazards and controls Date Inspector nameJob tasks clearly identified Date Inspector nameJob tasks clearly identified Date Inspector nameSTA includes specific hazards for each task Date Inspector nameSTA prepared at the work location Date Inspector nameSTA prepared at the work location Date Inspector nameSTA prepared at the work location Date Inspector nameSTA prepared at the work location Date Inspector nameSTA references rescue plan, emergency #'s, evacuation map/AssemblDate Inspector nameSTA reviewed as conditions change Date Inspector nameSTA reviewed by supervisor Date Inspector nameSTA signed by all crew members prior to beginning work Date Inspector nameBottles upright/cap/secured Date Inspector nameBottles upright/cap/secured Date Inspector nameBottles upright/cap/secured Date Inspector nameBottles upright/cap/secured Date Inspector nameBottles upright/cap/secured Date Inspector nameCylinder ID Date Inspector nameFire ext present Date Inspector nameFire ext present Date Inspector nameFire ext present Date Inspector nameFire ext present Date Inspector nameFire ext present Date Inspector nameFire ext present Date Inspector nameFire ext present Date Inspector nameGauges working properly Date Inspector nameProp PPE in use Date Inspector nameTorch hoses good cond Date Inspector nameTorch hoses good cond Date Inspector nameTorch hoses good cond Date Inspector nameTorch hoses good cond Date Inspector nameTorch hoses good cond Date Inspector nameTorch hoses good cond Date Inspector nameTorch hoses good cond Date Inspector name

Severity AntecedDone? ActionDue / CoSeverity Ranking Weighted Unsafes0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

Low CommuniNo Responsible Par 1 1Medium In Past, Yes Employee Insp 3 3Low Yes 1 1Low Yes 1 1Low Yes Supervisor 1 1

0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

0 00 00 00 00 00 00 00 00 00 00 0

Low InadequYes Responsible Pa 1 10 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

Low Lack of Yes 1 10 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

Low ExternalNo Responsible Pa 1 10 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

Medium Yes Employee Trai 3 30 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

0 00 00 0

Medium Yes Employee Prov 3 30 00 00 0

Low Lack of Yes 1 10 00 00 00 00 00 00 00 00 00 0

Low CommuniNo Responsible Par 1 1Low Lack of Yes 1 1Low Lack of Yes 1 1Low Lack of Yes 1 1Low Yes Employee 1 1Medium Yes Employee 3 3Low Yes 1 1Low Lack of Yes 1 1Medium Yes 3 3

0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

Low Yes Sub Contractor 1 10 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

Medium ExternalYes Supervisor Fix 3 3Medium ExternalYes Supervisor Fix 3 3

0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

0 00 00 00 0

Low CommuniNo Responsible Par 1 1High Correct Yes Employee Trai 5 5Low Lack of Yes 1 1Medium Lack of Yes Employee Prot 3 3

0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

0 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

0 00 00 00 00 00 00 00 00 00 0

Low ExternalYes Responsible Par 1 10 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 00 0

48

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1304