JOBSITE SAFETY REPORT Company: Project/Job: Location: Site Contact: Position: Acme Construction, LLC County Courthouse Addition Omaha, NE Bob Jones Superintendent Inspection Date: August 16, 2011 Scope of Work: Two-story addition to County Courthouse. Approximately 15 workers from multiple trades on site (plumbers, carpenters, masonry, mechanical, erectors, etc.). Score: 98.25% Observations: Aerial Lifts Yes No Workers tied off to boom or basket? (1926.453) 2 0 Operator(s) trained and authorized? (1926.453) 2 0 Both feet on floor of basket? (1926.453) 2 0 Midrail chain/gate used when working in aerial lifts? (1926.501) 1 0 Cranes/Rigging Yes No No visible defects affecting safe operation? (1926.1412) 1 0 Workers not allowed under suspended load? (1926.1501) 3 0 Outriggers/cribbing used when needed? (1926.1501) 1 0 Radius guard installed on crane? (1926.1501) 1 0 Tag lines used on loads that swing freely? (1926.1501) 1 0 Rigging equipment in good condition? (1926.1501) 4 0 Lift capacities marked on rigging equipment? (1926.1501) 4 0 Electrical Yes No Equipment installed/used as listed or labeled? (1926.403) 1 0 Path to ground permanent and continuous? (1926.403) 2 0 GFCI on 120V, single-phase, 15/20 amp receptacle outlets? (1926.404) 2 0 Worn/frayed extension cords not used? (1926.416) 4 0 Light bulbs protected from accidental contact/breakage? (1926.405) 1 0 Temporary lights not suspended by electric cords? (1926.405) 1 0 Breakers/switches legibly marked to indicate purpose? (1926.403) 1 0 Access to electrical rooms limited/restricted? (1926.416) 1 0 Electrical panels/circuits fully enclosed? (1926.405) 2 0 1
Fall Protection Yes No Fall protection provided when working above 6 feet? (1926.501) 5 0 Guardrail height at 42 inches (+/-3)? (1926.502) 2 0 Guardrails capable of withstanding 200 lb. force? (1926.502) 2 0 Toeboards erected to prevent falling objects? (1926.502) 2 0 Harnesses maintained in good condition? (1926.502) 3 0 Harnesses worn/fitted properly? (1926.502) 3 0 Lanyards in good condition/no defects? (1926.502) 3 0 Correct lanyard used for the job? (1926.502) 3 0 Suitable anchorage provided for personal fall arrest system? (1926.502) 3 0 Warning line 6 feet back from roof edge? (1926.502) 1 0 Warning line erected on all open sides? (1926.502) 1 0 Warning line flagged and suspended at proper height? (1926.502) 1 0 Fire Safety Yes No Fire extinguishers maintained in operating condition? (1926.150) 3 0 Fire extinguisher readily accessible, within 100 feet? (1926.150) 1 0 Minimum one fire extinguisher per floor? (1926.150) 1 0 Approved/UL listed fire extinguishers provided? (1926.150) 3 0 Flammables stored in approved/closed containers? (1926.152) 2 0 Housekeeping Yes No Good housekeeping maintained throughout? (1926.25) 0 1 Job trailer clean and reasonably organized? (1926.25) 1 0 Material staging area kept reasonably organized? (1926.25) 1 0 No protruding nails on unused lumber? (1926.250) 1 Comment(s): Better housekeeping is needed in bathroom remodel area. Also, several boards, scrap lumber on west end of building had protruding nails that need to be removed or bent down. Ladders/Stairs Yes No Ladders inspected/no visible defects? (1926.1053) 4 0 Side rails extend 3 feet above landing surface? (1926.1053) 2 0 Ladders set up at proper angle? (1926.1053) 2 0 Ladders secured to prevent side slip? (1926.1053) 2 0 Stairs/ladder/ramp used at elevation break of 19+ inches? (1926.1051) 1 0 Handrails on stairs with 4 or more risers? (1926.1052) 1 0 Spreaders used/fully engaged on stepladders? (1926.1053) 1 0 Area at top and bottom of ladder kept clear? (1926.1053) 2 0 Medical/FA Services Yes No First aid supplies easily accessible when required? (1926.50) 1 0 Adequate first aid supplies provided? (1926.50) 1 0 2
Emergency numbers conspicuously posted? (1926.50) 1 0 Location of nearest medical facilities known/posted? (1926.50) 1 0 MSDS/Chemical Safety Yes No MSDS for hazardous chemicals readily available? (1910.1200) 1 0 Hazardous chemicals properly labeled? (1910.1200) 3 0 PPE Yes No PPE maintained in sanitary/reliable condition? (1926.28) 2 0 Replacement PPE readily available? (1926.28) 1 0 Eye protection used as required? (1926.102) 1 Hard hats worn as required? (1926.100) 4 0 Hand Protection worn when needed? (1926.28) 4 0 Safety footwear worn as needed? (1926.96) 4 0 Comment(s): A couple sub-contractors were not wearing safety glasses. They immediately put them on upon being reminded of company policy. Postings/Safety Signs Yes No OSHA Workplace Poster posted? (1903.2) 1 0 Emergency numbers/contacts posted? (Best Practice) 1 0 Danger/warning signs posted as needed? (1926.200) 1 0 Safety Training Yes No Toolbox talks completed weekly? (1926.21) 1 0 Toolbox talks documented? (Best Practice) 1 0 Only qualified equipment/machinery operators? (1926.20) 2 0 Equipment/machine operator training documented? (1926.20) 2 0 Safety Orientation Training provided? (1916.21) 1 0 Sanitation Yes No Adequate supply of potable water provided? (1926.51) 1 0 Containers for drinking water marked/not used for other purpose? 1 (1926.51) 0 Common drinking cup prohibited? (1926.51) 1 0 1 toilet/urinal per 40 workers when more than 20 at jobsite? (1926.51) 1 0 Tools (Hand & Power) Yes No Hand and power tools in safe operating condition? (1926.300) 4 0 Guards in place/functional on power tools? (1926.300) 1 0 Power tools double-insulated or grounded? (1926.302) 3 0 Handles free of splinters/cracks and kept tight in tool? (1926.301) 2 0 Grinders equipped with safety guards? (1926.303) 1 0 Circular saws adequately guarded? (1926.304) 1 0 Hand-fed ripsaw adequately guarded? (1926.304) 1 0 3
Trenching/Excavation Yes No Competent Person completes daily inspection? (1926.651) 1 0 Sloping/benching adequate for soil type? (1926.652) 1 0 Spoils/material/equipment set back 2 feet from edge? (1926.651) 1 0 Travel distance to egress no more than 25 feet? (1926.651) 1 0 Utilities located/identified prior to start of excavation? (1926.651) 1 0 Signs/barricades provided when trench is unoccupied? (5a1) 1 0 Manual/visual test used to confirm soil classification? (1926.651) 1 0 Welding & Cutting Yes No Regulators/gauges in proper working order? (1926.350) 2 0 Welding hoses in good condition? (1926.350) 2 0 Fire extinguishing equipment in close proximity? (1926.352) 1 0 Fuel gas cylinders separated from oxygen cylinders? (1926.350) 1 0 Valve caps in place when stored/transported? (1926.350) 1 0 Cylinders secured in upright position? (1926.350) 3 0 Cylinder valves closed when work is finished? (1926.350) 3 0 Cylinders maintained in good condition? (1926.350) 3 0 Miscellaneous Yes No Construction areas properly illuminated? (1926.56) 1 0 Protruding rebar ends guarded? (1926.701) 1 0 Frequent/regular inspections of the jobsite completed? (1926.20) 1 0 Closing Comments: Housekeeping and PPE issues will be addressed by the Superintendent. He scheduled a meeting with subs in the afternoon to go over this report. Submitted by: John Doe, CSP Loss Control Consultant JobsiteReports.com (402) 555-1234 john.doe@jobsitereports.net 4
Jobsite Picture(s): Remove protruding nails from scrap lumber Poor housekeeping in restroom remodel area Safety glasses not worn by plumber 5