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ASSESSMENT PROFILE SHEET

ASSESSMENT DATE: Check One With "X"

SUB:
OPER. CO.: SELF PERFORM:

CLIENT NAME: CONSTRUCTION MGMT (CM)

ASSESSOR(S) LABOR POSTURE ACTIVITY

Type Name/Location Here OPEN SHOP CONSTRUCTION

Type Name/Location Here MERIT SHOP MAINTENANCE

Type Name/Location Here UNION

Type Name/Location Here OTHER

PROJECT INFORMATION
PROJECT NAME:
PROJECT NUMBER:

PROJECT MANAGER:
SITE MANAGER:
SAFETY MGR/REP:

PROJECT LOCATION:
CITY:
STATE:
ZIP: COUNTY

PROJECT REGION
Check With "X"

AMERICAS AFRICA EAST US NLA CANADA


ASIA PACIFIC EUROPE WEST US SLA CARIBBEAN
AUSTRAILIA MID EAST CENTRAL US CENTRAL AMER. OTHER

ASSESSMENT TYPE
Check One With "X"

GENERAL REQUESTED BY PROJECT


CONSULTATION POST ACCIDENT (Non-Fatal)
POST FATALITY FOLLOW-UP (Post Failure)
REQUESTED BY CLIENT OTHER

INJURY SUMMARY

Total LWC's - Project To Date: Total Recordables - Project To Date:


Total LWC's - Since Last Audit: Total Recordables - Since Last Audit:
FINAL SCORE SHEET

PROJECT NAME: MTH/DAY/YR


MTH/DAY/YR

PROJECT MANAGER: DISTRIBUTION (NAME/LOCATION)


DISTRIBUTION (NAME/LOCATION)
PROJECT NUMBER: DISTRIBUTION (NAME/LOCATION)
DISTRIBUTION (NAME/LOCATION)
ASSESSOR(S)

IMMINENT
IMMINENTDANGER
DANGERREDUCTION
REDUCTION
( (IDR
ASSESSMENT
ASSESSMENTSCORE
SCORESUMMARY
SUMMARY IDR) )
FINAL SCORE
COMPLIANCE
91.85 MAX POSSIBLE ASSESSED TOTAL
COMPLIANCE
SCORE
STANDARD
ACHIEVED

ADMINISTRATIVE 296.0 291.00 98.31 YES

Imminent Danger
FIELD EXECUTION 647.0 575.10 88.89 YES A. Instances
= 0

15% of Assessed
SUBTOTAL 943.0 866.10 91.85 YES B. Subtotal
= 129.92

IDR POINTS (SUBTRACT) 0.00 C. IDR Points ( A x B ) = 0.00

TOTAL 943.0 866.10 91.85 YES

10/26/2017
Score Summary
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SAFETY AUDIT
DETAILED ASSESSMENT SCORE SUMMARY
ADMINISTRATION

SCORE SET STANDARD REDUCTION

MAXIMUM ASSESSED MINIMUM MET / REPEAT IMMINENT


SECTION SECTION NAME
POSSIBLE TOTAL STANDARD NOT MET DEFICIENCY DANGER
1 Occupational health & safety policy statement 14.0 14.0 11.2 MET 0 0
2 Safety and medical recordkeeping practices 22.0 22.0 17.6 MET 0 0
3 Emergency preparedness 28.0 28.0 22.4 MET 0 0
4 Infectious diseases 30.0 30.0 24.0 MET 0 0
5 Hazard communication program 42.0 38.0 33.6 MET 0 0
6 Mobil Equipment 28.0 28.0 22.4 MET 0 0
7 Inspection Procedures 24.0 24.0 19.2 MET 0 0
8 Respiratory protection 12.0 11.0 9.6 MET 0 0
9 Enforcement and discipline 10.0 10.0 8.0 MET 0 0
10 Education and training 18.0 18.0 14.4 MET 0 0
11 Performance indicators 17.0 17.0 13.6 MET 0 0
12 Accident / incident investigation 9.0 9.0 7.2 MET 0 0
13 Contractors 22.0 22.0 17.6 MET 0 0
14 Safety Task Assignment (STA) 9.0 9.0 7.2 MET 0 0
15 Regulatory agency inspection / contact 8.0 8.0 6.4 MET 0 0
16 Claims Management 3.0 3.0 2.4 MET 0 0
17 Process Safety Management (PSM) 0.0 0.0 0.0 MET 0 0
18 Substance Abuse Program 0.0 0.0 0.0 MET 0 0
19 Strategic Initiatives 0.0 0.0 0.0 MET 0 0

TOTALS 296.0 291.0 207.2 MET 0 0

10/26/2017
Administration Summary 3
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SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

OCCUPATIONAL HEALTH &


1
SAFETY POLICY STATEMENT
A Policy statement is in writing. 1.0 1.0 100.0%
B Policy statement is dated. 1.0 1.0 100.0%

C A site specific safety plan has been developed. 1.0 1.0 100.0%

D Health & Safety objectives are clearly stated. 1.0 1.0 100.0%

E Health & Safety responsibilities are defined. 1.0 1.0 100.0%

The Site Specific Safety Plan has been


F 1.0 1.0 100.0%
approved / accepted by project management.

All contractors have been given a copy of the


G 2.0 2.0 100.0%
Site Specific Safety Plan.

Management commitment to safety is stated


H 1.0 1.0 100.0%
and communicated to all employees.

A current and complete copy of the Corporate


I APS manual is located on site and available to 2.0 2.0 100.0%
all members of management and supervision.

The project has implemented a safety incentive


J program for all site employees, including 1.0 1.0 100.0%
contractors and subcontractors.

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


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SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

OCCUPATIONAL HEALTH &


1 SAFETY POLICY STATEMENT
(cont'd)
The projects' safety incentive plans are in writing
K and have been approved by project 1.0 1.0 100.0%
management
The Pre-job accident prevention planning
L checklist (Corp. APS Manual) has been properly 1.0 1.0 100.0%
utilized.
M Other 0.0 0.0

TOTAL 14.0 14.0 100.0% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

SAFETY AND MEDICAL


2
RECORDKEEPING PRACTICES
Injury statistics are tabulated and utilized to
A 1.0 1.0 100.0%
identify positive / negative trends.
Mandatory regulatory injury and illness record
B
keeping.
The injury and illness log is available / utilized /
1 2.0 2.0 100.0%
accurate.
2 The previous years records are available. 2.0 2.0 100.0%
Employees first report of injury, or approved
3 equivalent form, is on file for each recorded 2.0 2.0 100.0%
injury or illness.
The injury and illness log corresponds with the
4 1.0 1.0 100.0%
corporate MAER statistics.
Employees Occupational Injury / Illness report
C 2.0 2.0 100.0%
form utilized.
D First Aid log utilized / current / accurate. 1.0 1.0 100.0%
Required First Aid supplies are available / stored
E 2.0 2.0 100.0%
/ dispensed in an approved manner.

Prescription medications are available / stored /


F 2.0 2.0 100.0%
dispensed with approval of medical doctor.

Person(s) administering First Aid are trained and


G 2.0 2.0 100.0%
certified.

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


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SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

SAFETY AND MEDICAL


2 RECORDKEEPING PRACTICES
(cont'd)
Employee exposure and medical records are
H 2.0 2.0 100.0%
maintained.
Return to work forms, or similar documentation
I with the attending physicians signature, are on 2.0 2.0 100.0%
file.

J All medical files are complete and organized. 1.0 1.0 100.0%

K Other

TOTAL 22.0 22.0 100.0% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

3 EMERGENCY PREPAREDNESS
A The Emergency Plan:
1 Is in writing. 2.0 2.0 100.0%
2 Communicated to all project employees 2.0 2.0 100.0%
3 The plan is site specific. 2.0 2.0 100.0%

4 Incorporates clients emergency procedures. n/a 0.0 #VALUE!

B There is a coordinator appointed. 2.0 2.0 100.0%


Supervisor First Aid training has been
C 2.0 2.0 100.0%
conducted.
Required emergency lighting and power are
D 2.0 2.0 100.0%
available.
Required emergency rescue equipment is
E 2.0 2.0 100.0%
available.
Emergency response members have been
F 2.0 2.0 100.0%
identified and trained.
Radios and other communication items are
G 2.0 2.0 100.0%
available.
Periodic emergency evacuation drills are
H 2.0 2.0 100.0%
conducted for all employees.
The plan includes a method of accounting for all
I employees after an emergency evacuation 2.0 2.0 100.0%
occurs.

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


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SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

EMERGENCY PREPAREDNESS
3
(cont'd)

Employees have a working knowledge of


J Emergency / Evacuation Procedures, Escape 2.0 2.0 100.0%
Routes and Emergency Notification Process.

Emergency evacuation signs or exit signs are


K posted where required and are adequately 2.0 2.0 100.0%
visible.
Key personnel and contact numbers are
L 2.0 2.0 100.0%
reviewed and updated on a monthly basis.
M Other 0.0 0.0

TOTAL 28.0 28.0 100.0% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


10/26/2017
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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

4 INFECTIOUS DISEASES
A written exposure control plan has been
A 2.0 2.0 100.0%
established.
Employees who have potential to come in
B contact with an infectious disease have been 2.0 2.0 100.0%
identified and trained.
Hepatitis B vaccination has been offered to
C 2.0 2.0 100.0%
those employees having potential exposure.

The medical treatment facility is maintained in a


D clean and sanitary condition and a cleaning 2.0 2.0 100.0%
schedule has been established.

Hand-washing facilities and procedures are


E 2.0 2.0 100.0%
established and utilized.
Employees exposed to blood or other bodily
F 3.0 3.0 100.0%
fluids utilize the P.P.E. required.
Surgical gloves, masks, eye / face and
G 3.0 3.0 100.0%
protective clothing are available.
H Bag valve masks are readily available. 3.0 3.0 100.0%
Sharps or syringes are placed in a labeled
I puncture- resistant, leak-proof container for 3.0 3.0 100.0%
disposal as required.
Equipment and instruments are immediately
J 3.0 3.0 100.0%
disinfected after each use.

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

4 INFECTIOUS DISEASES (cont'd)

Contaminated disposable objects or materials


(bloody bandages, etc.) are placed in a leak-
K
proof, puncture-resistant, red biohazard
3.0 3.0 100.0%
container for disposal as required.

Training related to infectious diseases safety


L and vaccinations given / refused is adequately 2.0 2.0 100.0%
documented.
M Other 0.0 0.0

TOTAL 30.0 30.0 100.0% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

HAZARD COMMUNICATION
5
PROGRAM
A Written Program:
1 Site specific 2.0 2.0 100.0%

2 There is a designated program administrator. 2.0 2.0 100.0%

3 Identifies labels and warning methods. 2.0 2.0 100.0%


Identifies methods of informing employees of
4 2.0 2.0 100.0%
non-routine tasks.
For multi-employer sites, communication
5 2.0 2.0 100.0%
between contractors (Re: Hazcom)
6 Procurement is involved. 2.0 2.0 100.0%
B Record keeping:

1 The inventory list is in place / current / complete. 2.0 2.0 100.0%

2 The MSDS file is in place / current / complete. 2.0 2.0 100.0%

3 Records of all Hazcom training on file. 2.0 2.0 100.0%


4 The written Hazcom plan is on file. 2.0 2.0 100.0%
Test results on file from Hazcom training
5 2.0 0.0 0.0%
sessions.
C Training includes:

1 OSHA requirements /standards on Hazcom. n/a 0.0 #VALUE!

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


10/26/2017
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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

HAZARD COMMUNICATION
5
PROGRAM (cont'd)

2 Fluor Daniel Hazcom program requirements. 2.0 2.0 100.0%

3 Labeling system. 2.0 2.0 100.0%


4 Location of MSDS's 2.0 2.0 100.0%
5 Use of MSDS 2.0 2.0 100.0%
6 Personal Protection Equipment 2.0 2.0 100.0%
7 Non-routine tasks 2.0 2.0 100.0%
8 Refresher / annual up date training 2.0 0.0 0.0%
Copies of on site contractor Hazcom programs
D 2.0 2.0 100.0%
are available.

Employees are knowledgeable of the Hazcom


E n/o 0.0 #VALUE!
program based on responses to questions.

Vessels and material containers are labeled as


F 2.0 2.0 100.0%
required.
Hazard information posters / signs are displayed
G 2.0 2.0 100.0%
to inform employees.
H Other 0.0 0.0

TOTAL 42.0 38.0 90.5% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


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** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

MOBILE EQUIPMENT
6
OPERATIONS
There is a maintenance schedule for all mobile
A 2.0 2.0 100.0%
equipment and the schedule is followed.

Daily pre-operational inspections are performed


B 2.0 2.0 100.0%
on all equipment.
Annual inspections are performed on all
C 2.0 2.0 100.0%
equipment (cranes certified).
Mobile equipment accidents are investigated
D 1.0 1.0 100.0%
and reported.
Suspended work baskets are certified as safe
E 3.0 3.0 100.0%
and utilized for personnel as required.
Suspended work baskets are built according to
F 3.0 3.0 100.0%
approved designs.

Suspended work baskets are labeled as


required to show maximum weight capacity,
G 3.0 3.0 100.0%
maximum number of persons allowed and total
basket weight (actual empty weight).

Permits are utilized and retained for suspended


H 3.0 3.0 100.0%
work basket usage.

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


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SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

MOBILE EQUIPMENT
6
OPERATIONS (cont'd)
Critical lift permits are utilized in accordance
I 3.0 3.0 100.0%
with corporate policy.
A load test has been performed that established
J a safety factor of 2 times for the suspended 3.0 3.0 100.0%
work basket.

Operator certification program is utilized for


K 3.0 3.0 100.0%
aerial lifts, heavy equipment and vehicles.

L Other 0.0 0.0

TOTAL 28.0 28.0 100.0% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


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SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

7 INSPECTION PROCEDURES
Regular safety inspections of the site / operation
A 2.0 2.0 100.0%
are conducted and documented.
Inspection program has been implemented for
B
the following:
1 Power tools 2.0 2.0 100.0%

2 Assured grounding and electrical cords / leads 2.0 2.0 100.0%

3 Fire extinguishers 2.0 2.0 100.0%


4 Ladders 2.0 2.0 100.0%
5 Scaffolds 2.0 2.0 100.0%
6 Rigging /Hoisting equipment and devices 2.0 2.0 100.0%
7 Fall protection equipment and devices 2.0 2.0 100.0%
8 Emergency and rescue equipment n/o 0.0 #VALUE!
9 Excavations 2.0 2.0 100.0%

10 Temporary electrical distribution installations 2.0 2.0 100.0%

11 Electrical (ARC) welding equipment 2.0 2.0 100.0%


There is a follow-up procedure established for
C the correction of deficiencies noted during 2.0 2.0 100.0%
inspections.
D Other 0.0 0.0

TOTAL 24.0 24.0 100.0% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


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SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

8 RESPIRATORY PROTECTION
There is a written respiratory protection program
which addresses the respiratory protection
A 2.0 2.0 100.0%
exposure / need as required, or a written
respirator use assessment.

Fit testing is provided for all employees required


B 2.0 2.0 100.0%
to wear respirators (both APR's and SAR's).

Employees are offered at least 2 different


C n/a 0.0 #VALUE!
makes, models and sizes of respirators.
Documentation of respirator selection criteria is
D available (i.e. air sample results, calculations, 2.0 2.0 100.0%
etc.)

Respiratory protection training is conducted,


E 2.0 2.0 100.0%
documented, and validated by testing.

Records of training, medical assessment and fit


F testing are available, and meet confidentiality 2.0 2.0 100.0%
requirement.
Seal checks are performed and documented
G n/o 0.0 #VALUE!
each time respirators are used.
Breathing air for supplied air respirators meets
H breathing air requirements. Sample results are n/o 0.0 #VALUE!
available.

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


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SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

RESPIRATORY PROTECTION
8
(cont'd)
If a breathing air compressor is used, it is
equipped with a proper filtration system, Co
I n/o 0.0 #VALUE!
Alarm, reserve air tank and compressor failure
alarm.
Hose couplings used with supplied air
J respirators are incompatible with other n/o 0.0 #VALUE!
couplings.

K Breathing air cylinders are labeled as required. n/a 0.0 #VALUE!

Respiratory protection equipment is properly


L n/a 0.0 #VALUE!
cleaned, sanitized, and stored after being used.

Periodic inspections are performed and


M documented to ensure that all elements of the 2.0 1.0 50.0%
written program are effective.

TOTAL 12.0 11.0 91.7% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


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SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)
ENFORCEMENT AND
9
DISCIPLINE
Employee Health & Safety responsibilities have
A 2.0 2.0 100.0%
been communicated to all employees.

Supervisor Health & Safety responsibilities have


B 2.0 2.0 100.0%
been communicated to all supervisors.

Records of employee safety related discipline


C are maintained. (i.e. verbal / written warning, 2.0 2.0 100.0%
retraining, termination, etc. )

Disciplinary action is initiated by supervision


D 2.0 2.0 100.0%
when unsafe acts and conditions occur.

The record of disciplinary action is consistent


E with the record of incidents and accidents where 2.0 2.0 100.0%
disciplinary action was warranted.

F Other 0.0 0.0

TOTAL 10.0 10.0 100.0% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


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SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

10 EDUCATION AND TRAINING


New employee orientation is provided for
A 2.0 2.0 100.0%
employees.
Safety training programs are conducted for
B 2.0 2.0 100.0%
management and supervisors .
C Task specific training is conducted. 2.0 2.0 100.0%
Safety meetings are conducted for all
D 2.0 2.0 100.0%
employees, supervisors and management.
Emergency preparedness and evacuation
E 2.0 2.0 100.0%
training is in place.
F Visitor safety induction program is in place. 2.0 2.0 100.0%
Training records are maintained in good order
G 2.0 2.0 100.0%
for all employee safety training.
Testing performed to assure employee
H 2.0 2.0 100.0%
understanding of safety training programs.
All site supervisors have attended Safety
I 2.0 2.0 100.0%
Leadership Training (SLT).
J Other 0.0 0.0

TOTAL 18.0 18.0 100.0% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


10/26/2017
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SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

11 PERFORMANCE INDICATORS
There has not been a fatal injury in the
A 10.0 10.0 100.0%
workplace during the past six months.
The year-to-date lost time injury frequency rate
B 3.0 3.0 100.0%
is zero.
The year-to-date recordable incidence rate is at
or below the current corporate goal.
C 3.0 3.0 100.0%
Actual, ytd _________ Current
Goal __________
Contractor / Subcontractor Experience is
D 1.0 1.0 100.0%
reported and measured.
E Other 0.0 0.0

TOTAL 17.0 17.0 100.0% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


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SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

ACCIDENT / INCIDENT
12
INVESTIGATION
A There is a written accident / incident policy. 1.0 1.0 100.0%
Accident / incident policy complies with local
B 2.0 2.0 100.0%
regulatory reporting requirements.
C A standard investigation format is used. 1.0 1.0 100.0%
Serious injury and fatal injury accidents are
D communicated to management personnel, 1.0 1.0 100.0%
expeditiously as required.
All lost time injury reports are reviewed by site
E 1.0 1.0 100.0%
management.

There is a remedial follow-up and action plan to


F 2.0 2.0 100.0%
prevent recurrent of accidents / incidents.

Accident / incidents information is shared with


G 1.0 1.0 100.0%
other operations / projects.
H Other 0.0 0.0

TOTAL 9.0 9.0 100.0% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


10/26/2017
22
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

13 CONTRACTORS
Written qualifications are established for the
A 2.0 2.0 100.0%
selection of contractors.
Past Health & Safety performance is factored
B 2.0 2.0 100.0%
into contractor selection.
Contractors are required to provide a copy of
C 1.0 1.0 100.0%
their safety program.
Prior to starting work on-site, contractors are
D 2.0 2.0 100.0%
provided site orientation.
Prior to starting work on-site, contractors are
E provided the operations health and safety rules, 2.0 2.0 100.0%
and emergency procedures.
Prior to starting work on-site, contractors are
F made aware of any chemicals they may 2.0 2.0 100.0%
encounter on-site.
Prior to bringing any chemicals on-site,
contractors are required to inform safety of the
G 2.0 2.0 100.0%
chemicals and provide a material safety data
sheet (MSDS).
Contractors are required to follow the same
H health and safety rules as Fluor Daniel 2.0 2.0 100.0%
employees.
I Safety violations are properly documented. 2.0 2.0 100.0%

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


10/26/2017
23
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

13 CONTRACTORS (cont'd)

Corrective action taken by subcontractors to


J 2.0 2.0 100.0%
correct violation and is properly documented

Contractors are required to utilize the FD STA


K 3.0 3.0 100.0%
process (or equivalent program).
L Other 0.0 0.0

TOTAL 22.0 22.0 100.0% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


10/26/2017
24
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

SAFETY TASK ASSIGNMENT


14
(STA)
A Employees are given STA by their supervisors 3.0 3.0 100.0%

The Safety Task Assignment form or equivalent


B 3.0 3.0 100.0%
is being used.

Employees questioned about the STA process


C n/o 0.0 #VALUE!
where knowledgeable of the requirement.

Evidence of STA planning / instruction is visible


D 3.0 3.0 100.0%
in the field.
E Other 0.0 0.0

TOTAL 9.0 9.0 100.0% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


10/26/2017
25
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

REGULATORY AGENCY
15
INSPECTION / CONTACT
Two members of management have been
identified as project representatives to
A 1.0 1.0 100.0%
participate in regulatory agency visits /
inspections.

The management members selected to


B represent the project during regulatory agency
visits have been trained in the following topics.

1 Opening Conference 1.0 1.0 100.0%


2 Walk around /inspection phase 1.0 1.0 100.0%
3 Records /note taking 1.0 1.0 100.0%
4 Tests n/a 0.0 #VALUE!
5 Photographs n/a 0.0 #VALUE!
6 Employee interview procedures 1.0 1.0 100.0%
7 Closing conference 1.0 1.0 100.0%
8 Post inspection report 1.0 1.0 100.0%
9 Corporate notification 1.0 1.0 100.0%
C Other 0.0 0.0

TOTAL 8.0 8.0 100.0% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


10/26/2017
26
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

16 CLAIMS MANAGEMENT
A Project has established Company physicians. 1.0 1.0 100.0%

Employees' First Report of Injury filed with


B n/a 0.0 #VALUE!
insurance carrier within 24 hours.
Employees have been notified in writing of their
C responsibility to report a Workers' n/a 0.0 #VALUE!
Compensation claim.
Modified Work / Restricted Work program
D 1.0 1.0 100.0%
established and implemented at Project.
Project Management is pro-Active in Post Injury
E follow up and to express their concern for the 1.0 1.0 100.0%
injured employee.
F Other 0.0 0.0

TOTAL 3.0 3.0 100.0% 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


10/26/2017
27
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

PROCESS SAFETY
17
MANAGEMENT (PSM)
Known fire, explosion, and toxic release hazards
have been communicated to employees who
A n/a 0.0 #VALUE!
are working on or around covered equipment or
processes.

Applicable provisions of the plant emergency


B action and evacuation plan has been n/a 0.0 #VALUE!
communicated to all affected employees.

Site safe work practices have been


C n/a 0.0 #VALUE!
communicated to all affected employees.
Affected employees have been trained in all of
the above listed procedures and practices.
D Testing procedures to ensure employee n/a 0.0 #VALUE!
competency and understanding have been
established.
E Other 0.0 0.0

TOTAL 0.0 0.0 #DIV/0! 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


10/26/2017
28
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

18 SUBSTANCE ABUSE PROGRAM


The project has an approved Substance Abuse
A Prevention Policy and Project Specific n/a 0.0 #VALUE!
Procedures.

The project conducts post-offer / pre-placement


B n/a 0.0 #VALUE!
testing for all new / rehire employees.

C The project conducts random screening. n/a 0.0 #VALUE!


The project conducts post accident and for
D n/a 0.0 #VALUE!
cause testing.
All contractors / subcontractors are required to
E adhere to the Corporate substance abuse n/a 0.0 #VALUE!
prevention program.
F The project includes testing for alcohol. n/a 0.0 #VALUE!
G Other 0.0 0.0

TOTAL 0.0 0.0 #DIV/0! 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


10/26/2017
29
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

19 STRATEGIC INITIATIVES
A The strategies 2000 manual is available on site. n/a 0.0 #VALUE!

Section 1 - Contractor prequalification


B evaluation process has been implemented as n/a 0.0 #VALUE!
required.
Section 2. - Accountability programs have been
C n/a 0.0 #VALUE!
implemented as required.
Section 3 - Pre-bid, pre-mobilization alignments
D for subcontractors has been implemented and n/a 0.0 #VALUE!
required.

Section 4 - Safety resources for subcontractors


E n/a 0.0 #VALUE!
has been implemented as required.

Section 5 - Safety orientation guidelines for


F subcontractors has been implemented as n/a 0.0 #VALUE!
required.
Section 6 - Safety Task Assignment (STA) for
G subcontractors has been implemented as n/a 0.0 #VALUE!
required.

Section 7 - Scaffold guidelines for subcontractor


H n/a 0.0 #VALUE!
has been implemented as required.

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


10/26/2017
30
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
ADMINISTRATION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)
STRATEGIC INITIATIVES
19
(cont'd)
Section 8 - Fall hazard management for
I subcontractors has been implemented as n/a 0.0 #VALUE!
required.
Section 9 - Remote travel and driver safety
J guidelines for subcontractors has been n/a 0.0 #VALUE!
implemented as required.
Section 10 - heavy haulage vehicle safety for
K subcontractors has been implemented as n/a 0.0 #VALUE!
required.
Section 11 - Safety training has been
L n/a 0.0 #VALUE!
implemented as required.
Section 12 - Corporate management ownership
M for subcontractors has been implemented as n/a 0.0 #VALUE!
required.

TOTAL 0.0 0.0 #DIV/0! 0 0

* REPEATED DEFICIENCIES = -10 MAX POSSIBLE


10/26/2017
31
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF THE ASSESSMENT SCORE
SAFETY AUDIT
DETAILED ASSESSMENT SCORE SUMMARY
FIELD EXECUTION

SCORE SET STANDARD REDUCTION

MAXIMUM ASSESSED MINIMUM MET / REPEAT IMMINENT


SECTION SECTION NAME
POSSIBLE TOTAL STANDARD NOT MET DEFICIENCY DANGER
1 Housekeeping 15.0 7.0 12 NOT MET 0 0
2 Health & Hygiene 26.0 21.0 20.8 MET 0 0
3 Work Area Lighting 9.0 9.0 7.2 MET 0 0

MET
4 Personal Protective Equipment (P.P.E.) 61.0 55.0 48.8 0 0
5 Hand Tools 13.0 13.0 10.4 MET 0 0
6 14.0 14.0 11.2 MET 0 0
7 Power Tools and Power Equipment 13.0 12.5 10.4 MET 0 0
8 Hot Work (Welding, Heating, Burning) 63.0 62.0 50.4 MET 0 0
9 Electrical 51.0 46.3 40.8 MET 0 0
10 Equipment Operations 123.0 95.0 98.4 NOT MET 0 0
11 Excavation and Trenching 30.0 30.0 24 MET 0 0
Steel Erection and Floor and Wall
12 7.0 7.0 5.6 MET 0 0
Opening
13 Material Handling Storage 19.0 18.0 15.2 MET 0 0
14 Signs, Signals, Barricades 22.0 20.0 17.6 MET 0 0
15 Fire Prevention and Protection 30.0 30.0 24 MET 0 0
Ladders, Scaffolds, and Elevated Work
16 94.0 93.3 75.2 MET 0 0
Platforms
Concrete, Concrete Forms, Shoring,
17 20.0 20.0 16 MET 0 0
Masonry
18 Demolition 15.0 0.0 12 NOT MET 0 0
19 Blasting - Use of Explosives 0.0 0.0 0 MET 0 0
20 High-Pressure Water Cleaning 0.0 0.0 0 MET 0 0
21 Confined Spaces 22.0 22.0 17.6 MET 0 0

TOTALS 647.0 575.1 517.6 MET 0 0

369816543.xls 32 10/26/2017
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

1 HOUSEKEEPING
Work areas are clean and free of excess trash /
A 3.0 1.0 33.3%
debris.
Provisions have been made for routing trash
B 1.0 1.0 100.0%
collection and disposal.

C Trash receptacles are provided in all work areas, 1.0 1.0 100.0%
and one is present at each water keg.
Scrap lumber is free of protruding nails or other
D 2.0 1.0 50.0%
puncture hazards.
Glass containers are prohibited, none were
E 2.0 1.0 50.0%
observed.
Electrical cords, hoses, welding leads, etc., are
F 3.0 1.0 33.3%
elevated to prevent tripping hazards.

G Butt cans, where used, are maintained free of n/o 0.0 #VALUE!
combustible material and emptied routinely.
Elevated areas are maintained clear of debris,
H material, tools, etc., where such items could fall 3.0 1.0 33.3%
to areas below.
Drip pans are utilized for oil dispensing locations
I and under threading machines and saws where n/o 0.0 #VALUE!
lubricant could drip
J Other 0.0 0.0

TOTAL 15.0 7.0 46.7% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


33
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

2 HEALTH & HYGIENE


The required number of toilets are provided (1
A 2.0 2.0 100.0%
toilet for every 29 workers).
Provisions for servicing / cleaning toilets has
B 2.0 2.0 100.0%
been made.
Toilets are kept clean and sanitary. Toilet paper
C 2.0 2.0 100.0%
is in place.
Washing facilities are available for worker use
D 2.0 2.0 100.0%
prior to lunch / breaks when required.
Vermin (rodents, insects, etc.) control is
E 2.0 2.0 100.0%
provided.
Ventilation in work areas is provided for the type
F 2.0 1.0 50.0%
of work being performed.
Local exhaust ventilation is used where
G 2.0 1.0 50.0%
necessary.

There are designated areas where employees


H can eat lunch / dinner in a sanitary environment 2.0 1.0 50.0%
separate from any toilet facility and not exposed
to toxic materials.
Lunch / dinner areas / facilities are clean and
I 2.0 1.0 50.0%
kept clean on a regular basis.
A common drinking cup is not allowed, individual
J 2.0 1.0 50.0%
cups are provided.

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


34
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

2 HEALTH & HYGIENE (cont'd)


The required supply of drinking water is
K 2.0 2.0 100.0%
provided and conveniently located.

L Where water kegs are used they are clean, 2.0 2.0 100.0%
labeled, as required and used only for drinking.
Water kegs are sealed to prevent / indicate
M 2.0 2.0 100.0%
tamerping
N Other 0.0 0.0

TOTAL 26.0 21.0 80.8% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


35
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

3 WORK AREA LIGHTING


Required lighting is provided for the work being
A 3.0 3.0 100.0%
performed.
Portable light plants are maintained and kept
B 1.0 1.0 100.0%
operational.
Portable light plants are positioned to provide
C 1.0 1.0 100.0%
maximum lighting where required.
Portable light plants are easily moved and
D 1.0 1.0 100.0%
positioned.
Portable light plant masts are easily raised and
E 3.0 3.0 100.0%
lowered.
F Other 0.0 0.0

TOTAL 9.0 9.0 100.0% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


36
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

PERSONAL PROTECTIVE
4
EQUIPMENT (P.P.E.)
A Head Protection
1 Worn where required. 3.0 3.0 100.0%
2 Bills worn to the front. 2.0 2.0 100.0%
Hard Hat suspension systems maintained in a
3 2.0 2.0 100.0%
safe manner.
Hard hats are free from cracks, holes or any
4 2.0 2.0 100.0%
damage
B Eye Protection
1 Worn where required. 2.0 2.0 100.0%
2 Side shields required and used. 2.0 2.0 100.0%
Lens cleaning stations and material are
3 n/a 0.0 #VALUE!
provided.
4 Face shields are worn when required. 2.0 2.0 100.0%
Signs are posted at bench grinders "Face
5 n/a 0.0 #VALUE!
shields required."
Safety glasses or goggles are worn under face
6 2.0 2.0 100.0%
shields or welding shields.
C Fall Protection
Safety harness is required and used where fall
1 4.0 4.0 100.0%
exposure > 2 meters is present. (6ft)

2 3.0 3.0 100.0%


Lanyard are equipped with shock absorbers.

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


37
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

PERSONAL PROTECTIVE
4
EQUIPMENT (P.P.E.) (cont'd)
Lanyards hooks are provided with locking safety
3 4.0 4.0 100.0%
latch to prevent "Roll Out".

4 Lanyards are secured to a substantial object - 4.0 4.0 100.0%


fall distance is maintained to a minimum.
Fall protection equipment is only used for fall
5 3.0 3.0 100.0%
protection
Static / catenary lines are installed to facilitate
6 tie-off and will support a force of 2,450 kgs. 4.0 4.0 100.0%
(5400 lbs.)
Fall protection equipment is inspected on a
7 1.0 1.0 100.0%
regular basis and tagged accordingly.
D Hearing Protection
Noise areas are posted as areas where hearing
1 n/o 0.0 #VALUE!
protection is required.
Noise surveys are performed periodically and
2 2.0 2.0 100.0%
documented.
Hearing protection is properly worn where and
3 2.0 2.0 100.0%
when required.
E Foot and Toe Protection

1 2.0 2.0 100.0%


Appropriate foot wear is worn by all employees
2 Steel toe protection is used where required 3.0 3.0 100.0%

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


38
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

PERSONAL PROTECTIVE
4
EQUIPMENT (P.P.E.) (cont'd)
Hand protection is provided by gloves that are
F selected according to specific hazards, 2.0 2.0 100.0%
anticipated or present.
Employees working near heavy equipment
G operations wear high visibility and reflective 3.0 3.0 100.0%
safety vests.
Employees working non-daylight hours are
H provided with reflective striped clothing, vests or 3.0 0.0 0.0%
other high visibility material.
Employees working non-daylight hours have
I 3.0 0.0 0.0%
reflective tape on their hard hats.

J All employees receive information and/or 1.0 1.0 100.0%


training on the proper use and care of PPE.
Emergency eye wash and shower stations are
K n/a 0.0 #VALUE!
clearly marked and not obstructed.
L Other 0.0 0.0

TOTAL 61.0 55.0 90.2% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


39
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

5 HAND TOOLS
Correct tools are used for the work being
A 3.0 3.0 100.0%
performed.
B Tools are used in an approved manner. 3.0 3.0 100.0%
C Tools are carried and stored properly. 1.0 1.0 100.0%
Chisels, hammer wrenches and other "striking
D tools" are dressed at the striking end to prevent 3.0 3.0 100.0%
"mushrooming".
Job made / home made tools are prohibited and
E 3.0 3.0 100.0%
none were observed.
F Other 0.0 0.0

TOTAL 13.0 13.0 100.0% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


40
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

6 POWDER ACTUATED TOOLS


Employees using powder actuated tools have
A 3.0 3.0 100.0%
been trained and certified.

B 3.0 3.0 100.0%


Correct load strengths are known and used.
Loads are removed while the tool is stored or
C 3.0 3.0 100.0%
left unattended.
Proper P.P.E. is worn by the tool operator while
D using the tool. Proper P.P.E. includes hard hat, n/o 0.0 #VALUE!
face shield, safety glasses and hearing
protection.
The tool and all loads are stored in a locked
E 1.0 1.0 100.0%
cabinet.
The tool and all loads are issued only to trained
F 3.0 3.0 100.0%
and certified employees.

G The tool is inspected on a regular basis and 1.0 1.0 100.0%


tagged to show that it has been inspected.
H Other 0.0 0.0

TOTAL 14.0 14.0 100.0% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


41
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

POWER TOOLS AND POWER


7
EQUIPMENT
All power tools are inspected on a regular basis
A and tagged to show that they have been 1.0 1.0 100.0%
inspected.
Required safety guards are in place and
B 3.0 3.0 100.0%
functional.
Work rests on bench grinders are adjusted
C n/o 0.0 #VALUE!
within 3mm of the wheel.
Wheels on bench and stand grinders are
D n/o 0.0 #VALUE!
dressed as required.
Discs on portable grinders are compatible with
E 3.0 3.0 100.0%
the equipment's maximum RPM's.

F Electrical cords are elevated, protected, or 3.0 2.5 83.3%


otherwise arranged so as to prevent damage to
the cord or create a tripping hazard.
Employees are trained and certified (When
G 3.0 3.0 100.0%
required) in safe operation of power tools.
H Other 0.0 0.0

TOTAL 13.0 12.5 96.2% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


42
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

HOT WORK (Welding, Heating,


8
Burning)

Hot work on or near areas or processes that


A involve flammable, combustible or explosive 4.0 4.0 100.0%
materials or chemicals is performed under a
safe work or hot work permit.

B A fire extinguisher is immediately available and 3.0 3.0 100.0%


operable at all Hot Work locations.

C Welding screens are used around all ground or 2.0 2.0 100.0%
floor level arc welding operations.
Arc welding is performed with a required
D 3.0 3.0 100.0%
electrical ground.

E Welding cables and ground cables are free of 3.0 3.0 100.0%
damage and non-insulated connections.
Welding cables and ground cables are
F 2.0 2.0 100.0%
inspected on a regular basis.

G Where cables are suspended or secured, they 2.0 2.0 100.0%


are done so by using non-conductive materials.
Cables, cords, and hoses are elevated or
H 3.0 2.5 83.3%
protected to prevent tripping hazards.
Compressed gas cylinders are labeled as
I 3.0 3.0 100.0%
required.
Compressed gas cylinders are stored and
J 3.0 2.5 83.3%
capped as required.

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


43
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** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

HOT WORK (Welding, Heating,


8
Burning) (cont'd)
Reverse flow or flash back arrestors are used
K 3.0 3.0 100.0%
on all oxygen/acetylene rigs.
Regulator gauges are attached as required and
L 3.0 3.0 100.0%
in good condition.
Compressed gas cylinder valves are turned off
M 3.0 3.0 100.0%
when not in use.
N Strikers are used to light torches. 3.0 3.0 100.0%
Welding rods are stored as required and rod
O stubs are placed in a container to prevent a 2.0 2.0 100.0%
tripping hazard.
Welding rods are not left in the
P 3.0 3.0 100.0%
electrode/rodholder while not in use.
Compressed gas cylinders are located outside
Q of closed areas and are not exposed to slag or 3.0 3.0 100.0%
sparks.
Gas cylinders are moved and transported in the
R 3.0 3.0 100.0%
required manner.
Hot slag and sparks are maintained and
S controlled as required to prevent fires and 3.0 3.0 100.0%
contact with employees.

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


44
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

HOT WORK (Welding, Heating,


8
Burning) (cont'd)
Required P.P.E. is worn for the hot work activity
T being performed or immediately exposed to, 3.0 3.0 100.0%
including eye protection, clothing, gloves, and
respirator if needed.
Oxygen / acetylene hoses are maintained free
U 2.0 2.0 100.0%
of oil and grease.
Compressed gas hoses are inspected and are
V 2.0 2.0 100.0%
free of damage.
Compressed gas cylinders are properly secured
W 2.0 2.0 100.0%
to prevent displacement.
X Other 0.0 0.0

TOTAL 63.0 62.0 98.4% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


45
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

9 ELECTRICAL
Electrical equipment is marked as to the amount
A 3.0 3.0 100.0%
of voltage and the control source.

B The required "lock out - tag out " procedure is 4.0 4.0 100.0%
implemented where circuits are de-energized
due to maintenance, repair or other activity.
Employees performing low, medium, or high
C n/a 0.0 #VALUE!
voltage work are trained and certified.
Protective gear (rubber gloves, blankets, hot
D sticks, etc.) are inspected by an independent n/a 0.0 #VALUE!
testing firm.
Tests are performed to determine if current
E 4.0 2.0 50.0%
carrying parts are "Hot" or De-energized
All line parts are guarded or protected against
F 4.0 2.0 50.0%
contact.
GFCI controlled outlets and panels are labeled
G 2.0 2.0 100.0%
and tested
Electrical cords are inspected and approved for
H the type of usage and are free of breaks in the 3.0 3.0 100.0%
insulation.
Outlets, receptacles, junction boxes, etc., are
I 3.0 3.0 100.0%
approved and maintained as required.
Where electrical cords are suspended or
J secured, they are done so by using non- 2.0 2.0 100.0%
conducting materials.
Electrical cords are elevated over passage
K ways, or are protected from damage when 3.0 2.5 83.3%
crossing roads or passage ways.

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


46
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

9 ELECTRICAL (cont'd)
Temporary lighting is installed as required using
L 3.0 3.0 100.0%
approved materials.
Light bulbs and fluorescent tubes are guarded
M 2.0 2.0 100.0%
as required.
Buried temporary electrical cables are marked
N on the surface to avoid accidental contact from 3.0 3.0 100.0%
drilling / excavating.

O Electrical plugs are maintained in good condition 3.0 3.0 100.0%


and are the proper type for voltage / amperage /
grounding requirements
All temporary electrical outlets, receptacles,
P junction boxes and panels are electrically 3.0 3.0 100.0%
grounded
All electrical tools are quipped with a ground
R 3.0 3.0 100.0%
conductor or are double insulated.

S Strain relief is provided for all cords or cables 3.0 2.8 93.3%
that prevents pull from being directly transmitted
to joints or terminal screws.
Cord repairs meet or exceed the original
T insulation and are performed by a qualified 3.0 3.0 100.0%
person.
U Other 0.0 0.0

TOTAL 51.0 46.3 90.8% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


47
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

10 EQUIPMENT OPERATIONS
A Crane Operations
Load charts are posted and utilized and
1 3.0 3.0 100.0%
operators manuals are available.
The swing radius of the counter weight is
2 3.0 3.0 100.0%
barricaded.

3 The crane is operated level with all outriggers 3.0 3.0 100.0%
fully extended on adequate outrigger pads.
Moving and travel practices are utilized to
4 3.0 3.0 100.0%
include the use of a flagger.
The operator is trained and certified for the
5 3.0 3.0 100.0%
specific crane being operated.
Specific attention to power line clearance is
6 n/a 0.0 #VALUE!
given.
Flagman is used to signal crane operators when
7 raising, lowering and swinging the hook, loaded 3.0 3.0 100.0%
or unloaded.
An anti-two-block limit switch is in place and
8 3.0 3.0 100.0%
functional on all cranes.
Crane, hook and hoist equipment is free from
9 4.0 4.0 100.0%
defects.
Operator determines weight of load prior to
10 3.0 3.0 100.0%
performing lift.
Operator determines weight of load prior to
11 3.0 0.0 0.0%
performing lift.

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


48
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

EQUIPMENT OPERATIONS
10
(cont'd)
B General Equipment
Operator is Certified as competent for
1 3.0 0.0 0.0%
equipment operation
Seat belts are provided and used with ROP
2 2.0 1.0 50.0%
structures.
3 All lights are operational 2.0 2.0 100.0%
4 Horns are operational 3.0 3.0 100.0%
5 Back-up alarms are operational. 3.0 3.0 100.0%

6 3.0 3.0 100.0%


Equipment is operated at a safe travel speed.
Flagmen are used to signal equipment
7 operators working in confined or congested 3.0 3.0 100.0%
areas.

8 Seat belts are worn by driver and all passengers 3.0 3.0 100%
in equipment provided with seat belts.
C Haulage Operations

1 Elevated fill areas/roads are identified or 3.0 0.0 0.0%


protected by cones, berms and/or guard rails.
2 Traffic flow is regulated and enforced. 3.0 0.0 0.0%
3 Speed limits are posted and observed. 3.0 0.0 0.0%

All Vehicles are clearly identified as Project


4 vehicles and have Project ID Numbers 2.0 0.0 0.0%
displayed.

5 Refueling maintenance activities are performed 2.0 0.0 0.0%


away from haulage road traffic areas.

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


49
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** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

EQUIPMENT OPERATIONS
10
(cont'd)
Haulage roads are maintained in good
6 2.0 0.0 0.0%
condition.
Dust is controlled to minimize haulage road
7 2.0 0.0 0.0%
hazards.
Dust control is implemented effectively when
8 3.0 3.0 100.0%
and where required.
D Rigging Equipment
1 Approved rigging practices are used. 3.0 3.0 100.0%
Rigging equipment is maintained and free of
2 3.0 3.0 100.0%
damage, excess wear or defect.
All crane and sling hooks are equipped with a
3 3.0 3.0 100.0%
functional safety latch.
Regular inspections of rigging equipment are
4 performed and the equipment is tagged 1.0 1.0 100.0%
accordingly.
The throat of load hooks are measured
5 2.0 2.0 100.0%
periodically to detect change in hook gap.
6 Cable clamps are installed properly 2.0 2.0 100.0%

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


50
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

EQUIPMENT OPERATIONS
10
(cont'd)
E Warning Methods
Reflective triangles are provided for all
1 equipment and vehicles, that operate on roads 2.0 0.0 0.0%
either on site or off-site.
Reflective triangles are employed to warn of
2 equipment breakdown / accident or road n/a 0.0 #VALUE!
hazards as required.

3 Flashing lights and/or strobes are used on all 2.0 0.0 0.0%
slow moving vehicles that operate in the vicinity
of large excavation and haulage equipment.
F Helicopter Operations

1 Helicopter landing areas provide required n/a 0.0 #VALUE!


clearance for rotors away from trees, buildings,
roadways, utilities, poles and overhead wires.

2 n/a 0.0 #VALUE!


Loose debris is kept clear of the landing area.
Required landing pad lighting is provided and
3 n/a 0.0 #VALUE!
operable for night operations.
A wind sock or wind direction indicator is in
4 n/a 0.0 #VALUE!
place and in view of the landing area.
Helicopter safety procedures are posted and
5 n/a 0.0 #VALUE!
communicated to all passengers.

6 Aviation life-jackets are provided and worn by all n/a 0.0 #VALUE!
passengers when operating over water.
Helicopter inspections are performed regularly
7 by the owner / operator and adequately n/a 0.0 #VALUE!
documented.

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


51
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

EQUIPMENT OPERATIONS
10
(cont'd)
G Machine and Equipment Guarding

1 Guards around pinch points, rotating equipment, 3.0 3.0 100.0%


shafts, pulleys, belt drives and chain drives are
guarded to prevent accidental contact.

Equipment guards are firmly attached and are of


2 a material or design that will prevent contact by 3.0 3.0 100.0%
hands, clothing, tools or material or any other
accidental worker contact.

Where rotating equipment maintenance work is


performed, the maintenance is performed with
3 all guards in place. If the guards(s) must be 3.0 3.0 100.0%
removed, the equipment is locked out and
tagged.

4 Emergency stop cords are installed on all n/o 0.0 #VALUE!


conveyor belt lines. The emergency stop cords
are functional and tested on a periodic basis.
Employees servicing or working near pinch
5 points or rotating equipment are not wearing 3.0 3.0 100.0%
loose clothing or any other loose articles.

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


52
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

EQUIPMENT OPERATIONS
10
(cont'd)
H Bridge Cranes
Bridge crane operators are properly trained /
1 n/a 0.0 #VALUE!
certified.
Bridge crane controls are locked out when not in
2 2.0 2.0 100.0%
use.
I Mobile Personnel Lifts
1 Operators are properly trained and certified. 3.0 3.0 100.0%
Traveling with the boom extended and/or
2 3.0 3.0 100.0%
elevated is prohibited.
3 The equipment is operated on level ground. 3.0 3.0 100.0%
All employees working in the lift basket are
4 3.0 3.0 100.0%
properly "tied off".
The capacity of the equipment is known by the
5 3.0 3.0 100.0%
operator and are not exceeded.
The equipment is not used to hoist or support
6 3.0 3.0 100.0%
equipment or material.
J Other 0.0 0.0

TOTAL 123.0 95.0 77.2% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


53
369816543.xls
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SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

11 EXCAVATION AND TRENCHING


A supervisor and a competent person is in
A 3.0 3.0 100.0%
charge of excavation and trenching.
B Required Excavation permits are utilized. 3.0 3.0 100.0%
Documented daily inspections performed
C 3.0 3.0 100.0%
including adverse weather changes.

D 3.0 3.0 100.0%


Spoil dirt is at least 6cm (2 FT) from the edge.

E Correct slope angle is maintained or shoring 3.0 3.0 100.0%


used where required and approved installation
and removal procedures are followed..
F Proper access and egress provided. 3.0 3.0 100.0%

G Approved barricades are erected at the edge of 3.0 3.0 100.0%


all open trenches and excavations as required.
Prior to beginning any excavation or trenching,
H all underground utilities in the work area are 3.0 3.0 100.0%
located.
Fall protection is implemented as required for
I. 3.0 3.0 100.0%
excavations > 2 meters(6 FT) in depth.
Confined space entry procedure followed when
J. working in any excavation in an operating facility 3.0 3.0 100.0%
or where there could be a presence of toxic /
hazardous substances.
K Other 0.0 0.0

TOTAL 30.0 30.0 100.0% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


54
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SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

STEEL ERECTION AND FLOOR


12
AND WALL OPENING
A Required access and egress provided. n/a 0.0 #VALUE!

B Required perimeter cables are used and n/a 0.0 #VALUE!


approved installation procedures are followed.
Floor openings are properly guarded or are
C covered with a secured cover and properly 4.0 4.0 100.0%
labeled as such.
Elevated areas are free of loose excess
D materials and debris that could fall to levels n/a 0.0 #VALUE!
below.
Static lines, catenary lines, etc., installed to
E n/a 0.0 #VALUE!
facilitate employee tie-off.
F Bolt-up requirements are met. n/a 0.0 #VALUE!
G Bolt buckets are used to contain bolts. n/a 0.0 #VALUE!
H Decking requirements are met. n/a 0.0 #VALUE!
I Approved rigging techniques are used. n/a 0.0 #VALUE!
Barricades and signs are posted in the area to
J n/a 0.0 #VALUE!
warn employees as required.
Employees providing hand signals have
K n/a 0.0 #VALUE!
received hand signal training.

L Signals or warnings are provided when loads n/a 0.0 #VALUE!


are raised.

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


55
369816543.xls
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FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

STEEL ERECTION AND FLOOR


12
AND WALL OPENING (cont'd)

M All employees are wearing and using required n/a 0.0 #VALUE!
PPE (safety harnesses and lanyards.).
Taglines are used to control movement of all
N n/a 0.0 #VALUE!
suspended loads.
Floor grating sections are adequately secured
O 3.0 3.0 100.0%
against displacement.
A steel erection safety plan has been developed
P n/a 0.0 #VALUE!
and implemented.
Q Other 0.0 0.0

TOTAL 7.0 7.0 100.0% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


56
369816543.xls
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SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

13 MATERIAL HANDLING STORAGE


All materials are stacked and stored in an
A 2.0 2.0 100.0%
approved manner.
Aisles, passageways are maintained clean and
B 2.0 2.0 100.0%
unobstructed.
Employees have been trained in safe material
C handling techniques and use safe handling 2.0 2.0 100.0%
techniques.
Materials are stacked to prevent displacement
D 3.0 3.0 100.0%
and falling.
Employees have been trained in the Back
E 3.0 2.0 66.7%
Safety Course.
Material handling equipment is used to handle /
F 2.0 2.0 100.0%
move material when possible.

G Materials handling equipment (mono-rails, A- n/o 0.0 #VALUE!


frames, etc.) is labeled to identify load capacity.
Softeners are used to protect wire and nylon
H 3.0 3.0 100.0%
chokers where needed.
Employees use gloves to protect hands when
I 2.0 2.0 100.0%
handling materials.
J Other 0.0 0.0

TOTAL 19.0 18.0 94.7% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


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SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

14 SIGNS, SIGNALS, BARRICADES


Accident prevention signs, symbols, tags are
A used as required to warn employees where 3.0 3.0 100.0%
potential hazards exist.
B Flagmen used where required. 3.0 3.0 100.0%
Barricade methods used to prevent all
C 3.0 2.0 66.7%
unauthorized entry.
Barricades are used to warn of potential
D 3.0 2.0 66.7%
hazards.

E 1.0 1.0 100.0%


A barricade procedure has been established.

F Flashing lights or other such method are used to 3.0 3.0 100.0%
warn equipment and vehicle operators of
hazards on or near the roadway.
Signs are clearly posted to advise operators and
G drivers of speed limits, pedestrians, and 3.0 3.0 100.0%
hazardous conditions.
Regular surveys are conducted to assure
H adequate and proper signage is present in all 3.0 3.0 100.0%
work areas.
I Other 0.0 0.0

TOTAL 22.0 20.0 90.9% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


58
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FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

FIRE PREVENTION AND


15
PROTECTION
A
Fire extinguishers are provided as required.
Located adjacent to each stairway on each floor
1 2.0 2.0 100.0%
level.
Where more than 18 liters of flammable or
2 3.0 3.0 100.0%
combustible liquids are used. (5.0 gal.)
At least one 9 kg. extinguisher at fuel dispensing
3 3.0 3.0 100.0%
areas. (20 lbs.)
Required access to fire extinguishers is
B 3.0 3.0 100.0%
maintained.
C Extinguishers are identified as required. 2.0 2.0 100.0%

D Inside storage of flammable liquids does not 3.0 3.0 100.0%


exceed 90 liters outside of an approved cabinet.

E Inside storage cabinets are labeled as required, n/o 0.0 #VALUE!


and maximum limits (225 liters / cabinet and 3
cabinets / area) are not exceeded. (60 gal.)
Materials that react to water are not stored with
F 3.0 3.0 100.0%
flammables.
Containers are electrically interconnected
G (bonded) when flammable liquids are n/o 0.0 #VALUE!
transferred from one container to another.

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


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SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

FIRE PREVENTION AND


15
PROTECTION (cont'd)
Portable storage tanks containing liquid
H flammables are located at least 6 meters away 3.0 3.0 100.0%
from buildings. (20 FT.)
NO SMOKING - NO OPEN FLAMES signs are
I posted where flammable liquids are used or 3.0 3.0 100.0%
dispensed or stored..

J 3.0 3.0 100.0%


LPG containers are not stored inside buildings.
Smoke detectors are provided in sleeping
K n/a 0.0 #VALUE!
quarters and are tested on a regular basis.

L Fire suppression systems are inspected on a n/o 0.0 #VALUE!


regular basis to assure functional availability.
Employees have been trained on how to
M 2.0 2.0 100.0%
operate a fire extinguisher.
N Other 0.0 0.0

TOTAL 30.0 30.0 100.0% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


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* **
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POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

LADDERS, SCAFFOLDS, AND


16
ELEVATED WORK PLATFORMS
A Ladders
1 Are in good condition. 3.0 2.8 93.3%
2 Built and used in an approved manner. n/a 0.0 #VALUE!
Secured in an approved manner and placed at
3 3.0 3.0 100.0%
the correct angle.
Exceed the landing area by 1 meter or have a
4 3.0 3.0 100.0%
grab rail. (3 FT.)
Are not used where they can be displaced by
5 doors, equipment, etc., unless protected by 3.0 3.0 100.0%
guards or barricades.
Metal ladders are not used where contact with
6 4.0 4.0 100.0%
electrical energy is possible.
7 Fixed ladder landing areas are kept clear. 3.0 3.0 100.0%
Sections of cable tray or other materials are not
8 3.0 3.0 100.0%
used as ladders.
B SCAFFOLDS
1 Provided with required access and egress. 3.0 3.0 100.0%
Has a standard guard rail (106 cm top rail, 53
2 cm midrail, and 10cm toe board) whenever 3.0 3.0 100.0%
possible.

3 Scaffold tags are used to identify incomplete 1.0 1.0 100.0%


scaffolds and requirements for safe use.

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


61
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

LADDERS, SCAFFOLDS, AND


16 ELEVATED WORK PLATFORMS
(cont'd)
Complete decking is provided whenever
4 3.0 3.0 100.0%
possible and is of scaffold grade material.
Employees who erect and dismantle scaffolds
5 3.0 3.0 100.0%
are qualified and competent.
Scaffolds are free of defects and built per
6 3.0 3.0 100.0%
specifications.
Overhead protection is provided where there is
7 3.0 3.0 100.0%
exposure.

8 Casters are locked and pinned on mobile 3.0 3.0 100.0%


scaffolds when in use and no riding allowed.

9 Outriggers are provided and used or the scaffold 3.0 3.0 100.0%
is secured to the structure when the height
exceeds 4 times the minimum base dimension.
10 An approved base is provided. 3.0 2.5 83.3%
11 Scaffold boards are secured. 3.0 3.0 100.0%
Two-point suspension scaffolds are erected in
12 n/o 0.0 #VALUE!
an approved manner.

13 Scaffold components are not interchanged 3.0 3.0 100.0%


between manufacturers / type.

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


62
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

LADDERS, SCAFFOLDS, AND


16 ELEVATED WORK PLATFORMS
(cont'd)
Rope and / or cable are not used for guardrail
14 3.0 3.0 100.0%
protection.

15 A competent person inspects all scaffolding on a 3.0 3.0 100.0%


daily basis and maintains a current and
complete record of those inspections.
a Approved design. n/o 0.0 #VALUE!
b Approved life lines are provided. n/o 0.0 #VALUE!
c Approved rope grab lanyards provided. n/o 0.0 #VALUE!
d Tie-off fall protection used. 3.0 3.0 100.0%
Elevated work platforms (high-jackers, scissors
C
lifts, JLG's, etc.)

1 Elevated scaffold platforms are of substantial 3.0 3.0 100.0%


construction and secured properly.
2 A means of tie-off is provided and used. 4.0 4.0 100.0%
3 Required access and egress is provided 3.0 3.0 100.0%

4 Elevated work platforms are used in accordance 3.0 3.0 100.0%


with manufacturers recommendations.
a Outriggers provided and used as required. 3.0 3.0 100.0%

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


63
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

LADDERS, SCAFFOLDS, AND


16 ELEVATED WORK PLATFORMS
(cont'd)
b Ground controls operational. 3.0 3.0 100.0%
c Operators trained and certified. 3.0 3.0 100.0%
d Fall protection provided and used. 4.0 4.0 100.0%
Employees maintain both feet on the platform,
e and do not use equipment as a means of 3.0 3.0 100.0%
access /egress, and do not work from guard
rails.
D Other 0.0 0.0

TOTAL 94.0 93.3 99.3% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


64
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

CONCRETE, CONCRETE FORMS,


17
SHORING, MASONRY
A Required access and egress provided. 3.0 3.0 100.0%
All exposed rebar ends protected from
B 3.0 3.0 100.0%
exposure, both vertical and horizontal.
Masonry saws are guarded with a semicircular
C 3.0 3.0 100.0%
enclosure cover.

D All shoring erected to contain and / or support 3.0 3.0 100.0%


concrete is the required type and approved
installation procedures are followed.

E Precast and lift slab operations are performed in 3.0 3.0 100.0%
accordance with respective standards.

F PPE required for these operations is provided 2.0 2.0 100.0%


and used which would include safety glasses,
gloves, proper clothing and foot wear.
All connections on air hoses and pipes are
G 3.0 3.0 100.0%
secured to prevent displacement.
H Other N/A 0.0

TOTAL 20.0 20.0 100.0% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


65
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

18 DEMOLITION
A All operations are planned ahead. 3.0 0.0 0.0%
B Required access and egress provided. 3.0 0.0 0.0%

C Material removal (floor holes, skip-pan, chutes, 3.0 0.0 0.0%


etc.) is conducted in an approved manner.
Any and all asbestos containing material was
D 3.0 0.0 0.0%
removed prior to demolition.
Structural member removal is conducted in an
E 3.0 0.0 0.0%
approved manner.
F Other 0.0 0.0

TOTAL 15.0 0.0 0.0% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


66
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

BLASTING - USE OF
19
EXPLOSIVES

A A blasting procedure has been developed and n/a 0.0 #VALUE!


addresses all current blasting activities.
B The blasting procedure is adhered to. n/a 0.0 #VALUE!
Storage and transport of explosives are done in
C accordance with regulatory requirements, n/a 0.0 #VALUE!
manufacturers instruction and the blasting policy
and procedures.
An approved method for identifying and safely
D removing / eliminating "Boot Legs" or n/a 0.0 #VALUE!
unsuccessfully detonated charges has been
developed.
Employees handling and using explosives have
E n/a 0.0 #VALUE!
been trained and are certified.
F Other 0.0 0.0

TOTAL 0.0 0.0 #DIV/0! 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


67
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

HIGH-PRESSURE WATER
20
CLEANING
Operators are wearing rain suits, gloves, face
A shields, hard hats, safety glasses with side n/a 0.0 #VALUE!
shields, rubber steel toe boots or metatarsal
guards.
Standby Operator(s) is wearing hard-hat and
B n/a 0.0 #VALUE!
safety glasses with side shields.
Operators are not allowing any part of their body
C n/a 0.0 #VALUE!
to be placed in front of the water jet.
Operators are not handling hose within one foot
D n/a 0.0 #VALUE!
of hose-to-hose connections.

E n/a 0.0 #VALUE!


Operators are trained annually at a minimum.

Hose data such as manufacturer's symbol,


serial number, working and test pressure, and
F certified rating which will provided a safety factor n/a 0.0 #VALUE!
of 3 to 1 against burst is recorded and retained
at the project.

G Work area is barricaded at a minimum of 4.5 n/a 0.0 #VALUE!


meters and signs stating, "DANGER - HIGH
PRESSURE WATER CLEANING." (15 FT.)
Equipment to be cleaned is dismantled /
H n/a 0.0 #VALUE!
isolated, locked and tagged as required.

I All fittings and components meet manufacturer's n/a 0.0 #VALUE!


guidelines.

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


68
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

HIGH-PRESSURE WATER
20
CLEANING (cont'd)
Records of high-pressure water cleaning
J n/a 0.0 #VALUE!
equipment inspection are on file.
Lance or mole marker 60 cm (24 in.) from
K n/a 0.0 #VALUE!
nozzle end.

L Shotguns have a 2 meter (6 FT.) shroud and are n/a 0.0 #VALUE!
a minimum of 165 cm (66 in.) in length.
Safety equipment has not been altered or by-
M n/a 0.0 #VALUE!
passed.
N Other 0.0 0.0

TOTAL 0.0 0.0 #DIV/0! 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


69
369816543.xls
** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE
SAFETY AUDIT
FIELD EXECUTION

SCORE PENALTY
* **
MAXIMUM % REPEATED IMMINENT
POSSIBLE
ASSESSED
0 - 100 DEFICIENCIES DANGER
ASSESSORS COMMENTS
(X) (X)

21 CONFINED SPACES
A confined space entry procedure, which meets
A 2.0 2.0 100.0%
requirements, is in place .

B Lighting and electrical tools used inside confined 3.0 3.0 100.0%
spaces are 12 volt or GFCI protected.

C Required emergency equipment is available (i.e. 3.0 3.0 100.0%


body harness, S.C.B.A., fire extinguisher, etc.)
Stand-by ("Hole Watch") person(s) are utilized
D and are trained in confined space procedures 3.0 3.0 100.0%
and their responsibilities.
Air sampling performed, checking % 02 and %
E 3.0 3.0 100.0%
L.E.L, at a minimum.
Energy isolation / lock-out is implemented
F 3.0 3.0 100.0%
relative to confined space work.
Entry permits, which meets requirements are
G used, and sign-off for responsible parties is 2.0 2.0 100.0%
provided and adhered to.
Winch / Hoisting equipment is immediately
H available to hoist personnel out of confined 3.0 3.0 100.0%
spaces if emergency situation requires.
I Other 0.0 0.0

TOTAL 22.0 22.0 100.0% 0 0

* REPEATED DEFICIENCY = -10 MAX POSSIBLE 10/26/2017


70
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** IMMINENT DANGER = 15% REDUCTION OF ASSESSMENT SCORE