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YANSAB PROJECT
Weekly Safety Assessment Report
The following is to be used as a guide by the team to perform the safety inspection.
Observations should be noted on the attached observation sheet. Upon completion
of the inspection each category should be rated as: from 10 high to 1 low.
Subtract 1 point for each deficiency/violation. 0 Lacking or N/A Not Applicable.
Deduct 10 points off total score for each life threatening/imminent danger.
Supervisor's Name: Date: Score Points %
Location: Safety Rep.: 0.00% Awarded
1 Housekeeping
1 Project work areas are clean and free of excess trash, debris 10
2 Walkways and passageways clear 10
3 Material or equipment properly stored 10
4 Electrical cords, hoses, welding leads, etc. elevated to prevent trip hazards 10
5 Scrap material free of protruding nails or other puncture hazards 10
6 Trash receptacles are provided for work areas and water kegs 10
7 Barricades, and/or rebar caps installed and maintained 10
8 Other;
POSSIBLE POINTS AWARDED 70 0 0%
3 Fall Protection
1 Body harness required and worn in a proper manner 10
2 Lanyards are adequately secured to suitable anchorage 10
3 Perimeter guarding 10
4 Static lines, rat lines installed and capable of supporting 5,400 lbs. of force 10
5 Fall protection equipment is used only for fall protection 10
6 Fall protection maintained and has current inspection 10
POSSIBLE POINTS AWARDED 60 0 0%
4 Excavations
1 Sloped and shored properly 10
2 Access and egress provided every 25 ft. 10
3 Daily documented inspections conducted 10
POSSIBLE POINTS AWARDED 30 0 0%
9 Fire Protection
1 Flammables stored properly 10
2 Oxygen and combustibles separated 10
3 Containers labeled as to content 10
4 Fire extinguishers properly located and inspected 10
5 Flash arrestors installed 10
6 Compressed gas cylinders properly maintained 10
7 Containment of hot work and welding screens as required 10
8 Regulator gauges properly attached and maintained 10
POSSIBLE POINTS AWARDED 80 0 0%
09a-Weekly-Safety-Assessment.xls
ATTACHMENT A Page 3 of 4
YANSAB PROJECT
85 to 89 Fair 70 to 84 Lacking
1 Housekeeping 0%
3 Fall Protection 0%
4 Excavations 0%
9 Fire Protection 0%
09a-Weekly-Safety-Assessment.xls
ATTACHMENT A Page 4 of 4
The responsible individual for observations requiring corrective action shall sign off as
corrected and return this report within 24 hours of receipt. A status report shall be attached
for observations that are not corrected.
09a-Weekly-Safety-Assessment.xls