S EALANT • WATERPROOFING AND RESTORATION INSTITUT E
SAFETY & HEALTH MANUAL
Site Specific Safety Plan
TABLE OF CONTENTS
 Introduction
2 Steps to Develop a Site Specific Safety Plan
3 Pre-Project Safety Checklist
4 Site Specific Safety Plan (Sample)
5 Job Safety Analysis (JSA) Task Specific
6 Job Safety Analysis (JSA) Task Specific – Blank Form
7 Safety and Health Inspection Form
8 Subcontractor’s Site Specific Safety and Health Plan
9 Summary
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
06/07
11.
SWR Institute Safety & Health Manual
 Introduction
T
his section of SWR Institute’s Safety & Health Manual is
dedicated to ensuring job site safety as recommended
by OSHA. Thorough job site safety preparation
requires planning and procedure implementation
before onsite work commences. The forms and checklists
contained herein are provided to help companies plan and
prepare for the various hazards that are part of all construction
and repair work. By utilizing these tools, a company can build
a step-by-step action plan to train its employees how to foresee
potential dangers and take necessary precautions, as well as the
procedures to follow when accidents occur.
 Steps for Developing a Site-Specific Safety Plan
1. Determine the scope of work.
a. Involve project management
b. Determine hazardous materials to be used
2. Establish all specific tasks involved with the project.
a. Develop a Job Safety Analysis (JSA) for each task
3. Determine the location of the nearest medical facility.
a. Establish dialogue with medical facility staff to make prior
arrangements for:
i. Worker’s Compensation claims, billing, etc.
ii. Direct billing
iii. Case management
iv. Drug screening
v. Pre-employment physicals
vi. Etc.
b.Determine the fastest, most convenient route to the medical
facility, print map with route directions (MapQuest works
well) and include in the Site Specific Safety Plan (SSSP).
4. Survey jobsite to ascertain existing and potential hazards to
workers, as well as building occupants and pedestrians. Keep in
mind that the work to be performed may transform a safe area
to a highly hazardous one. For example: the removal of balcony
railings creates a significant fall hazard where workers must
wear Personal Fall Arrest System (PFAS) and measures must be
taken to keep occupants from gaining access to the balconies.
The person surveying the jobsite must anticipate issues such as
this and is why determining the scope of the work is step #1.
Determine control and abatement methods/procedures for
hazards identified during survey:
i. Elimination – controlling the hazard at source
ii. Substitution – replacing one substance or activity with a
less hazardous one
iii. Engineering controls – installing guards on machinery
iv. Administrative controls - policies and procedures for safe
work practices
v. Personal protective equipment (PPE) – PFAS, respirators,
earplugs, etc.
5. Establish an Emergency Action Plan (EAP) specific to the
site. Specify the following and include in the plan:
a. Contact info – project and property management
b. First aid location(s) – supplied and existing
c. Eye-wash station(s) – supplied and existing
d. Fire extinguisher location(s) – supplied and existing
e. Location of Material Safety Data Sheets
f. Flammable storage area(s)
g. Smoking/non-smoking areas
h. Waste removal plan
i. Additional?
6. Plan must be reviewed/approved by Project Manager,
Safety Manager and Property Manager.
7. Match workers to task – ensure workers are trained and
capable of performing all tasks safely.
8. Ensure all workers are familiar with the plan – an extended,
documented toolbox talk is an effective way of accomplishing this.
9. Use the tools and documents in sections 3 through 8
below in efforts to develop a comprehensive Site Specific
Safety Plan.
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
11 . SWR Institute Safety & Health Manual
 Pre-Project Safety & Health Checklist
Contractor
ABC Contracting
Date prepared
Prepared by (Foreman if possible)
Foreman/Supervisor for the job
John Smith
Phone
John Smith
Employee responsible for safety inspections
List the work crews to be briefed about this analysis 555-555-5555
Cell
Cell
Phone
Cell
555-555-5555
555-555-5555
Date of briefing
Job number
Cutout old sealants, recaulk new Sealants, Silicone Coating
12345
555-545-5555
555-545-5556
555-545-5557
George Jones (Lead Man), Robert White, Fred Green
Job description Phone
John Doe
5/10/2010
5/10/2010
Job location (Bldg.No./Site)
Egypt, TX
Submission of this completed form is a prerequisite for issuance of the Start Work Notice.
Instructions: Complete this form for all construction work. Identify all hazards that could be present in the job to be preformed. If a box is
checked “Yes”, then state the hazard and describe your hazard control method. If a hazard is not listed below and is present on the job, then
check the box for item 41 “Other” and describe hazard and hazard control method.
YES
EXAMPLE NO Ladders/Scaffolds/Stairways – for example: Body Harness, Lanyards, Training, Safety Net, Other
Hazard/Hazard Control
1. Ladder Use - Our employees are only using 6-foot ladders. If a greater height needs to be reached,
a man basket will be used.
Yes No Fall Protection – For example: Fall Protection Plan, Body Harness, Lanyards, Guardrails, Handrails, Training, Other
PFAS, Mfg. Swing Stage Training, Guardrails & Stairways, Onsite Comp. Person for Rigging/Inspect.
Hazard/Hazard Control
2. Ladders / Scaffolds / Stairways – For example: Body Harness, Lanyards, Safety Net, Aerial Lifts, Guardrails, Training, Other
Hazard/Hazard Control
PFAS 100% while working above 6' (Note: when working on balconies off step ladders tie-off before setting up ladder)
3. Excavation / Trenching / Shoring – For example: Excavation Permit, Selection of Protective Systems, Shoring, Slope Detail, Spoils Pile, Soil Classification, Sloping and Benching, Hydraulic Shoring, Access Ladders, Traffic Plates, Other
4. Hazard/Hazard Control
Lockout and Tagout Control of Hazardous Energy – For example: Locks and Tags, Blinds, Safety Meetings, Training, Other
Hazard/Hazard Control
5. Electrical Hot Work, Permit Required – For example: Energized Electrical Permit, Rubber Mat, Sleeves, PPE, Other
Hazard/Hazard Control
6. Electrical / Power Transmission – For example: Wiring Design, Wiring Protection, Hazardous Location Installation, Other
220v for stage power to be inspected prior to stage use & properly disconnected/stored after use daily
Hazard/Hazard Control
7. Hoisting / Rigging – For example: Operator Permits, Equipment Inspections and Tags, Training, Other
Hazard/Hazard Control
Stages require daily inspections w proper tagging & record-keeping by onsite compet. person
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11 . SWR Institute Safety & Health Manual
8. Yes No
Confined Space – For example: ESH Entry Approval/Permit, Training, Air Monitoring, Rescue Plan and Equipment, Other
Hazard/Hazard Control
9. Demolition – For example: Preparatory Operations, Work Practices, Chutes, Mechanical Demolition, Barricades, Other
Hazard/Hazard Control
10. Signs/Signals/Barricades – For example: Caution Tape, Barriers, Barricades, Signs, Traffic Cones, Tags, Traffic Vests, Other
"Men working above" signs to be used at ea. end of stage areas under aerial platforms w caution tape & barricades
Hazard/Hazard Control
11. Head Protection and Rollover Protective Structure – For example: Hard Hats, Bump Caps, Equipment Inspection, Other
Hard hats with chin straps must be worn at all times while working on stages
Hazard/Hazard Control
12. Eye Protection – For example: Safety Glasses, Safety Goggles, Face Shields, Portable Eye Wash Unit, Other
ANSI Z87.1 glasses with side shields to be worn at all times on jobsite
Hazard/Hazard Control
13. Ear Protection – For example: Ear Plugs, Ear Muffs, Other
Ear plugs must be worn while operating a power washer during the cleaning scopes
Hazard/Hazard Control
14. Breathing Protection – For example: Engineering Controls, Respirators, Air Filters, Dust Masks, HEPA Filters, Other
Note: MSDS recommends use of respirators in poorly ventilated areas. Work on outside should not apply
Hazard/Hazard Control
15. Hand Protection – For example: Gloves, Gauntlets, Sleeves, Barriers, Cream, Other
Cut resistant gloves to be worn with cutting scopes or working with sharp objects (metals, etc.)
Hazard/Hazard Control
16. Torso Protection – For example: Flame Resistant Clothing, Coveralls, Aprons, Bib Overalls, Other
Hazard/Hazard Control
17. Foot Protection – For example: Steel Toed Shoes, Metatarsal Guards, Boots, Other
Leather boots must be worn at all times while on the jobsite and must be in good condition
Hazard/Hazard Control
18. Site Exits / Means of Egress – For example: Emergency Action Plans -- Marked and Clear, Outdoor Job, Other
Hazard/Hazard Control
19. Emergency Action Plan Attached
Fire Protection/Prevention – For example: Extinguishers, Fire Watch, 2-Way Radio, Pull Box, Alarms, Other
5 lb. ABC extinguishers at a minimum with power washer use on stages. Interior locations determined
Hazard/Hazard Control
20. Welding/Cutting/Brazing – For example: Welding/Burn Permit, Fire Watch, Fire Blanket, Site Screen, Gas Bottle Safety, Other
Hazard/Hazard Control
21. Hot Work, Permit Required – For example: Welding, Brazing, Torch Cutting, Temporary Heating, Pressured Air Line, Other
Hazard/Hazard Control
22. Material Handling, Storage, Use, and Disposal – For example: Flammables, Combustibles, Labeling, Gas Bottle Storage,
LP-Gas Safety, Safety Containers/Cans, Waste Materials, Disposal Process, Other
Hazard/Hazard Control
Gasoline, xylene & toluene must be properly labeled in approved containers and stored in safe areas
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
11 . SWR Institute Safety & Health Manual
Yes No
23. ■ Concrete / Masonry – For example: Debris Pile, Chutes, Wet Cuts, Other
Hazard/Hazard Control
24. Crane / Derrick / Hoist / Helicopter / Conveyors – For example: Drum Hoists, Elevators, Cable Inspections, Other
Hazard/Hazard Control
25. Tunnel / Shaft / Caissons / Compressed Air – For example: Underground Construction, Cofferdams, Blasting Safety, Other
Hazard/Hazard Control
26. Steel Erection – For example: Falling Object Protection, Site-Specific Erection Plan, Construction Sequence, Other
Hazard/Hazard Control
27. Vehicle Safety / Mechanized Equipment – For example: Operator Permits, Equipment Inspection, Hydraulic Inspection, Other
Swing stage operators must have current/valid training certifications & conduct required daily inspections
Hazard/Hazard Control
28. Construction Power – For example: Extension Cords, GFCI, Generators, Battery Charging, Air Receivers, Other
GFCIs will be used and all cords and equipment must be inspected prior to each use. Defective Equip to be removed immediately
Hazard/Hazard Control
29. Blasting and Use of Explosives – For example: Blaster Qualifications, Transportation, Storage, Loading, Inspection, Other
Hazard/Hazard Control
30. Powder Actuated Tool Safety – For example: (HILTI) Operator Training, Valid License, Other
Hazard/Hazard Control
31. Power and Hand Tool Safety – For example: Guards, Cords, Ground Prong, GFCI, Jacks, Abrasive Wheels, Other
Each employee will have proper training w the piece of equipment they are using. Defective equip to be removed from service immed
Hazard/Hazard Control
32. Area Lighting – For example: Flood Lights, Traffic Control Lights, Drop Lights, Flashlights, Other
Note: Scope of work is outside
Hazard/Hazard Control
33. Housekeeping – For example: Debris Pile, Hazardous Waste Disposal Containers, Clear Work Area, Other
Daily cleanup of working areas. Trash bags on stages to be secure and debris contained inside at all times
Hazard/Hazard Control
Traffic Control – For example: Flagman, Signboard, Caution Lights, Traffic Vests, Whistle, Other
34. Hazard/Hazard Control
35. See Section 10
Hazard Communication / Toxic Substances – For example: Material Safety Data Sheets, Asbestos, Benzene, Other
MSDS readily available on the project by our onsite crew. Review daily before starting work
Hazard/Hazard Control
36. Ionizing and Non-ionizing Radiation – For example: Radiation Badges, Training, Distance, Shielding, Time, Other
Hazard/Hazard Control
37. Environmental – For example: Excavation Permit, Segregated Debris Pile, Asbestos, Run-off Prevention, Other
Hazard/Hazard Control
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11 . SWR Institute Safety & Health Manual
Yes No
38. Hazard/Hazard Control
39. All training records avail upon request. Renewal of training will ensure proper training retainment
Sanitation – For example: Drinking Water, Toilets, Eating Areas, Washing Areas, Other
Hazard/Hazard Control
41. 1st aid kits w each employee. Foreman & lead man are first aid/cpr/aed certified. Follow EAP designed
General Health and Safety Provisions – For example: Recordkeeping, Work Practices, Equipment Maintenance, Training, Other
Hazard/Hazard Control
40. Medical Protection – For example: First Aid Kit, C.P.R. Trained Personnel, 2-Way Radio, Telephone 911, Other
Each employee has their own water jugs. Waste facilities designated on the jobsite by management
Other – Identify any other hazard control associated with this job.
Hazard/Hazard Control
Overhead work, potential for falling objects to pedestrians. See following sections for specific control methods
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
11 . SWR Institute Safety & Health Manual
4a Site Specific Safety Plan (Sample)
Project Name:
Job #: Date:
Project Manager:
Site Foreman:
1st Site Contact: 2nd Site Contact:
3rd Site Contact:
Site Contact (Safety):
Site Contact (General):
OSHA Required Competent Person or Persons Onsite
• _______________________________ (Primary)
• _______________________________ (Secondary)
Location of Medical Facility
• Minor Injuries – Name of Facility Here, Phone # Here
• Serious Injuries – Name of Facility Here, Phone # Here
• Directions with Maps Are Enclosed with this Site Specific Safety Plan
Location of First Aid
• i.e, Truck, Job Box and/or Break Room
Location of Fire Extinguishers
• 5# - ABC to be kept on swing-stage platform
• Minimum 5# - ABC in vicinity of swing-stage support system
• 10# - ABC in vicinity of gas-powered equipment
Location of MSDS
• i.e, Truck, Job Box and/or Break Room
Flammable Storage Area if Required
• Gasoline shall be kept in approved safety cans and will be stored in
the job trailer at the end of day.
Designated Smoking/Non-Smoking Areas
• Smoking is NOT permitted on rooftop or within facility.
• Smoking is NOT permitted in the outdoor equipment areas enclosed
by chain-link fencing.
• Smoking is permitted in designated areas - these designated areas
will be reviewed during the Site Orientation.
Waste Removal Plan
(e.g., All debris to be transported to container located near
loading dock.)
Fall Protection Plan (Example)
• Rooftop – The rooftop has a protected edge (42” parapet) except
for the peak above the loading dock area. When work needs to be
performed in this area (within 10 feet of the roof edge), workers
shall be tethered to a safety line using their fall-arrest gear. Name
of Company’s employees should only enter the roof area for the
set-up of the swing-stage and Bosun’s chair support system and the
accompanying safety system, as well as the required daily pre-start
inspection.
• Swing-Stage Platform – Complete fall-arrest gear to be used at all
times, body-harness, 3-foot shock-absorbing lanyard w/self-trailing
rope grab connected to ½-inch safety line attached to a roof anchor.
• Bosun’s Chair - Complete fall-arrest gear to be used at all times,
body-harness, 18-inch shock-absorbing lanyard with rope grab
connected to ½-inch safety line attached to a roof anchor.
• Mast Climber
• High Reach
• Pipe Scaffolding
Emergency Rescue Plan (Example)
Bosun’s Chair
• Self rescue by transferring descent device to safety line and descending
to lower level.
Swing-Stage Platform
• An extension ladder may be used to reach employee if they are close
enough to the ground and all Name of Company’s Safety Policies
and Procedures regarding safe ladder use are adhered to.
• Have a qualified RDS/Chair person descend to victim with a spare
RDS/Chair setup.
• If any of the prior methods shown cannot be successfully implemented
or the suspended employee(s) are unconscious or injured, call 911
for assistance.
NOTE: In an effort to avoid “suspension trauma”, suspended workers
shall create a “foot loop” by tying a knot in the safety line below the
rope-grab to stand in while awaiting rescue. If any of the prior methods
shown cannot be successfully implemented or the suspended employee(s)
are unconscious or injured, call 911 for assistance.
Facility Emergency Action Plan (EAP)
Workers need to know what to do when they are alerted to an emergency.
After notification to evacuate the building, employees should take the
following steps:
1. If on the rooftop or within the building, immediately exit the building
in an expeditious and calm manner, using the closest and most
convenient exit. Do not use elevators.
2. If on a scaffold or Bosun’s chair, pipe frame ladders etc., immediately
descend to the ground level in a safe manner.
3. Assemble in the designated area shown below;
Insert area here:
_____________________________________________
4. Await a head count and further instructions.
Work Zone Establishment (Example of the detail)
• Side #1 (West) – Lawn Area (non-public space) – a perimeter
shall be established in the area under and adjacent to any suspended
equipment through the use of cones spaced intermittently.
• Side #2 (South) – Loading Dock Area (public space) – a
perimeter shall be established in the area under and adjacent to any
suspended equipment through the use of cones and caution tape. It
is important to use caution tape as a barrier inside the loading dock
approximately 3 to 5 feet from face of building to prevent pedestrians
from entering. Suspended equipment can only be used above one
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(1) loading dock area at a time as the other must remain open to
provide service to the facility – There are two (2) doorways as well
as a pedestrian ramp at the far ends of the loading dock area – as
they serve as emergency exits, they cannot be locked, however, two
(2) cones should be placed at the inner side of the doorways and a
“Warning” sign that states it is for “Emergency Exit Only” should be
placed on the inner side of door OR overhead protection should be
provided by creating a passageway made of walk-through scaffolding
that extends at least 12 feet from the face of the building.
• Side #2 (South) – Electrical Equipment Area (non-public space)
– This area is accessible through a gate in the chain-link fence. Just
beyond the gate is an extensive amount of electrical equipment set on a
concrete slab with a concrete curb around the perimeter. Caution tape
shall be set parallel and just prior to curb line as a warning line, as well
as appropriate signage (Spanish/English) posted to alert workers of
the hazards beyond. NOTE: Great care must be taken during the set-up
and breakdown of associated equipment and swing-stage platform to
keep it from swinging beyond the warning line. Name of Company’s
workers shall not loiter in this area.
• Side #3 (East) – Mechanical Equipment Area (non-public space)
– Caution tape and/or barricades shall be used to guide workers to
the work area and also prevent them from coming in proximity with
the mechanical and electrical equipment in this area. Workers shall
not loiter in this area and will be instructed that the area opposite
the caution tape/barricading is “Off-Limits”. Two (2) cones should be
placed at the inner side of the doorway of stairway #9 at the basement
level and a “Warning” sign should be put on the inner side of door
that states it is for “Emergency Exit Only”.
Suspended Scaffold System
(More examples of the level of detail)
Suspended System (Platform) – Name of Company uses the brand
name of equipment, a heavy-duty modular platform. A description of
all components of this system can be found in the enclosed literature
on pages A through Z. The typical platform configuration to be used
at the facility is shown on page A of the enclosed literature. Platform
lengths will be determined onsite and may vary due to building geometry
and/or site conditions as work progresses.
Support System (Beams w/Counterweights) – Name of Company
uses a support system manufactured by Name of Vendor – a blueprint
of the arrangement to be used at Name of Working Facility.
Safety System – A personal fall-arrest system (PFAS) will be utilized
by Name of Contractor’s employees at all times when working from and
operating the swing-stage platform. Rope-grabs shall be connected to
the safety line prior to accessing the platform from any level. Name
of Contractor uses a PFAS consisting of the following:
• Class III full-body harness
• 3-foot shock-absorbing lanyard
• Self-trailing rope-grab
• ½-inch safety line
SPECIAL NOTES
• Scaffolds must be inspected daily and documented on the “Inspection
Record” tag attached to each part of the support system.
• All rooftop equipment shall be delivered to the facilities loading dock
and taken to the freight elevator’s uppermost floor – it will then be
carried to the roof via stairway #6.
• Side #1 (West) – The swing-stage platform will be assembled at
ground level.
• Side #2 (South) – The swing-stage platform will be assembled at
ground level in all areas; however, at the stair and ramp area (between
column line A and D), procedures similar to those shown below for
the pipe rack/tray area must be used.
• Side #2 (South) – At the loading dock areas, the swing-stage platform
must have top rails installed on the building side. If needed, the top
rail (building side only) may be lowered ONLY when the platform is
above the loading dock.
• Side #3 (East) – When practical, the swing-stage platform will be
assembled at ground level.
• Side #3 (East) – Swing-stage platform will be assembled atop the
canopy above stair #9, taking the following precautions:
Safety lines (secured to roof anchors) will be lowered past the
canopy to the ground.
An extension ladder will be set-up at the edge of the canopy
extending a minimum of 36 inches above the edge. The ladder
will be secured to the canopy and its feet will be set atop plywood.
Employees will access the top of the canopy via the ladder –
they will be attached to the safety line at all times with a 3-foot
lanyard and a “parking” rope-grab. The rope-grab shall be set
and kept above eye level while atop the canopy.
The top of the canopy will be covered with rigid foam insulation
then plywood – when complete; it will be lashed to the structure
with nylon straps. This serves to protect the canopy from damage,
as well as to provide a more suitable walking surface.
The platform will then be assembled atop the canopy per the
previous “Assembly” instructions – with one exception. The hoist
motors will be weaved on the ground and powered up the support
cable to the top of the canopy then attached to the stirrups. This
is done to reduce the risk of lifting (back) injury.
Components of the platform will be passed by employees on the
ground to employees atop the canopy one (1) piece at a time
and when needed. Subsequent components will not be passed
up until previous ones have been assembled. This is done to
avoid clutter and potential tripping hazards.
• Side #3 (East) – Pipe Rack/Tray Area
The entire swing-stage assembly will be erected between column
lines 9 and 11.
The platform will be brought to the roof level and employees
will exit the platform to the roof (Personal Fall Arrest Systems
connected at all times during the transfer).
The casters are to be unlocked and the entire rig will be rolled to
the location above the pipe rack/tray area (between column lines
7 and 9). Beam tiebacks should remain during this maneuver,
though additional slack will likely be needed and provided
beforehand.
Casters are to be relocked and the safety line and equipment
tiebacks shall be reset to the roof anchors directly behind the
support system.
• Side #3 (East) – There is an active steam vent pipe that runs
approximately halfway up the building. This will be redirected when
work is being performed in the area next to and adjoining the vent pipe
– this will be coordinated with Name of Company management. The
device used for this redirect will be locked-out by both maintenance
and the Name of Company’s Site Foreman.
• Side #3 (East) – Small canopy at column line #3 (stair #7).
This area will be accessed by Bosun’s chair/RDS – no special
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precautions are needed.
Assembly/Disassembly
Rope Descent System (RDS)
• Route the suspension line by doing the following:
Remove the outer control sleeve
Pull down and lock the control ring
Insert the line through the gate
Release the control ring and return to original position
Route the line through the groove on the lower end of the shaft
Wrap the line around the shaft with the appropriate number of
turns and have the line exit through a groove at the top of the
shaft
Replace the outer control sleeve
Support System
• Connect the front and rear wheel units to the telescoping tubes
• Install the front beam support frame to the front wheel unit
• Assemble beam sections (2)
• Connect the beam to the top of the front beam support frame and
rear wheel unit
• Detach the free ends of the left and right struts from the front beam
support frame and attach to the middle of the beam
• Install the counterweights on the rear of beam and secure them with
the pin and safety clip
• Secure the tieback line to tieback loop at the end of the beam
• Secure the opposite end of the tieback line to roof anchorage
• Secure the suspension to the rigging pin at the front of beam
• Pass the suspension line over the parapet to the ground
Safety System
• Secure safety line to roof anchor
• Secure the safety line to the rigging pin at the front of beam
• Pass the safety line over the parapet to the ground
INSPECT THE ENTIRE SYSTEM
Disassembly – reverse order of assembly
SPECIAL NOTES
• Support system for the Bosun’s chair must be inspected daily and
documented on the attached “Inspection Record” tag.
• Name of Contractor’s Site Manager may opt to perform a “straight drop”
where the support and safety lines connect directly to independent roof
anchorages, eliminating the need for a transportable counterweighted
outrigger. This can be done if the parapet can support the weight and
has been adequately protected from damage.
• All rooftop equipment shall be delivered to the facilities loading dock
and taken to the freight elevator’s uppermost floor – equipment will
then be carried to the roof via stairway #6.
Power washing
Wall coating
Task Analysis Forms are enclosed with this Site Specific Safety Plan.
Inspections (Color Coding)
All tools and equipment must be inspected prior to each use and kept in
good order. All electrically powered tools must be inspected, tagged and
operated in accordance with manufacturer requirements. Documented
color-coding will apply, but is not limited to the following (monthly
inspections):
• Swing-Staging
• Electrical Cords
• GFCIs
• Electrical Tools
• Body Harnesses
• Lanyards
• Rope-grabs
• Bosun’s Chairs
May..................Green and Yellow
June.................Green and Blue
July..................Red
August..............Red and Yellow
September.......Red and Blue
Required Paperwork (Safety related)
• Daily
DP-802.306 “Task Safety Awareness”
• Per Occurrence
Name of Contractor – “First Report of Incident” to be used in
place of both DP-802.401-3 “Accident/Incident Report” and DP802.401-2 “Employee’s Report of Occupational Illness/Injury”
Name of Contractor – “Incident Investigation Report”
Additional
• Eating or drinking is NOT permitted on rooftop or within facility.
Job Hazard Analysis
• Tasks
Removal of sealant, cleaning and replacement
Safety Plan Approval
Authorized Customer Approval Authorized Contractor Approval
X
X
Date
Date
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4b Site Specific Safety Plan
Project Name: Green Acres
Job #: 56789
Date:
Project Manager: George Washington
Site Foreman:
1st Site Contact: John Smith
2nd Site Contact:
3rd Site Contact:
5/10/2010
John Smith
John Doe
Harry Truman
Site Contact (Safety):John Doe
Site Contact (General):
John Smith
OSHA Required Competent Person or Persons Onsite
John Smith
• ____________________________________
(Primary)
Doe
• John
____________________________________
(Secondary)
Location of Medical Facility
Minor Injuries - Urgent Care Medical Center (Main St.) 555.555.0100
Serious Injuries - XYZ Hospital (EMS Ave.) 555.555.1111, or 911
Directions with Maps are enclosed with this Site Specific Safety Plan
Location of First Aid
Each Employee have their own first aid kit, Inspected weekly.
Location of Fire Extinguishers
2.5 lb. - ABC provided to each employee and inspected monthly, but prior to each use.
Minimum 5 lb. - ABC in vicinity of swing stage support system
5 lb. - ABC in vicinity of gas-powered equipment
Location of MSDS
Job folder (Foreman), On site Superintendent's Office, Employees using materials will keep
a copy with them.
Flammable Storage Area
Gasoline, Xylene & Toluene shall be kept in approved safety cans and will be stored in the
designated room on the first floor (storage room identified at pre-con). All materials shall
be properly labeled with their known product name specified on the MSDS.
Designated Smoking/Non-Smoking Areas
Smoking is NOT permitted on rooftop or within the facility.
Smoking is NOT permitted in the outdoor equipment areas.
Smoking is permitted in designated areas - these designated areas were reviewed at the
Pre-Con.
Waste Removal Plan
All debris and empty buckets will be properly disposed of at the on site designated
dumpster discussed at the orientation. All material must be completed cured (setup) prior
to disposing into the dumpster. Solvent must have completely flashed out of containers
before disposing of.
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
11 . 10
SWR Institute Safety & Health Manual
FALL PROTECTION PLAN
Rooftop - The rooftop does not have any parapet edge. The means for setup of swing
stages and rigging equipment outside of the protection shield (or anywhere within 10' of the
roof edge) shall require workers to be tethered to a safety line using their fall arrest gear.
Employees of the ABC Contracting should only use the area for the required daily
inspections of the safety equipment and hazard evaluation.
Swing-Stage Platform - Compete fall arrest gear to be used at all times: full body harness, 6
foot shock-absorbing lanyard with self-trailing rope grab connected to a 5/8" safety line
attached to an approved roof anchor.
Bosun's Chair - Complete fall arrest gear to be used at all times: full body harness, 6 foot
shock-absorbing lanyard with self-trailing rope grab connected to a 5/8" safety line, attached
to an approved roof anchor. Employee spotting the jumper to also be rigged in the same
manner.
Rolling Roof Rig - Install per the manufacturer's manual. Tie-backs shall only be connected
to an approved anchor point, separate from any life lines.
EMERGENCY RESCUE PLAN
Bosun's Chair - Self-Rescue by transferring descent device to safety line and descending to
lower level.
Swing-Stage Platform
- An extension ladder may be used to reach the employee is they are close enough to the
ground and all of ABC Contracting's policies and procedures regarding safe
ladder use are followed.
- Have a qualified RDS/Chair person descend to victim with a spare RDS/Chair setup.
- If any of the prior methods shown cannot be successfully implemented or the suspended
employee(s) are unconscious or injured, call 911 for assistance.
Note: In an effort to avoid "suspension trauma," suspended workers shall create a "foot
loop" by tying a knot in the safety line below the rope grab to stand in while awaiting rescue.
Each employee is properly trained to accomplish this. If any of the prior methods shown
cannot be successfully implemented or the suspended employee(s) are unconscious or
injured, call 911 for assistance.
FACILITY EMERGENCY ACTION PLAN (EAP)
Workers need to know what to do when they are alerted to an emergency. After notification
to evacuate the building, employees should take the following steps:
1. If on the rooftop or within the building, immediately exit the building in an expeditious and
calm manner, using the closest and most convenient exit. Do not use elevators.
2. If on a stage or bosun's chair, immediately descend to the ground level in a safe manner.
3. Assemble in the designated area shown below;
PER THE ATTACHED EMERGENCY ACTION PLAN
4. Await a head count and further instructions.
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
11 . 11
SWR Institute Safety & Health Manual
WORK ZONE ESTABLISHMENT
Side#1 - West - Driveway Entry Location - All perimeters shall be established in the area
under and adjacent to any suspended equipment through the use of cones/barricades, tape
Sides #2 & #3 - North & South - Terrace Area & Public Walks - A perimeter shall be
established in the area under and adjacent to any suspended equipment through the use of
signage marked, "Men Working Above," cones and caution tape. There are numerous
south facing patios/balconies from floors 1-10 that are guarded by privacy fencing/gates.
The onsite superintendent will help coordinate our drop sequence schedule with these
residents. Stages will be grounded on the north side overnight, but the Southern exposure
to vehicular and pedestrian traffic still poses potential problems. Stages will need
suspended at least 2 levels up (or more) and tied on each side to prevent sway or fall
potential. Access into the stage will be from the ground unless otherwise said.
Side #3 - South Continued - Main Building Entrance (Public Access) - This area poses high
hazard potential to public safety die to the high pedestrian traffic at this entry. Extreme
caution needs to be taken with the overhead work being performed. An additional safety
measure has been taken to install a walk-through style scaffolding system. This will not
only protect the occupants/visitors from overhead falling objects, but also protect the entry
sign that is installed directly over the double doors. Scaffold will allow smooth operation of
the doors and be covered with plywood and a tarp to add rigidity and prevent water from
hitting the public.
Side #4 - East - Side Entrance with Stairwell (egress area) - Caution tape and/or barricades
shall be used to guide workers to the work area and also prevent them from coming in
proximity with the overhead suspended equipment in this area. Workers shall not loiter in
this area and will be instructed that the area opposite the caution tape/barricade system is
"Off-Limits." Two (2) cones should be placed at the inner side of the entry stairwells and at
the main level and a "Warning" sign should be put on the inner side of the gate that states it
is for an "Emergency Exit Only."
SUSPENDED SCAFFOLD SYSTEM
Suspended System - ABC Contracting uses XYZ Company's Heavy-duty modular platform.
A description of all components of this system can be found in their field manuals (provided
to ABC). The typical platform configuration to be used at the facility, shown on the attached
drop sequence plan. Platform lengths will be determined on site and may vary due to
building geometry and/or site conditions as work progresses.
Support System - ABC uses a support system manufactured by XYZ, a plan of the
arrangement to be used at Green Acres.
Safety System - A personal fall arrest system (PFAS) will be utilized by all of ABC's working
employees at all times when working from and operating the swing-stage platform. Rope
grabs shall be connected to the safety line prior to accessing the platform from any level.
ABC uses PFAS consisting of: Class III full-body harness, 6 foot shock-absorbing lanyard,
self-trailing rope grab, and a 5/8" safety line.
NOTE: Scaffolds and rigging must be inspected by a competent person before each work
shift. Platforms shall have a documented "Inspection Record" tag attached to the platform.
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
11 . 12
SWRInstitute Safety & Health Manual
5 Job Safety Analysis (JSA) Task Specific (Sample)
Page:
Job Site/Number:
Job/Operation:
1
Location:
Analysis By:
Logo
Here
Job Title:
Date Prepared:
Recommended/Required PPE Required: (Example) Leather work gloves, safety glasses or goggles, face shield, half-mask
respirator, ear plugs or muffs and rubber work gloves.
Potential Significant Hazards
Sequence of Basic Job Steps
Step No. 1, 2, 3 etc.
Sample
Step No. 1a, 1b, 1c, 1d, 2a, 2b etc.
Hazard Control Method
Sample
Sample
1
Cut out old caulk with razor
1
Cuts to hands or body
PPE – Hand protection, Leather work
gloves
2
Remove old backer rod
2
Particulates in eyes
PPE – Eye protection, safety glasses or
goggles
3
Grind surface to prep for new sealant
3a
Particulates in eyes
PPE – Eye protection, goggles and face
shield
3b
Dust inhalation
PPE – Respiratory protection, filtering face
piece
3c
Excessive noise
PPE – Hearing protection, ear plugs or
muffs
3d
Cuts to hands
PPE – Hand protection, leather work
gloves
4
Install new backer rod
4a
None established
None
5
Prime surface
5a
Fume inhalation
PPE – Respiratory protection, half-mask
respirator w/appropriate cartridge (purple)
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
11 . 13
SWRInstitute Safety & Health Manual
6 Job Safety Analysis (JSA) Task Specific
Construction
Task Analysis
Job/Operation: Air
TA No. Rev:
Barrier Installation
Page
1
Title:
Job Site:
Analysis By:
Shady Grove
TX
John Doe
Location: ,
Subcontractor:
ABC Contracting
Recommended/Required PPE Required:
Equipment for this Job:
Safety
glasses, hard hats, safety vests, leather boots, work gloves (scope specific)
Sequence of Basic Job Steps
Potential Significant Hazards
Hazard Control Method
Step No. 1, 2, 3 etc.
Step No. 1a, 1b, 1c, 1d, 2a, 2b etc.
E/I/M.
.
1
Daily Huddle
1
Exposures
1
proper training, crew selection
(With all employees before starting work)
2
Frame Scaffold Inspection
Daily JHA of work areas and
2a
Overhead Falling Objects
2a
Awareness and communication
2b
Housekeeping (Slip/Trip)
2b
Awareness and trade communication
prior to entering scaffold
(Only on areas needing accessed)
Trash/Debris removal before working
3
Joint Prep at Sheathing
3a
Fall Hazard (Slips, Trips and Falls)
3a
Pre-Task Planning/JHA prior to startup
and Scaffolding inspection by competent
person
3b
Cuts to the hand
3b
PPE - Cut Resistant gloves to be worn
4a
Fall Hazard (Slips, Trips and Falls)
4a
Pre-Task Planning/JHA prior to startup
anytime utility knife is used
4
Membrane Flashing at Transitions/Openings
and scaffolding inspection by competant
person
4b
Cuts to the Hands
4b
PPE - Cut Resistant gloves to be worn
5a
Overhead work and Falling objects
5a
2 Men required to install opening flashing
anytime a utility knife is used
5
Metal Flashing at Transitions/Openings
Signage "Men Working Above" to be
in place with danger red taped off area
below work area(s) at ground level
5b
Cuts to the hand and body
5b
PPE - Cut Resistant gloves to be worn
anytime knives are used or with handling
metal flashing or sharp objects
5c
Fall Hazards (Slips, Trips and Falls)
5c
Pre-Task Planning/JHA prior to startup
and scaffolding inspection by competent
person
6
Air Barrier Installation
6a
Loud Noises (Spray Rig Operation)
6a
PPE - Ear plus shall be worn
(via Graco Pump Sprayer)
6b
Fume Inhalation & of adjacent trades
6b
Only use pump sprayer on the exterior
PPE - Respiratory Protection per MSDS
3M N95 disposable respirator mask
6c
Particulates in Eyes
6c
PPE - Safety glasses 100% enforced
Goggles to be worn during spraying
6d
Fall Hazards (Slips, Trips and Falls)
6d
Note
Pre-Task Planning & Communication
2 Men to operate pump spray rig
(Specifically on supply hoses for Graco Pump)
Aerial Lifts
a
Qualifications of employees
a
Employees shall have proper training certification
(Social Venue)
b
Fall Hazards, Uneven Grade
b
Pre-Task Planning/JHA prior to startup
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
11 . 14
SWR Institute Safety & Health Manual
7 Job Safety Analysis (JSA) Task Specific
Safety & Health Inspection Form (In Detail)
1. PERSONAL SAFETY
EQUIPMENT AND REQUIRED
CLOTHING
Adjacent trade are using PAG's
OK
Action
Comments
x
Ear plug use w spray rig operation
d. Long pants
x
Req. at level 5 & metal scaffold planks
e. Sleeved shirts
x
a. Eye protection: Z-87.1 and rated for Task
x
b. Ear protection: noise levels > 85 Dbs
c. Work boots: leather/die electric/steel toe/metatarsal/other
Use of cut-resist. handling metal
x
No cut-offs permitted
f. Hard hats at all times, on job sites
x
g. Reflective vests (traffic control)
x
h. Floatation devices when on, over or near water
-
N/A
i. Chemical protection: tyvec suits/rain suites/1/2 sleeves
-
N/A
j. Hand protection: welding/leather/cut proof/chemical/other
k. PPE: competent person assessed, inspected and maintained
2. HOUSEKEEPING
x
a. Rebar caps used to eliminate impalement potential?
Action
Comments
x
Trash & Debris left on scaffold
x
b. Debris being cleaned up regularly?
c. Point loading of debris on elevated decks?
Monthly (per job)
x
OK
Use of neoprene w/ solvents
x
d. Proper storage of materials, supplies, equipment?
e. Trip hazards removed? (i.e.,ice, oil, electrical cords, air lines, etc.)
f. Proper means of disposal used? (i.e., dumpsters, trash cans
with lids, etc.)
x
g. Combustible debris cleaned up and not creating fire hazard?
x
h. Nails pulled from scrap wood?
I. Pedestrian walkways free of trip and slip hazards?
3. Structure Safety and
Protection
x
Screws/nails, spray rig lines, suspend cords
x
Some areas were found/fixed immed.
N/A
-
OK
a. Loose and delaminated concrete removed prior to working?
x
b. Has engineered shoring plan been developed for this work?
x
c. Has shoring plan been properly implemented, maintained?
x
d. Is shoring left in place until completion of proper cure time?
x
Action
Comments
Per sections - slabs
(75% of design strength)
e. Is shoring around columns when concrete removed?
x
f. Is structure capable of supporting construction equipment?
-
g. Is structure capable of supporting construction debris?
x
h. Is there point loading of stored materials?
x
I. Have imbedded electric conduits and other electrical systems
been located?
x
N/A - Frame Scaffold & Tower Cranes aerial
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
11 . 12
SWR Institute Safety & Health Manual
4. RESPIRATORY/HAZARDOUS
COMMUNICATION
OK
Action
Comments
Respirators Procedures
a. Competent person assessing effectiveness of Respirator Program?
x
Safety Mgr. to assess
b. Right respirator for the specific hazard?
x
For use w spraying air barrier
c. Respirators stored/cleaned/disinfected properly?
-
N/A - Disposal type (N95)
d. Respirator users trained, given physicals, and fit tested?
-
N/A - Assess if scope requires one
E. Respirators used properly?
x
Hazard Communication Procedures
b. Chemical lists posted?
x
c. Employees trained on hazcom and specific chemicals in use?
x
d. Proper identification labels on cans?
e. MSDS onsite and available to employees?
5. FALL PROTECTION
x
x
OK
a. Do employees have the proper Fall Protection Training?
x
b. Are daily/weekly/monthly fall equipment inspections done?
x
c. Vertical and horizontal life lines properly rated and inspected?
-
d. Are there any unprotected floors and walkways (6ft or higher)?
e. Are floor openings covered, clearly marked or guarded?
Do not use Gatorade bottles w/ Xylene
see "c" above
Action
Comments
per use & w mgmt quarterly inspections
N/A
x
see frame scaffold section below
x
working surface is 14" from wall - add 2x4
x
f. Are handrails properly constructed top/middle/toe board?
g. Is fall arrest equipment logged in and dated?
x
h. Are employees tied off at all times when exposed to falls?
x
I. Does Motion Stopping System meet OSHA requirements?
x
J. Tie off points 5000 lbs/man?
x
6. EQUIPMENT: SAFE USE,
INSPECTION & MAINTENANCE
w foreman & onsite safety mgmt.
OK
per company policy
only approved/designated anchor point for PF
Action
Comments
Access Procedures
a. 1) Swing stage properly constructed and inspected?
-
N/A
2) Roof setup for swings properly constructed and inspected?
-
N/A
3) Swing Stage: Employees trained/competent/proper use?
-
N/A
4) Men, tools and equipment weight within scaffold rating?
-
N/A
1) Frame scaffold properly constructed and inspected?
tagged by competent person (scaffoldb.erector)
missing top rails - add 2x4's at top
x
2) Overloaded frame scaffolds/platforms/work decks, etc.?
x
3) Frame scaffold: Employees trained/competent on proper use?
x
daily inspect. checklist required per use
records available
4) Landing areas/platforms free of debris/trip hazards?
x
5) Employees not over-reaching limits of scaffolds?
x
c. 1) Ladder at proper angle/tied off at top/3 feet above landing?
x
All scaffold work
2) Non-conductive ladders used if working around electricity?
x
All scaffold work
3) Ladders with broken/missing/cracked/damaged
x
components tagged out and taken out of service?
caution at areas 14" from wall
-
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
N/A
11 . 13
SWR Institute Safety & Health Manual
Overhead Head Hazard
4) Upper and lower landings free of debris/trip hazards?
x
5) Ladders: Employees trained/competent on proper use?
x
d. 1) Stair rails provided for stairs with four or more risers?
x
2) Stairs free of debris, sand, oil/ice, electrical cords, air lines?
x
3) Stairs adequately lighted?
x
4) Stairs not used for storage of materials?
x
e. 1) Aerial man lifts: Employees trained on competent/proper use?
Scaffold door opens up to scaffold tie-back
XYZ & 123 training certifications
x
2) Stable, level drive area?
x
Uneven grade: avoid driving in those areas
3) Employees tied off at all times to basket?
x
4) Equipment not used as a crane to lift materials?
x
5) Cords/cables/ropes/air lines not hanging form the basket?
x
6) Men and equipment load within manufacturer’s specification?
x
f. 1) Scissors lifts: Employees trained on competent/proper use?
-
N/A
2) Stable, level drive area?
-
N/A
3) Employees tied off, if possible, to platform?
-
N/A
4) Equipment not used as a crane to lift materials?
-
N/A
5) Cords/cables/ropes/air lines not hanging from the basket?
-
N/A
6) Men and equipment load within manufacturer’s specification?
-
N/A
g. Stairs or ladder provided when breaks in elevation is > 19”?
x
h. 1)Elevated platforms: Landing/form traveler/knee bracket?
x
2) Equipment weight within rated load capacity?
x
3) Hand rails complete?
x
i) 1) Bracket scaffold: Adequate access/hand rails/rigging/use?
2) Following proper jumping procedure?
-
N/A
-
N/A
Equipment Procedures
Adjacent trades are using
a. Skid steers: Employees trained on competent/proper use?
-
N/A
Adjacent trades are using
b. Concrete Buggies: Employee trained on competent/proper use?
-
N/A
c. Forklifts: Employees trained on competent/proper
use/maintainance?
-
N/A
f. Water blasters: Employees trained on competent/proper use?
-
N/A
g. Sand pots: Employees trained on competent/proper use?
-
N/A
h. Hand tools? (i.e., chipping, guns, drills, scarifier, etc.)
x
training records available upon request
i. Grout pumps? (i.e., epoxy, chemical, concrete, cleaning, etc.)
-
N/A
j. Air lines and receiver tanks is safe working condition?
-
N/A
k. Air compressors properly maintained and used?
-
N/A
l. Other equipment: Employees trained on competent/proper use?
x
Graco Pump - Manufacturer training
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
11 . 14
SWR Institute Safety & Health Manual
Company Vehicle Procedures
Posted site speed limit
a. Vehicle inspection checklist done daily with defects corrected?
x
b. Towing equipment properly connected? (i.e., safety chains, etc.)
x
c. Tow hitches and ball hitch connections maintained?
x
d. Load is stable/secured properly, does not overload vehicle?
x
e. Mechanized equipment driven safely?
x
f. Proper protection and warning signs in public/traffic areas?
x
g. Required safety equipment on vehicle?
x
h. Scheduled maintenance up to date?
x
Other Tools and Equipment Procedures
a. Grinders used with guards and handles?
x
b. Saws with proper guards and not modified/two hands on saw?
x
c. Running equipment not left unattended?
x
d. Keys removed from equipment when not attended?
x
e. Equipment cleaned and free of debris?
x
f. Proper use of tuggers or pushers?
x
g. 1) Roof cranes/hoists inspected and used properly?
-
N/A
2) Load rating marked on basket?
-
N/A
3) Properly inspected? (i.e., daily, weekly, monthly, annual)
-
N/A
4) Operator at controls while load is suspended?
-
N/A
5) Three full wraps on winding drum?
-
N/A
7. JOB SITE SAFETY
OK
Action
Comments
Job site Requirements
AED training certification as well
Additional in GC trailers
a. OSHA, minimum wage, discrimination, etc...
x
b. Employee required training
x
c. Managers First Aid and Adult CPR training
x
Foreman plus appointed lead man
d. First aid kits/eye wash/burn stations
x
Located with each employee on site
e. Bloodborne pathogens kits available
x
f. Worker’s Compensation Incident reporting procedures
x
per company policy
Electrical Safety
GC provided for interior work
a. Assured grounding inspection and taping done correctly?
x
b. Adequate lighting for work areas?
x
c. Electrical cords and panels properly constructed and inspected?
x
d. Correct wiring for string lights?
x
e. Electric pannel boxes have proper covers?
x
f. GFCI used if exposed to weather or wet/damp conditions?
x
g. Electric tools unplugged if repairing or changing bits/blade/etc.?
x
Exterior work - not needed
Sanitation
GC has numerous water stations set up
on site water with disposable cups and trash receptacle?
a. Drinking
x
b. Water containers cleaned and sanitized daily?
x
c. Proper trash disposal at drinking/eating/work areas?
x
d. Proper number of toilets and wash-up facility provided?
x
2 gallon water jug provided per employee
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
11 . 15
SWR Institute Safety & Health Manual
Compressed Air & Gas Cylinder Safety
a. Air lines tie wired or secured at couplings?
-
N/A
b. Compressed air receiver tanks equipped with blow off valve?
-
N/A
b. Compressed air not used to blow dust from clothing?
-
N/A
c. Compressed cylinders stored and secured vertically?
-
N/A
d. Caps on cylinders when not in use?
-
N/A
e. 1) O2 and fuel gases stored 20’ apart or
-
N/A
-
N/A
f. Flash back arresters on torch handle and at cylinder?
-
N/A
g. Compressed gas cylinders handled and moved safely?
-
N/A
2) Separated by fireproof wall?
Fuel Handling and Flammable liquids
a. OSHA regulation gas cans with flash arrester
x
b. Equipment turned off while fueling
x
c. Fuel storage area: Signs/Containment/>20lbs Extinguisher
x
d. Proper storage of flammable liquid construction products
x
Fire Protection
a. Adequate
fire extinguishers:
inspection/placement/size
5 lb. extinguishers will be added at heavy
machinery
areas
employees each have their own 2.5 lb. extingu
x
b. Welding, burning, cutting: No combustibles in area
x
c. Fire watch provided when necessary
x
d. Oily rags stored in proper container
x
e. Designated smoking area provided and marked
x
f. No smoking signs posted
x
g. Fire extinguishers being maintained
x
h. Employees trained in proper use of fire extinguishers
x
Done during on site orientation
Daily check and monthly inspection
Ventilation
a. Confined space requires 20 air changes per hour
-
N/A
b. Provide clean, breathable air with constant monitoring
-
N/A
c. Air flow sufficient to reduce contaminants to a safe level
x
Outside Work
a. Following demolition procedure: PPE/shoring/compressed air
-
N/A
b. Following concrete placement procedure: forms/shoring
-
N/A
c. 1) Following confined space procedures
-
N/A
2) Employees trained in Confined Space procedures
-
N/A
3) Qualified person assessing CS effective procedures
-
N/A
d. Following lock-out, tag-out procedures
x
N/A
e. Following working on over or near water procedures
-
N/A
f. 1) Following trenching procedures
-
N/A
2) Employees competent in trenching procedures
-
N/A
3) Qualified person assessing effective trench procedures
-
N/A
4) Shoring, benching, sloping engineered
-
N/A
5) Proper entry and exits provided
-
N/A
x
Daily stretch and flex program before working
Other Procedures
g. Lifting: 1) plan 2) bend knees 3) keep close 4) pivot, don’t twist
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
11 . 16
SWR Institute Safety & Health Manual
8. GENERAL SAFETY
OK
adjacent trades on step ladders working
above window
heights
a. Overhead
protection
from falling/flying debris/tools/equipment
b. Public warning/hazard signs, signals or communication
missing at section turns
x
x
missing handrails on scaffold
e. Dust/Vapor: dust curtains, tape doors/windows, ventilate area
x
Siding subs cutting hardy board - flying dust
f. Noise control: monitoring/noise barriers/distance
x
Use ear plugs - Siding subs & Graco pump
g. Water hazards: life rings/hand rails/signage
-
h. Public protected from flying/spilled construction chemicals
x
x
k. Owner’s glass/tile/flooring/vehicles/property protected
x
OK
a. Project mgrs dedicate time to safety mtgs/action items
x
b. JSA’s are done daily and when new processes or tasks start
x
c. Pre Project Planning (PrePP) done for changed conditions
x
d. Pre Task Planning (PreTP) done prior to starting new tasks
x
e. Site specific safety training from PrePP implemented
x
f. Follow-up on action items from JSA’s, MSA’s, PrePP, PreTP
x
g. Site Specific Safety Plan from PrePP implemented
x
h. New employees given Standard Orientation prior to starting work
x
10. LIST COMPETENT PERSONS FOR:
N/A
Spray rig kept inside during operation
x
j. Adequate pedestrian barriers/fences/gates/flagging
9. SAFETY CULTURE
Per GC's Plan
water cooler sitting on window sill ledge
x
Left on scaffold - Cleanup required each
shift
I. Pedestrian
walkways protected from trip and slip hazards
GC - Daily JHA's
Comments
x
c. Fall potential: open holes covered, fencing, hand rails,
d. Traffic control: signs, direction, barrels, barricades
Action
OK
Action
Siding/plaster/insulation materials & debris
Comments
ABC - Weekly, plus at scope changes
Non-Compliance Follow-up
Action
Comments
a. Respirator protection:
x
b. Confined space:
x
John Doe
c. Scaffolds, platforms and ladders:
x
Robert Williams
d. Personal Protection Equipment:
x
Robert Williams
e. Fall protection:
x
John Doe
f. Welding:
-
N/A
g. Cranes/hoists and rigging:
-
N/A
h. Grouting:
-
N/A
I. Forming:
-
N/A
J. Trenching:
-
N/A
k. Motorized access equipment:
-
N/A
l. Other specialty equipment (1):
x
m. Other specialty equipment (2):
-
John Smith
PAG's
John Smith
N/A
Job Site Information
Shady Grove
John Doe
Project:
Report By:
Date:
7/21/2010
Number of
Emp.:
18
Harry Truman
Project Manager:
Branch:
Germany
-
Superintendent:
PE:
-
Foreman 2:
John Smith
Robert Williams
Foreman 1:
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
11 . 17
SWR Institute Safety & Health Manual
8
Subcontractor’s Site Specific Safety and Health Plan
To be completed and handed to (main contractor) site management prior to commencement of work on site
To be read in conjunction with the explanatory notes attached.
ABC Contracting
To:
(Main contractor)
From:
XYZ Commercial Roofs
(Subcontractor)
For:
Green Acres
(Project)
For: Roofing (General) - Downspouts
(Subcontract Works)
We undertake as follows:
1. Site Safety Representative:
Mike Ditka
Our nominated on site Safety Representative for this project is: ………………………………………………………….(name)
2. Notifiable Works:
Yes
■ No
■ Yes
No
We have notifiable works associated with our subcontract and OSH has been advised.
(If yes, a copy of the notification must be attached. Refer attached notes for supervisory requirements.)
3. Hazard Management:
An analysis of the significant hazards associated with our subcontract work and the methods
to control such hazards are attached.
(Note: If not attached, then hazard ID and method of control must be submitted prior to starting work on site.)
■ Yes
We understand that all new hazards identified by our staff will be notified immediately.
No
■ No
Hazardous products are associated with our subcontract work.
Yes
(If yes, the appropriate Material Safety Data Sheets must be attached.)
4. Communication:
The methods of communicating safety information to our employees are by: (tick methods used)
Toolbox talks
Pre-task planning meetings
Notice board
Co-ordination meetings
Onsite Training
■ Other…………………………………………………………………………………………………………………………
(State methods)
5. Emergencies:
With each employee
Our first aid kit is located:………………………………………………………………………………………………………
(State location)
We have an emergency plan in place.
■ Yes
No
We have procedures in place and a trained first aid person on site to render assistance
in the event of an accident or emergency. ■ Yes
No
Clay Matthews (GC) & then John Doe (ABC)
In the event of an evacuation, our staff reports to: ………………………………………………………………………………………
(State whom)
and assemble at the evacuation area nominated by the (Main Contractor) Site Management.
6. Accident Reporting:
We have an accident/incident reporting system in place and keep an accident register.
■ Yes
No
All accidents will be reported to (Main Contractor) Site Management along with a copy of our accident report.
7. Safety Inspections and Safety Reviews:
Frequency of our safety inspections is: 8. Training/Induction:
All persons under our control on site are trained to carry out their work safely.
■ Yes
No
(Attach list of employees with card numbers.)
All persons under our control on site are given a site-specific safety induction.
Mike Ditka
Signed:
Date:
5/10/2010
Date:
5/10/2010
■ Yes
No
■ Yes
No
(Subcontractor Representative)
Clay Matthews & John Doe
Approved:
Weekly
All persons under our control hold a current Site Safe Passport or Gold Card.
All persons under our control on site are appropriately qualified, competent or fully supervised.
■ Daily
(Main Contractor Site/Project Manager)
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
11 . 18
SWR Institute Safety & Health Manual
Subcontractors Site Specific Safety & Health Plan
Explanatory notes
Introduction
Prior to completing the requirements of this Site Specific
Health and Safety Plan you will forward to (main contractor)
a copy of your Company Safety Program, which details
your company’s commitment to health and safety, and
by doing so have become a preferred subcontractor.
Site Safety Representative
This person must actively promote health and safety in the
workplace for your company and ensure appropriate safe work
practices for your on site personnel. This person may a dedicated
health and safety person, your supervisor, or one of your senior
workers who is designated to act on behalf of your company with
regard to health and safety.
Notifiable Works
Where notifiable work, as defined in the Health and Safety
Regulations Sections 2 and 26, is to be carried out by your
company, you must notify OSHA in writing at least 24 hours
prior to commencement of such work. (Main contractor) site
management will require confirmation that you have done this
and a copy of the notification for their records. If engaged on
notifiable work, then you must have a full-time on site supervisor
and he/she must be the holder of the Site Safe Gold Card or the
BCITO National Certificate in Construction Health and Safety and
Injury Prevention.
Hazard Management
All hazards to be brought onto site or created during the course
of the work must be identified and controlled. The standard Task
Analysis Sheet (copy attached) may be used to analyse the various
tasks within your trade work, identify the significant safety hazards
and detail the method of control. These sheets must be attached
and forwarded with your Site Specific Safety Plan.
Hazardous substances that you may use on site must have the
appropriate MSD Sheets on site and be addressed on the Task
Analysis Sheets.
Communication
Appropriate on-site communications must be established with the
Site Management team to disseminate all information pertaining
to safety requirements on site. This will include the notification
of hazards brought onto site or created during the course of the
work. This may be done by posting the hazard sheets on notice
boards, the main site hazard board, or advised during regular
Toolbox Talks. The aim is to ensure that all workers on site are
aware of the hazards as they arise and equally be advised when
they no longer exist. If English is the second language of your
employees, then you must maintain on site a liaison person who
can effectively communicate with our site management team.
Emergencies
In the event of a site evacuation the site siren will be sounded
and your employees must promptly evacuate the site. The Site
Management Team will notify you of your assembly point at the
time of your induction onto the site.
Some emergencies that you may need to prepare for and have
a procedure to follow include spillage of hazardous substances,
serious harm accidents to your staff, and rescue of a fall
arrest victim.
You must have a person on site who is trained in First Aid in
case of an injury accident to any of your staff.
Accident Reporting
All accidents must be reported immediately to (Main contractor)
Site Management and serious harm accidents also reported direct
to OSHA. Accident and investigation reports are to be copied to
the main contractor within 48 hours. Accident scenes will not
be disturbed until a full and complete accident investigation has
been undertaken.
Safety Inspections and Safety Reviews
You are expected to carry out regular documented safety
inspections (minimum weekly) of your own work areas while
on this site. Copies of the inspection reports must be given to
the (main contractor) site team for discussion at safety meetings.
Any recommended/completed corrective action will be advised
at these meetings.
Training/Inductions
All persons starting work on this site must go through a formal
induction process. During this process, safety rules and various
site-specific issues will be discussed.
To work on a (Main contractor) site you must have either a
current Site Safe Passport or Gold Card. You will not be admitted
to site without either of these cards. Please supply a list of all
your staff working on this site along with their passport/gold card
numbers at the time of the induction. All staff will be expected
to show their passport/gold card at the time of the induction.
Where appropriate (Main contractor) will require you to provide
evidence of your employees’ skills training. For example: trade
qualifications, certificates of competency, etc.
9 Summary
This section of the SWR Institute Safety & Health Manual describes the
procedures for developing a Site Specific Safety Plan.
The rate of injury for workers in the construction industry is
approximately 60 percent higher than the overall average for all
workers. Recognition of the hazards is essential to the prevention
of job-related injuries. This technique focuses on job tasks as a way
to identify hazards before they occur. It is a relationship between the
worker, the task, the tools and the work environment.
It is necessary for management to make the commitment to correct
identified hazards, so the entire effort is not wasted. Involve employees
by training them to recognize potential hazards and unsafe working
conditions. Get employees to buy in, empower them to correct hazards
and unsafe working conditions. The combination of management
commitment and employee buy in will add value to your business,
your work place and your life.
SECTION 11 ■ Safety & Health Manual | Site specific safety plan
11 . 19