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O'T'IE- <br /> M <br /> OMda Ta1N InllgrtOE EMNpIY <br /> 'Al <br /> Site Safety and Health Inspection Form Page 1 of 4 <br /> Project Name: Soil Excavation at California National Guard Armory, Lodi, California <br /> Contract Number: W91238-09-D-0017, DO 0004 <br /> A knowledgeable OTIE project management representative shall fill in each section and provide <br /> a copy to the PM, SSHO, and the Corporate SHM (if requested). A sheet for comments is <br /> provided at the end of this form for observations that require explanation. <br /> Job Name: Today's Date <br /> Owner/Client <br /> Project Address <br /> Person Filling Out This Form (Name) <br /> Your Relation to the Project <br /> Not <br /> OK OK N/A Documentation and Meetings <br /> 1. Is there a copy of the OTIE Health and Safety Plan on site? <br /> 2. Is the OTIE Site-Specific Health and Safety Plan available for site personnel <br /> to read? <br /> 3. Is a map (with phone number and address)to a emergency medical facility, <br /> and job site posters posted in a conspicuous location? <br /> 4. Is there a current file with OTIE and subcontractor's medical and training <br /> records on site? <br /> 5. Is there a field logbook on site that includes recent entries on Safety and <br /> Health? <br /> 6. Are Daily Safety Tool Box Talks being conducted and documented? <br /> Medical Support <br /> 7. Are First Aid supplies adequate for the project? <br /> 8. Have eye rinse stations been up set for work areas? <br /> 9. Does a member of the crew hold First Aid and CPR Certification? <br /> Site Areas <br /> 10. Are designated traffic patterns, road layouts, and parking areas being <br /> followed by site personnel? <br /> 11. Are work zones boundaries established and effective to keep unauthorized <br /> personnel out? <br /> 12. Is lighting adequate to perform work safely? <br /> 13. Is dust on the project being controlled properly? <br />