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H&S Self-Assessment Checklist - EXCAVATIONS Page 1 of 2 This checklist shall be used by CH2M HILL personnel only and shall be completed at the frequency specified in the project’s Field Safety Instructions. This checklist is to be used at locations where CH2M HILL employees enter excavations. Designated Safety Coordinator may consult with excavation contractors when completing this checklist, but shall not direct the means and methods of excavation operations nor direct the details of corrective actions. Excavation contractors shall determine how to correct deficiencies and we must carefully rely on their expertise. Items considered to be imminently dangerous (possibility of serious injury or death) shall be corrected immediately or all exposed personnel shall be removed from the hazard until corrected. Project Name: ______________________________________________________ Project No.: ______________________ Location: ______________________________________________________ PM: __________________________________ Auditor: ____________________________________ Title: _________________________________ Date: _____________ This specific checklist has been completed to: Evaluate CH2M HILL employee exposures to excavation hazards • Check “Yes” if an assessment item is complete/correct. • Check “No” if an item is incomplete/deficient. Deficiencies shall be brought to the immediate attention of the excavation subcontractor. Section 3 must be completed for all items checked “No.” • Check “N/A” if an item is not applicable. • Check “N/O” if an item is applicable but was not observed during the assessment. Numbers in parentheses indicate where a description of this assessment item can be found in Standard of Practice HS-32. PERSONNEL SAFE WORK PRACTICES (3.1) 1. Competent person has completed daily inspection and has authorized entry 2. Personnel aware of entry requirements established by competent person 3. Protective systems are free from damage and in stable condition 4. Surface objects/structures secured from falling into excavation 5. Potential hazardous atmospheres have been tested and found to be at safe levels 6. Precautions have been taken to prevent cave-in from water accumulation 7. Personnel wearing appropriate PPE, per HSP/FSI EXCAVATION ENTRY (3.2.4) 8. Trenches > 4’ deep provided with safe means of egress within 25’ 9. Structure ramps designed and approved by competent person 10. Potential hazardous atmospheres tested prior to entry 11. Rescue equipment provided where potential for hazardous atmospheres exists 12. Ventilation used to control hazardous atmospheres and air tested frequently 13. Appropriate respiratory protection used when ventilation does not control hazards 14. Precautions taken to prevent cave-in from water accumulation in the excavation 15. Precautions taken to prevent surface water from entering excavation 16. Protection provided from falling/rolling material from excavation face 17. Spoil piles, equipment, materials restrained or kept at least 2’ from excavation edge SECTION 1 Yes No N/A N/O GNV310133632156.DOC/090840008 A-89
H&S Self-Assessment Checklist - EXCAVATIONS Page 2 of 2 SECTION 1 Yes No N/A N/O EXCAVATION PROTECTIVE SYSTEMS (3.2.5) 18. Protective systems used for excavations 5’ or deeper 19. Protective systems for excavation deeper than 20’ designed by registered PE 20. If soil unclassified, maximum allowable slope is 34 degrees 21. Protective systems free from damage 22. Protective system used according to manufacturer recommendations and not subjected to loads exceeding design limits 23. Protective system components securely connected to prevent movement or failure 24. Cave-in protection provided while entering/exiting shielding systems 25. Personnel removed from shielding systems when installed, removed, or vertical movement SECTION 2 Complete this section for all items checked “No” in Sections 1. Deficient items must be corrected in a timely manner. Item # Corrective Action Planned/Taken Date Corrected 2.2.30 Rev.0 A-90 GNV310133632156.DOC/090840008
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Contents Section Page 1 Introductio
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CONTENTS, CONTINUED Section Page 9
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SECTION 1.0 Introduction 1.1 Purpos
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SECTION 2.0 Program Description 2.1
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SECTION 3.0 Program Organization an
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SECTION 3.0 PROGRAM ORGANIZATION AN
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SECTION 4.0 Services During Bidding
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SECTION 5.0 Construction Management
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SECTION 5.0 CONSTRUCTION MANAGEMENT
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SECTION 6.0 PROJECT MEETINGS The pr
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SECTION 6.0 PROJECT MEETINGS Re
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SECTION 7.0 PROGRESS CONTROL AND RE
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SECTION 8.0 INSPECTIONS AND QA/QC T
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SECTION 8.0 INSPECTIONS AND QA/QC T
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SECTION 9.0 CONSTRUCTION QA/QC PROG
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SECTION 11.0 CH2M HILL FIELD SAFETY
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SECTION 12.0 UNIFORM CONSTRUCTION F
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SECTION 12.0 UNIFORM CONSTRUCTION F
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SECTION 13.0 CONSTRUCTION PROGRAM F
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Field Safety Instructions - Baton R
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Obie Watts/BTR Tom Ridgik/GNV Mike
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Telephone: (504) 455-2090 Subcontra
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Training on the actual fall protect
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2.2.2 Cement/Lime Dust (Reference C
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• Review and sign Attachment 1 to
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• Cranes shall not be used to lif
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• Maintain safe distance from ope
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hazard, as specified in the followi
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• Fall protection equipment and c
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Increase fluid intake. Recovery usu
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• Always lock your car, even for
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• Personnel must not use pan and
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• Remember no sunscreen provides
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2.2.29 Welding and Cutting (Referen
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2.3.5 Shipping and Transportation o
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o Reapply repellants before the dur
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Page 109 and 110: 2.4.8.3 Post Exposure CH2M HILL wil
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Page 113 and 114: Work around vehicular traffic and h
Page 115 and 116: Instead of implementing a work-area
Page 119 and 120: Revisions Approved By: Alan Cyrier
Page 123 and 124: Attachment 2 to FSI: Page 1 of 1 Pr
Page 125 and 126: Emergency Contacts Attachment 4 to
Page 127 and 128: Attachment 4 to FSI: Page 2 of 3 PR
Page 131 and 132: (Respirator Protection: Page 1 of 1
Page 133 and 134: Confined-Space Entry Permit (CSEP:
Page 135 and 136: Confined Space Alternative Procedur
Page 137 and 138: Confined-Space Non-permit Certifica
Page 139 and 140: PROJECT FALL PROTECTION EVALUATION
Page 141 and 142: PERSONAL PROTECTIVE EQUIPMENT Hazar
Page 143 and 144: TABLE 1 Hazard/Risk Category Classi
Page 145 and 146: TABLE 2 Protective Clothing and Per
Page 151 and 152: ENTRY UNDER A CONFINED-SPACE ENTRY
Page 153 and 154: H&S Self-Assessment Checklist: CONF
Page 155 and 156: H&S Self-Assessment Checklist—CRA
Page 157: H&S Self-Assessment Checklist - EAR
Page 161 and 162: H&S Self-Assessment Checklist - FAL
Page 163 and 164: H&S Self-Assessment Checklist - FAL
Page 165 and 166: H&S Self-Assessment Checklist - SCA
Page 167 and 168: MSDS Page 1 of 10 A-98 GNV310133632
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Page 187 and 188: CH2M HILL FIELD SAFETY INSTRUCTIONS
Page 191 and 192: DETAILED TASK HAZARD ANALYSIS (Deta
Page 193 and 194: Personnel to Perform Task (Personne
Page 195 and 196: SAFETY PRE-TASK PLANNING POTENTIAL
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