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H&S Self-Assessment Checklist - SCAFFOLDS 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 work from scaffolds. Designated Safety Coordinator may consult with scaffold contractors when completing this checklist, but shall not direct the means and methods of scaffold operations nor direct the details of corrective actions. Scaffold 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 scaffold 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 scaffold 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-73. PERSONNEL SAFE WORK PRACTICES (3.1) SECTION 1 Yes No N/A N/O 1. Competent person has completed work shift inspection and has authorized scaffold access 2. Personnel aware of and following access requirements established by competent person 3. Scaffold free from damage and in stable condition 4. Safe means of access provided to scaffold platform 5. Personnel remaining within guardrail system when provided 6. Personnel using personal fall arrest systems (PFAS) when required 7. Personnel working from suspension scaffolds or boatswains’ chairs using PFAS 8. CH2M HILL personnel have completed CH2M fall protection training when PFAS use required 9. Personnel not standing on objects or ladders on top of scaffold platforms 10. Personnel not using ladders on top of scaffold platforms unless platform covers the entire floor 11. Personnel not working on scaffolds covered with snow or ice 12. Personnel not work on scaffolds during storms/high winds unless adequate protection provided Rev.0 GNV310133632156.DOC/090840008 A-95
H&S Self-Assessment Checklist - SCAFFOLDS Page 2 of 2 SECTION 1 Yes No N/A N/O 13. Supported scaffolds > 10 feet provided with guardrails or PFAS 14. When required, adequate guardrail system installed on all platform open sides and ends 15. When required, adequate PFAS provided (may also use fall protection checklist HS31) 16. Falling object protection provided to personnel working on scaffolds/under scaffolds 17. Safe clearance maintained from overhead power lines MOBILE SCAFFOLDS (3.2.4) 18. Casters/wheels locked while scaffold used in the stationary position 19. Personnel not riding mobile scaffolds unless safe to move SUSPENSION SCAFFOLDS (3.2.5) 20. Suspension scaffolds and boatswains’ chairs > 10 feet provided with personal fall arrest system 21. Supporting devices inspected by competent person prior to scaffold use 22. Suspension ropes inspected by competent person before each work shift 23. Damaged or repaired wire rope not used as suspension rope 24. Suspension ropes joined together only by eye splice thimbles connected by shackles 25. Wire rope clips inspected/retightened after initial loading and before each work shift 26. Scaffold ropes protected from welding, heat, and corrosives 27. Scaffolds tied or otherwise secured from swaying ADJUSTABLE SUSPENSION SCAFFOLDS (3.2.6) 28. Adjustable suspension scaffolds > 10 feet provided with guardrails and PFAS 29. Hoists have braking device/locking pawl that engages during scaffold uncontrolled movements 30. Manually operated hoists require positive crank force to lower 31. Gasoline-powered hoists not used SECTION 2 Complete this section for all items checked “No” in Section 1. Deficient items must be corrected in a timely manner. Date Item # Corrective Action Planned/Taken Corrected A-96 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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fever, neck stiffness, stupor, diso
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2.4.8.3 Post Exposure CH2M HILL wil
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Page 113 and 114: Work around vehicular traffic and h
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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 and 158: H&S Self-Assessment Checklist - EAR
Page 159 and 160: H&S Self-Assessment Checklist - EXC
Page 161 and 162: H&S Self-Assessment Checklist - FAL
Page 163: H&S Self-Assessment Checklist - FAL
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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