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Safety Report <strong>July</strong> <strong>2019</strong><br />

Issued August <strong>2019</strong><br />

Anthony Torres Demolition<br />

ANTHONY<br />

TORRES<br />

DEMOLTION<br />

ANTHONY TORRES DEMOLITION CORP | 1807 MOUNT VERNON AVE POMONA CA 91768


Anthony Torres<br />

Demolition<br />

<strong>July</strong> <strong>2019</strong><br />

SAFETY COMMITTEE MEETINGS


www.thepriceofsafety.com<br />

info@thepriceofsafety.com<br />

The Price of Safety Inc - Safety Committee Meeting Minutes<br />

AUGUST<br />

1485 SPRUCE STREET, SUITE M<br />

RIVERSIDE CA 92507<br />

MEETING CALLED BY<br />

TYPE OF MEETING<br />

FACILITATOR<br />

NOTE TAKER<br />

NEXT MEETING<br />

ATTENDEES<br />

Anthony Torres Demolition & The Price of Safety, Inc.<br />

Safety Committee Meeting<br />

Mayra Martinez<br />

Mayra Martinez<br />

TBD<br />

Mayra Martinez, Brittany Price, Sandra Castillo, John Torres, Erica Pompa,<br />

Note: Due to <strong>ATD</strong>’s work schedule, <strong>July</strong>’s SCM was rescheduled for August.<br />

Old Business<br />

SAFETY EVALUATIONS<br />

REVIEW<br />

MAYRA MARTINEZ<br />

7.1 The Price of Safety Performed the following Safety Evaluations for the month of <strong>July</strong>:<br />

1. 7/10/<strong>2019</strong> Rakin Amos attempted to perform SER @ 3141 La Novia<br />

Work Completed & Crew Left @ Safety Manager’s 11am arrival time<br />

(Please Review SER)<br />

2. 7/10/<strong>2019</strong> Rakin Amos performed SER @ Laguna Beach/Foreman: Sal Flores<br />

(Please Review SER) 0 Failed items | 0 Abated items | Inspection Score: 100%<br />

3. 7/15/<strong>2019</strong> Rakin Amos performed SER @ Jack in the Box/Foreman: Abel Castro<br />

(Please Review SER) 0 Failed items | 1Abated item Inspection Score: 100%<br />

DISCUSSION<br />

4. 7/15/<strong>2019</strong> Rakin Amos performed SER @ Kathy’s House, Inc./Leadman: Sergio Duarte<br />

(Please Review SER) 1 Failed item | 0 Abated items Inspection Score: 97.37%<br />

5. 7/16/<strong>2019</strong> Rakin Amos performed SER @ Chick-fil-A/Foreman: Sixtos Molina<br />

(Please Review SER) 1 Failed item | 0 Abated items Inspection Score: 97.44%<br />

6. 7/18/<strong>2019</strong> Rakin Amos performed SER @ Jack in the Box/Foreman Teodocio Mendoza<br />

(Please Review SER) 1 Failed item | 0 Abated items Inspection Score: 94.59%<br />

7. 7/18/<strong>2019</strong> Rakin Amos performed SER @ Joe Black House /Jesus Pineda<br />

(Please Review SER) 1 Failed item | 0 Abated items Inspection Score: 97.56%<br />

8. 7/24/<strong>2019</strong> Mayra Martinez performed Incident Investigation @ Care First Medical Group<br />

in response to H. Chavarria/Foreman Teodocio Mendoza’s incident @ Chik-fil-a N. Western Ave<br />

(Please Review Incident Investigation Report)<br />

Average Score: 97.83%<br />

Notes: Safety Manager Mayra Martinez accompanied H. Chavarria @ Care First Medical Group on 7/31/<strong>2019</strong> for his follow up<br />

appointment.<br />

Prepared by The Price of Safety on behalf of Anthony Torres Demolition<br />

1485 Spruce St., Suite M, Riverside, CA 92507 | www.thepriceofsafety.com


ACTION ITEMS PERSON RESPONSIBLE DEADLINE<br />

Crystalline-Silica & Respiratory Training. Coordinate with Sandra. Mayra Martinez/Sandra Castillo TBD<br />

Personal Protective Equipment/Personal Fall Arrest System Refresher Mayra Martinez/Sandra Castillo<br />

TBD<br />

Mechanical Guarding Training. Coordinate with Sandra. Mayra Martinez/Sandra Castillo TBD<br />

7.2 Accident Investigation: Humberto Chavarria<br />

DISCUSSION<br />

• On 7/24/<strong>2019</strong> Humberto Chavarria injured his hand while it was placed on a waste trailer simultaneously<br />

as Foreman Teodocio Mendoza was driving the CAT 232b2 Skid Steer Loader at the Chik-fil-a N.<br />

Western Ave job site.<br />

H. Chavarria was injured in an incident when his fourth finger on his left hand was pinched between a CAT 232b2<br />

Skid Steer Loader and a metal waste trailer on 7/24/<strong>2019</strong> at 11:45am. The site supervisor and designated safety<br />

personnel were notified shortly after the incident occurred.<br />

CONCLUSIONS<br />

M. Martinez met with H. Chavarria at Care First Medical Group in Ontario, CA on 7/24/<strong>2019</strong>. M. Martinez conducted<br />

an incident investigation while she accompanied H. Chavarria during his treatment for his injury. H. Chavarria<br />

received eleven (11) stitches around his distal interphalangeal joint (joint/knuckle closest to the fingertip).<br />

H. Chavarria was released the same day with light duty, no use of left hand work restrictions. He was cleared to<br />

return to work the next day and a follow up appointment was scheduled for 7/31/<strong>2019</strong> at the Care First Medical<br />

Group in Ontario, CA.<br />

M. Martinez concluded from her incident investigation that the incident was due to the following:<br />

• Manpower deficiency to perform task correctly<br />

• Lack of proper hand protection during the time of the injury<br />

• Back-up alarms were not used at the time of the incident<br />

• Lack of employee training<br />

• Missing or incomplete safety documentation (JHA, Site Inspection)<br />

• Lack of Safety Awareness<br />

The incident was preventable and reoccurrence can be prevented by revising the IIPP to include a mandatory<br />

“Buddy System”.<br />

Dai<br />

Additional improvements identified from Incident Investigation:<br />

• Conduct safety orientation (company & site)<br />

• JHAs and site inspections- performed by site supervisors<br />

• Provide workers more adequate means of hand protection (full hand, back hand)<br />

ACTION ITEMS<br />

Accompany H. Chavarria to his follow up appointment at Care First Clinic in Ontario,<br />

CA.<br />

PERSON<br />

RESPONSIBLE<br />

Mayra Martinez<br />

DEADLINE<br />

Revise <strong>ATD</strong> IIPP to include mandatory “Buddy System” John Torres 7/31/<strong>2019</strong><br />

7/31/<strong>2019</strong> @ 3:45pm<br />

7.3 According to our observations, findings on previous Safety Evaluations & Incident reports, The Price of<br />

Safety, Inc. suggests the following trainings:<br />

DISCUSSION<br />

• Crystalline-Silica & Respiratory Training<br />

• Personal Protective Equipment/Personal Fall Arrest System Refresher<br />

• Mechanical Guarding Training<br />

CONCLUSIONS<br />

Based on the current terms of our agreement, The Price of Safety, Inc. offers Anthony Torres Demolition 1 free<br />

awareness level training per month.<br />

Due to <strong>ATD</strong>’s work schedule, vital trainings did not take place in <strong>July</strong> and there was an incident involving a CAT<br />

232b2 Skid Steer Loader on 7/24. Proper training helps reduce incidents and creates a positive safety culture on all<br />

Anthony Torres Demolition job sites.<br />

Mayra suggests <strong>ATD</strong> utilize the free training on the Crystalline-Silica & Respiratory, which will address the most<br />

imperative training needs at this time.<br />

Prepared by The Price of Safety on behalf of Anthony Torres Demolition<br />

1485 Spruce St., Suite M, Riverside, CA 92507 | www.thepriceofsafety.com


In addition, the PPE and Mechanical Guarding trainings are vital. Mayra suggests that <strong>ATD</strong> partners with The Price<br />

of Safety, Inc. to schedule pertinent trainings to address <strong>ATD</strong>’s critical safety needs as soon as possible.<br />

Notes: The Hilti Reciprocating Saw training scheduled for 7/27 was canceled by <strong>ATD</strong>. We recommend re-scheduling in August <strong>2019</strong>.<br />

ACTION ITEMS PERSON RESPONSIBLE DEADLINE<br />

Reschedule Hilti Reciprocating Saw Training Mayra Martinez/Sandra Castillo August <strong>2019</strong><br />

Schedule Joint-Training with Emmons Roof Services, Inc. Mayra Martinez/Sandra Castillo August <strong>2019</strong><br />

Crystalline-Silica & Respiratory Training. Coordinate with Sandra. Mayra Martinez/Sandra Castillo August <strong>2019</strong><br />

Personal Protective Equipment/Personal Fall Arrest System Refresher.<br />

Coordinate with Sandra.<br />

Mayra Martinez/Sandra Castillo 8/20/<strong>2019</strong><br />

Mechanical Guarding Training. Coordinate with Sandra. Mayra Martinez/Sandra Castillo August <strong>2019</strong><br />

OBSERVERS<br />

RESOURCE<br />

PERSONS<br />

SPECIAL NOTES<br />

Prepared by The Price of Safety on behalf of Anthony Torres Demolition<br />

1485 Spruce St., Suite M, Riverside, CA 92507 | www.thepriceofsafety.com


SAFETY SYNOPSIS


ANTHONY TORRES SAFETY SYNOPSIS<br />

<strong>July</strong> <strong>2019</strong><br />

This month’s Safety Report reflects a cumulative data analysis collected during the first quarter and recent evaluations.<br />

Our findings outline pertinent training needs and innovative strategies Anthony Torres Demolition can use to meet<br />

essential Safety Culture goals.<br />

OSHA officers are often tasked with identifying and documenting tragic events related to demolition workers.<br />

Demolition work involves direct contact with construction hazards and unknown factors. These unknown factors make<br />

the scope of work acutely dangerous. For example, structural design changes, hidden materials within structural<br />

modifications, and unidentified construction material conditions can all contribute to potential hazards on the worksite.<br />

To combat hazards, everyone on the worksite must be fully aware of the hazards they may encounter, plan ahead to get<br />

the job done safely, ensure the right protection and equipment is provided, and train all employees about hazards and<br />

how to use equipment safely, ensure the right protection and equipment is provided, and train all employees abut<br />

hazards and how to use equipment safely.<br />

SUMMARY OF MEANS<br />

The methods of mitigation strategies include:<br />

§ Conduct 360 Degree Evaluations<br />

§ Work Quality Evaluations<br />

§ Employee Corrective Reviews<br />

§ Gauge Time Management<br />

§ Barrier Identification<br />

These measures will help us ascertain the leading<br />

and lagging indicators, which will help us to<br />

implement strategies to eliminate or decrease<br />

incidents and injuries.<br />

SUMMARY RESULTS<br />

Based on data collected and forecasted scope of<br />

work, we recommend Anthony Torres implement<br />

the following mitigation strategies:<br />

§ Safety Orientations (Company & Site)<br />

§ JHA and Site Inspections (Site<br />

Supervisors)<br />

§ PPE Refresher<br />

§ Crystalline-Silica & Respiratory<br />

§ Machine Guarding<br />

§ Hilit Reciprocating Saw Training<br />

§ Corrective Action: Revise IIPP to include a<br />

mandatory “Buddy System”<br />

Analytics Overview<br />

Prepared by The Price of Safety on behalf of Anthony Torres Demolition<br />

1485 Spruce St., Suite M, Riverside, CA 92507 | www.thepriceofsafety.com


Prepared by The Price of Safety on behalf of Anthony Torres Demolition<br />

1485 Spruce St., Suite M, Riverside, CA 92507 | www.thepriceofsafety.com<br />

ANTHONY TORRES SAFETY SYNOPSIS


SAFETY<br />

PERFORMANCE


Monthly Safety Performance Report<br />

Note: This report summarizes the Safe and Failed results for all evaluated jobsites this month. Please make sure to<br />

report all man-hours, incidents and loss time from work by the end-of-the-month. This helps to implement changes and<br />

decrease the number of incidents on-site.<br />

<strong>July</strong> <strong>2019</strong> Anthony Torres Demolition 07.01.<strong>2019</strong> - 07.31.<strong>2019</strong><br />

Jobsites Evaluated<br />

Foreman Location Results Company Notified<br />

Teodocio Mendoza Culver City 0 Failed Responses/ 0 Abated/ 111 Safe Sandra Castillo<br />

Sergio Duarte Rosemead 1 Failed Response / 0 Abated/ 110 Safe Sandra Castillo<br />

Sal Flores Laguna Beach 0 Failed Response / 0 Abated/ 111 Safe Sandra Castillo<br />

San Juan Capistrano (Crew Departed site prior to Safety Manager’s<br />

Arrival)<br />

Abel Castro Anaheim 0 Failed Responses / 0 Abated/ 111 Safe Sandra Castillo<br />

Sergio Duarte San Clemente 1 Failed Response / 0 Abated/ 110 Safe Sandra Castillo<br />

Sixtos Molina Sierra Vista 1 Failed Response / 0 Abated/ 110 Safe Sandra Castillo<br />

Teodocio Mendoza Laguna Beach 1 Failed Response / 0 Abated/ 110 Safe Sandra Castillo<br />

Prepared by The Price of Safety on behalf of Anthony Torres Demolition<br />

1485 Spruce St., Suite M, Riverside, CA 92507 | www.thepriceofsafety.com


SITE STATISTICS


Site Statistics <strong>July</strong> <strong>2019</strong><br />

QUARTERLY SUMMARY RESULTS<br />

This report focuses on the quarterly progress for Anthony Torres Demolition and reflects the safety site statistics<br />

per job-site. The criteria will help identify the leading indicators and will assist in creating proactive and<br />

conceptual safety strategies that will decrease incidents and ascertain training recommendations.<br />

Foreman <strong>July</strong> August September<br />

Teodocio Mendoza 100%,97.44%<br />

Abel Castro 100%<br />

Sal Flores 100%<br />

Sixtos Molina 97.44%<br />

Jesus Pineda 97.56%<br />

Omero/Jesus Diaz<br />

N/A<br />

Juan Duarte<br />

N/A<br />

Sergio Duarte 97.37%,97.37%


SAFETY EVALUATION<br />

REPORTS


Anthony Torres Demolition / 8 Jul <strong>2019</strong> / Rakin Amos<br />

Safety Evaluation Report (SER)<br />

Complete<br />

Inspection score<br />

100.00%<br />

Failed items<br />

0<br />

Created actions<br />

0<br />

Client / Site<br />

Anthony Torres Demolition<br />

Date of Audit<br />

8th Jul, <strong>2019</strong><br />

Prepared by<br />

Rakin Amos<br />

Location<br />

11211–11219 Lucerne Ave<br />

Culver City, CA 90230<br />

United States<br />

(34.00007676145109, -118.4026641848946)<br />

Private & Confidential Page 1/20


Audit 100.00%<br />

CONTRACTOR AND PROJECT INFORMATION<br />

Contractor<br />

Anthony Torres Demolition<br />

Safety Manager<br />

Mara Martinez<br />

Project Name<br />

McDonald’s<br />

Project Number<br />

0000<br />

Project Manager<br />

Tedodocio Mendoza<br />

Superintendent<br />

John Torres<br />

Inspector of Record (IOR)<br />

N/A<br />

Today's Weather Conditions (include 5 day forecast)<br />

Cloudy<br />

— Photos<br />

Photo 1<br />

1. PROGRAM ADMINISTRATION<br />

Private & Confidential Page 2/20


A. Attach photo of Safety Program YES<br />

— Photos<br />

Photo 2<br />

B. Attach photo of Weekly Safety Meeting YES<br />

— Photos<br />

Photo 3 Photo 4 Photo 5<br />

C. Were any Safety Orientations performed today NO<br />

D. Safety Violation Notifications issued? NO<br />

E. Attach photos of Emergency Procedures including Emergency<br />

Contact list.<br />

YES<br />

— Photos<br />

Photo 6<br />

Private & Confidential Page 3/20


F. Attach photos of OSHA required posters. YES<br />

— Photos<br />

Photo 7 Photo 8 Photo 9 Photo 10 Photo 11<br />

Photo 12 Photo 13 Photo 14 Photo 15<br />

G. Attach photos to identify contractor's on site First Aid and CPR<br />

certified workers.<br />

YES<br />

— Photos<br />

Photo 16<br />

H. Did Owner's Safety Representative perform a job walk today? if<br />

so, list all safety concerns along with photos accompanied by your<br />

abated photos.<br />

YES<br />

— Photos<br />

Photo 17 Photo 18 Photo 19<br />

I. Did the Inspector (IOR) have any safety concerns today? If so, list<br />

them and along with your abated photos.<br />

NO<br />

2. HEAT ILLNESS PREVENTION<br />

Private & Confidential Page 4/20


A. Attach photo of Heat Illness Plan (English & Spanish) SAFE<br />

— Photos<br />

Photo 20<br />

B. Is ample shade provided for workers? (80 degrees = 6 workers per<br />

canopy)<br />

SAFE<br />

C. Are at least 2 Gallons of fresh cool drinking water available per<br />

worker with disposable cups? If not, what's in place for<br />

replenishing?(attach photo)<br />

ABATED<br />

— Notes<br />

Heat Illness Hazard: Water was not available on site for the employees.<br />

Corrective Action: I spoke with Foreman Teodocio Mendoza about the water hazard and he immediately<br />

located the nearest store and purchased a case with 24 16oz water bottles.<br />

— Photos<br />

Photo 21 Photo 22<br />

D. Attach the documented Pre-Shift 90 degree High Heat Training<br />

provided for workers with sign in sheet?<br />

N/A<br />

3. FIRE PREVENTION & PROTECTION<br />

A. OSHA approved metal gas containers N/A<br />

Private & Confidential Page 5/20


B. Fire extinguishers available and inspected SAFE<br />

— Notes<br />

Fire extinguisher was inspected:<br />

1.) Good condition<br />

2.) Valid inspection date<br />

3.) Safety pin in place<br />

4.) Pressure gauge reads 'charged'<br />

— Photos<br />

Photo 23 Photo 24 Photo 25<br />

4. PERSONAL PROTECTIVE EQUIPMENT<br />

A. Approved hard hats SAFE<br />

— Photos<br />

Photo 26 Photo 27<br />

B. Safety glasses SAFE<br />

C. Are face shields or goggles required? NO<br />

D. Are respirators being used? If so, attach medical<br />

evaluations been provided by company.<br />

N/A<br />

E. Proper foot wear SAFE<br />

Private & Confidential Page 6/20


F. Proper clothing/hand protection/reflective vests SAFE<br />

— Photos<br />

Photo 28<br />

• Do you have hoists, cranes, derricks & rigging on your site?<br />

NO<br />

• Do you have heavy equipment in your site?<br />

YES<br />

— Photos<br />

Photo 29<br />

6. HEAVY EQUIPMENT<br />

A. Seat belts used correctly SAFE<br />

B. Operators properly trained and authorized SAFE<br />

— Photos<br />

Photo 30 Photo 31<br />

C. Daily pre-use inspections done and documented N/A<br />

D. Backup alarms and signal men SAFE<br />

7. ELECTRICAL TOOLS<br />

Private & Confidential Page 7/20


A. Terminal boxes covered N/A<br />

B. Ground prong in place N/A<br />

C. 12-gauge cords placed along wall line or elevated 7 feet. Damage<br />

cords removed<br />

N/A<br />

D. Temp / permanent lighting adequate and protected N/A<br />

E. GFCI’s in place N/A<br />

F. Mechanical guards in place N/A<br />

G. Proper tools for each job SAFE<br />

H. Powder actuated tools operated by qualified persons N/A<br />

I. Tools inspected. Defected tools removed from service SAFE<br />

8. FALL PROTECTION<br />

A. Fall protection policy in effect (6’) SAFE<br />

— Photos<br />

Photo 32<br />

B. PFAS worn correctly N/A<br />

C. Inspection and maintenance of PFAS conducted N/A<br />

D. Employees trained in fall protection and fall hazard recognition N/A<br />

9. BARRICADES / GUARD RAILS / STAIRS<br />

A. Floor / wall openings covered & labeled N/A<br />

Private & Confidential Page 8/20


B. Roadways, walkways and stairs free of obstacles SAFE<br />

C. Adequate lighting SAFE<br />

D. Trenches and excavations N/A<br />

• Do you have ladders in your site?<br />

NO<br />

• Is their scaffolding on site?<br />

NO<br />

• Is welding or cutting being performed on site?<br />

NO<br />

• Are their any excavations or shoring on site?<br />

NO<br />

• Is their any concrete work being performed on site?<br />

NO<br />

• Is any steel erection work being performed on site?<br />

NO<br />

• Is their any mobile equipment on site?<br />

NO<br />

• Do you have any confined space work being performed on site?<br />

NO<br />

CONTRACTORS (List our client first)<br />

Please click "Add Contractor" button.<br />

Contractor<br />

Contractor 1<br />

Name of Contractor/Company<br />

Anthony Torres Demolition<br />

Private & Confidential Page 9/20


JHA Verified<br />

Yes<br />

— Photos<br />

Photo 33<br />

Toolbox<br />

Yes<br />

— Photos<br />

Photo 34<br />

Head Count<br />

5<br />

DAILY SAFETY NARRATIVE (DSN)<br />

Please put your Daily Safety Narrative here<br />

I arrived on site at 6:40 am at McDonalds in Culver City, and met with the Foreman Teodocio Mendoza<br />

and the crew to understand the scope of work and to ensure they were around of all hazards involved on<br />

site.<br />

There was 5-man crew on site today and all were wearing appropriate PPE. Due to the scope of work, no<br />

electricity is being utilized, therefore GFCIs or extension cords are on site.<br />

During my inspection, I noted one deficiency:<br />

1.) Heat Illness Hazard: There was no water available for the crew on site.<br />

Corrective Action: I spoke with the Foreman Teodocio Mendoza and advised him of the hazard. Teodocio<br />

then located the nearest store and purchased a 24 case of 16 oz bottles of water.<br />

Teodocio was operating the Skid Steer Loader, I verified his certification.<br />

This concludes my narrative.<br />

COMPLETION AND SIGN-OFF<br />

Private & Confidential Page 10/20


Auditor<br />

Name and Signature<br />

Rakin Amos<br />

8th Jul, <strong>2019</strong> 7:36 AM PDT<br />

Private & Confidential Page 11/20


Photos<br />

34 Photos<br />

Photo 2<br />

Photo 1<br />

Photo 4<br />

Private & Confidential Page 12/20


Photo 3<br />

Photo 6<br />

Photo 5<br />

Photo 8<br />

Private & Confidential Page 13/20


Photo 7<br />

Photo 10<br />

Photo 9<br />

Photo 12<br />

Private & Confidential Page 14/20


Photo 11<br />

Photo 14<br />

Photo 13<br />

Photo 16<br />

Private & Confidential Page 15/20


Photo 18<br />

Photo 15<br />

Photo 20<br />

Photo 17<br />

Photo 22<br />

Private & Confidential Page 16/20


Photo 19<br />

Photo 24<br />

Photo 21<br />

Photo 26<br />

Private & Confidential Page 17/20


Photo 23<br />

Photo 28<br />

Photo 25<br />

Photo 30<br />

Private & Confidential Page 18/20


Photo 32<br />

Photo 27<br />

Photo 29<br />

Photo 34<br />

Private & Confidential Page 19/20


Photo 31<br />

Photo 33<br />

Private & Confidential Page 20/20


Anthony Torres / Walmart / 8 Jul <strong>2019</strong> / Rakin Amos<br />

Safety Evaluation Report (SER)<br />

Complete<br />

Inspection score<br />

97.37%<br />

Failed items<br />

1<br />

Created actions<br />

0<br />

Client / Site<br />

Anthony Torres / Walmart<br />

Date of Audit<br />

8th Jul, <strong>2019</strong><br />

Prepared by<br />

Rakin Amos<br />

Location<br />

1765 Walnut Grove Ave<br />

Rosemead, CA 91770<br />

United States<br />

(34.049406946867855, -118.08465926907917)<br />

Private & Confidential Page 1/19


Failed items<br />

1 Failed<br />

Audit / 3. FIRE PREVENTION & PROTECTION<br />

B. Fire extinguishers available and inspected DEFICIENT<br />

— Notes<br />

No month inspection tag or signature.<br />

— Photos<br />

Photo 17<br />

Private & Confidential Page 2/19


Audit 1 Failed 97.37%<br />

CONTRACTOR AND PROJECT INFORMATION<br />

Contractor<br />

Anthony Torres Demoition<br />

Safety Manager<br />

Mayra Martinez<br />

Project Name<br />

Walmart<br />

Project Number<br />

0000<br />

Project Manager<br />

Sergio Duarte<br />

Superintendent<br />

Brian Hocutt<br />

Inspector of Record (IOR)<br />

Sergio Duarte<br />

Today's Weather Conditions (include 5 day forecast)<br />

Cloudy<br />

— Photos<br />

Photo 1 Photo 2<br />

1. PROGRAM ADMINISTRATION<br />

Private & Confidential Page 3/19


A. Attach photo of Safety Program YES<br />

— Photos<br />

Photo 3 Photo 4<br />

B. Attach photo of Weekly Safety Meeting YES<br />

— Photos<br />

Photo 5<br />

C. Were any Safety Orientations performed today NO<br />

D. Safety Violation Notifications issued? NO<br />

E. Attach photos of Emergency Procedures including Emergency<br />

Contact list.<br />

YES<br />

— Photos<br />

Photo 6<br />

Private & Confidential Page 4/19


F. Attach photos of OSHA required posters. YES<br />

— Photos<br />

Photo 7 Photo 8 Photo 9 Photo 10<br />

G. Attach photos to identify contractor's on site First Aid and CPR<br />

certified workers.<br />

NO<br />

H. Did Owner's Safety Representative perform a job walk today? if<br />

so, list all safety concerns along with photos accompanied by your<br />

abated photos.<br />

NO<br />

— Photos<br />

Photo 11 Photo 12 Photo 13<br />

I. Did the Inspector (IOR) have any safety concerns today? If so, list<br />

them and along with your abated photos.<br />

NO<br />

2. HEAT ILLNESS PREVENTION<br />

A. Attach photo of Heat Illness Plan (English & Spanish) SAFE<br />

— Photos<br />

Photo 14 Photo 15<br />

B. Is ample shade provided for workers? (80 degrees = 6 workers per<br />

canopy)<br />

SAFE<br />

Private & Confidential Page 5/19


C. Are at least 2 Gallons of fresh cool drinking water available per<br />

worker with disposable cups? If not, what's in place for<br />

replenishing?(attach photo)<br />

SAFE<br />

— Photos<br />

Photo 16<br />

D. Attach the documented Pre-Shift 90 degree High Heat Training<br />

provided for workers with sign in sheet?<br />

N/A<br />

3. FIRE PREVENTION & PROTECTION 1 Failed<br />

A. OSHA approved metal gas containers N/A<br />

B. Fire extinguishers available and inspected DEFICIENT<br />

— Notes<br />

No month inspection tag or signature.<br />

— Photos<br />

Photo 17<br />

4. PERSONAL PROTECTIVE EQUIPMENT<br />

Private & Confidential Page 6/19


A. Approved hard hats SAFE<br />

— Photos<br />

Photo 18<br />

B. Safety glasses SAFE<br />

C. Are face shields or goggles required? NO<br />

D. Are respirators being used? If so, attach medical<br />

evaluations been provided by company.<br />

N/A<br />

E. Proper foot wear SAFE<br />

F. Proper clothing/hand protection/reflective vests SAFE<br />

— Photos<br />

Photo 19<br />

• Do you have hoists, cranes, derricks & rigging on your site?<br />

NO<br />

• Do you have heavy equipment in your site?<br />

NO<br />

7. ELECTRICAL TOOLS<br />

A. Terminal boxes covered N/A<br />

B. Ground prong in place N/A<br />

C. 12-gauge cords placed along wall line or elevated 7 feet. Damage<br />

cords removed<br />

N/A<br />

Private & Confidential Page 7/19


D. Temp / permanent lighting adequate and protected SAFE<br />

— Photos<br />

Photo 20<br />

E. GFCI’s in place N/A<br />

F. Mechanical guards in place N/A<br />

G. Proper tools for each job SAFE<br />

H. Powder actuated tools operated by qualified persons N/A<br />

I. Tools inspected. Defected tools removed from service SAFE<br />

8. FALL PROTECTION<br />

A. Fall protection policy in effect (6’) N/A<br />

B. PFAS worn correctly N/A<br />

C. Inspection and maintenance of PFAS conducted N/A<br />

D. Employees trained in fall protection and fall hazard recognition N/A<br />

9. BARRICADES / GUARD RAILS / STAIRS<br />

A. Floor / wall openings covered & labeled SAFE<br />

— Photos<br />

Photo 21<br />

Private & Confidential Page 8/19


B. Roadways, walkways and stairs free of obstacles SAFE<br />

C. Adequate lighting SAFE<br />

— Photos<br />

Photo 22<br />

D. Trenches and excavations N/A<br />

• Do you have ladders in your site?<br />

YES<br />

— Photos<br />

Photo 23 Photo 24<br />

10. LADDERS<br />

A. Secured to prevent slipping, sliding or falling SAFE<br />

— Photos<br />

Photo 25 Photo 26<br />

B. Side rails extend 36” above top of landing, tied off and secured. N/A<br />

Private & Confidential Page 9/19


C. Step ladders fully open when in use. SAFE<br />

— Photos<br />

Photo 27<br />

• Is their scaffolding on site?<br />

NO<br />

• Is welding or cutting being performed on site?<br />

NO<br />

• Are their any excavations or shoring on site?<br />

NO<br />

• Is their any concrete work being performed on site?<br />

NO<br />

• Is any steel erection work being performed on site?<br />

NO<br />

• Is their any mobile equipment on site?<br />

NO<br />

• Do you have any confined space work being performed on site?<br />

NO<br />

CONTRACTORS (List our client first)<br />

Please click "Add Contractor" button.<br />

Contractor<br />

Contractor 1<br />

Name of Contractor/Company<br />

Anthony Torres Demolition<br />

Private & Confidential Page 10/19


JHA Verified<br />

Yes<br />

— Photos<br />

Photo 28<br />

Toolbox<br />

Yes<br />

— Photos<br />

Photo 29<br />

Head Count<br />

11<br />

DAILY SAFETY NARRATIVE (DSN)<br />

Please put your Daily Safety Narrative here<br />

Arrive on site at 10:15 am performed site perimeter check, walk the job out with foreman. Everyone Is<br />

following the safety guidelines.<br />

Deficiency: I observed the current fire extinguisher has no month inspection signature on the tag.<br />

Corrective action: I recommend to Sergio to get that inspected.<br />

COMPLETION AND SIGN-OFF<br />

Auditor<br />

Name and Signature<br />

Rakin amos<br />

8th Jul, <strong>2019</strong> 11:21 AM PDT<br />

Private & Confidential Page 11/19


Photos<br />

29 Photos<br />

Photo 1<br />

Photo 2<br />

Photo 3<br />

Private & Confidential Page 12/19


Photo 5<br />

Photo 4<br />

Photo 7<br />

Photo 6<br />

Private & Confidential Page 13/19


Photo 9<br />

Photo 8<br />

Photo 11<br />

Photo 10<br />

Private & Confidential Page 14/19


Photo 12<br />

Photo 13<br />

Photo 14<br />

Photo 15<br />

Photo 16<br />

Private & Confidential Page 15/19


Photo 18<br />

Photo 17<br />

Photo 20<br />

Photo 19<br />

Private & Confidential Page 16/19


Photo 21<br />

Photo 22<br />

Photo 23<br />

Photo 24<br />

Private & Confidential Page 17/19


Photo 25<br />

Photo 26<br />

Photo 27<br />

Photo 28<br />

Private & Confidential Page 18/19


Photo 29<br />

Private & Confidential Page 19/19


Anthony Torres/Laguna Beach / 10 Jul <strong>2019</strong> / Rakin<br />

Amos<br />

Safety Evaluation Report (SER)<br />

Complete<br />

Inspection score<br />

100.00%<br />

Failed items<br />

0<br />

Created actions<br />

0<br />

Client / Site<br />

Anthony Torres/Laguna Beach<br />

Date of Audit<br />

10th Jul, <strong>2019</strong><br />

Prepared by<br />

Rakin Amos<br />

Location<br />

2–98 S Vista de la Luna<br />

Laguna Beach, CA 92651<br />

United States<br />

(33.493455906306224, -117.73240083544363)<br />

Private & Confidential Page 1/19


Audit 100.00%<br />

CONTRACTOR AND PROJECT INFORMATION<br />

Contractor<br />

Anthony Torres Demolition<br />

Safety Manager<br />

Mayra Martinez<br />

Project Name<br />

2-98 S Vista de la Luna<br />

Project Number<br />

Laguna Beach<br />

Project Manager<br />

Sal Flores<br />

Superintendent<br />

John Torres<br />

Inspector of Record (IOR)<br />

Salvador Flores<br />

Today's Weather Conditions (include 5 day forecast)<br />

Cloudy<br />

— Photos<br />

Photo 1 Photo 2<br />

1. PROGRAM ADMINISTRATION<br />

Private & Confidential Page 2/19


A. Attach photo of Safety Program YES<br />

— Photos<br />

Photo 3 Photo 4 Photo 5 Photo 6 Photo 7<br />

B. Attach photo of Weekly Safety Meeting YES<br />

— Photos<br />

Photo 8<br />

C. Were any Safety Orientations performed today NO<br />

D. Safety Violation Notifications issued? NO<br />

E. Attach photos of Emergency Procedures including Emergency<br />

Contact list.<br />

YES<br />

— Photos<br />

Photo 9<br />

Private & Confidential Page 3/19


F. Attach photos of OSHA required posters. YES<br />

— Photos<br />

Photo 10 Photo 11 Photo 12 Photo 13 Photo 14<br />

G. Attach photos to identify contractor's on site First Aid and CPR<br />

certified workers.<br />

YES<br />

— Photos<br />

Photo 15 Photo 16<br />

H. Did Owner's Safety Representative perform a job walk today? if<br />

so, list all safety concerns along with photos accompanied by your<br />

abated photos.<br />

NO<br />

I. Did the Inspector (IOR) have any safety concerns today? If so, list<br />

them and along with your abated photos.<br />

NO<br />

2. HEAT ILLNESS PREVENTION<br />

A. Attach photo of Heat Illness Plan (English & Spanish) SAFE<br />

— Photos<br />

Photo 17<br />

B. Is ample shade provided for workers? (80 degrees = 6 workers per<br />

canopy)<br />

N/A<br />

Private & Confidential Page 4/19


C. Are at least 2 Gallons of fresh cool drinking water available per<br />

worker with disposable cups? If not, what's in place for<br />

replenishing?(attach photo)<br />

SAFE<br />

— Photos<br />

Photo 18<br />

D. Attach the documented Pre-Shift 90 degree High Heat Training<br />

provided for workers with sign in sheet?<br />

N/A<br />

3. FIRE PREVENTION & PROTECTION<br />

A. OSHA approved metal gas containers N/A<br />

B. Fire extinguishers available and inspected SAFE<br />

— Photos<br />

Photo 19 Photo 20<br />

4. PERSONAL PROTECTIVE EQUIPMENT<br />

A. Approved hard hats SAFE<br />

— Photos<br />

Photo 21<br />

Private & Confidential Page 5/19


B. Safety glasses SAFE<br />

C. Are face shields or goggles required? NO<br />

D. Are respirators being used? If so, attach medical<br />

evaluations been provided by company.<br />

N/A<br />

E. Proper foot wear SAFE<br />

F. Proper clothing/hand protection/reflective vests SAFE<br />

• Do you have hoists, cranes, derricks & rigging on your site?<br />

NO<br />

• Do you have heavy equipment in your site?<br />

NO<br />

7. ELECTRICAL TOOLS<br />

A. Terminal boxes covered SAFE<br />

— Photos<br />

Photo 22<br />

B. Ground prong in place SAFE<br />

C. 12-gauge cords placed along wall line or elevated 7 feet. Damage<br />

cords removed<br />

N/A<br />

D. Temp / permanent lighting adequate and protected SAFE<br />

— Photos<br />

Photo 23<br />

Private & Confidential Page 6/19


E. GFCI’s in place SAFE<br />

— Photos<br />

Photo 24<br />

F. Mechanical guards in place N/A<br />

G. Proper tools for each job SAFE<br />

H. Powder actuated tools operated by qualified persons N/A<br />

I. Tools inspected. Defected tools removed from service SAFE<br />

8. FALL PROTECTION<br />

A. Fall protection policy in effect (6’) N/A<br />

B. PFAS worn correctly N/A<br />

C. Inspection and maintenance of PFAS conducted N/A<br />

D. Employees trained in fall protection and fall hazard recognition N/A<br />

9. BARRICADES / GUARD RAILS / STAIRS<br />

Private & Confidential Page 7/19


A. Floor / wall openings covered & labeled SAFE<br />

— Photos<br />

Photo 25 Photo 26 Photo 27 Photo 28 Photo 29<br />

Photo 30<br />

B. Roadways, walkways and stairs free of obstacles SAFE<br />

— Photos<br />

Photo 31<br />

C. Adequate lighting SAFE<br />

— Photos<br />

Photo 32<br />

D. Trenches and excavations N/A<br />

• Do you have ladders in your site?<br />

YES<br />

10. LADDERS<br />

Private & Confidential Page 8/19


A. Secured to prevent slipping, sliding or falling SAFE<br />

— Photos<br />

Photo 33<br />

B. Side rails extend 36” above top of landing, tied off and secured. SAFE<br />

C. Step ladders fully open when in use. SAFE<br />

— Photos<br />

Photo 34<br />

• Is their scaffolding on site?<br />

NO<br />

• Is welding or cutting being performed on site?<br />

NO<br />

• Are their any excavations or shoring on site?<br />

NO<br />

• Is their any concrete work being performed on site?<br />

NO<br />

• Is any steel erection work being performed on site?<br />

NO<br />

• Is their any mobile equipment on site?<br />

NO<br />

• Do you have any confined space work being performed on site?<br />

NO<br />

CONTRACTORS (List our client first)<br />

Please click "Add Contractor" button.<br />

Contractor<br />

Private & Confidential Page 9/19


Contractor 1<br />

Name of Contractor/Company<br />

Anthony Torres Demo<br />

JHA Verified<br />

Yes<br />

— Photos<br />

Photo 35<br />

Toolbox<br />

Yes<br />

Head Count<br />

15<br />

DAILY SAFETY NARRATIVE (DSN)<br />

Please put your Daily Safety Narrative here<br />

Arrive on site at 11 am. Spoke with Foreman Sal Flores and did a job walk with him.<br />

All required documentation was on site, including Safety Plans, Emergency Procedures, OSHA posters,<br />

Heat Illness Plan, and the Weekly Safety Meeting had been conducted.<br />

The fire extinguishers were valid and were inspected for overall condition, pressure gauge on charged,<br />

secured safety pin, and inspection date.<br />

Foreman Sal Flores had his CPR certificate. It is valid until August 5, <strong>2019</strong>.<br />

Although the crew was not working in direct sunlight, I recommended that they kept hydrated throughout<br />

the day. I also noticed a lot of traffic indoor and outdoors, I proposed to be mindful of the other workers in<br />

the area.<br />

COMPLETION AND SIGN-OFF<br />

Auditor<br />

Name and Signature<br />

Rakin Amos<br />

10th Jul, <strong>2019</strong> 12:10 PM PDT<br />

Private & Confidential Page 10/19


Photos<br />

35 Photos<br />

Photo 1<br />

Photo 2<br />

Photo 3<br />

Private & Confidential Page 11/19


Photo 5<br />

Photo 4<br />

Photo 7<br />

Photo 6<br />

Private & Confidential Page 12/19


Photo 8<br />

Photo 9<br />

Photo 10<br />

Photo 11<br />

Private & Confidential Page 13/19


Photo 13<br />

Photo 12<br />

Photo 15<br />

Photo 14<br />

Private & Confidential Page 14/19


Photo 17<br />

Photo 16<br />

Photo 19<br />

Photo 18<br />

Private & Confidential Page 15/19


Photo 21<br />

Photo 20<br />

Photo 23<br />

Photo 22<br />

Private & Confidential Page 16/19


Photo 25<br />

Photo 24<br />

Photo 27<br />

Photo 26<br />

Private & Confidential Page 17/19


Photo 28<br />

Photo 29<br />

Photo 30<br />

Photo 31<br />

Photo 32<br />

Private & Confidential Page 18/19


Photo 33<br />

Photo 34<br />

Photo 35<br />

Private & Confidential Page 19/19


Anthony Torres demolition / 10 Jul <strong>2019</strong> / Rakin<br />

Amos<br />

Safety Evaluation Report (SER)<br />

Complete<br />

Inspection score<br />

100.00%<br />

Failed items<br />

0<br />

Created actions<br />

0<br />

Client / Site<br />

Anthony Torres demolition<br />

Date of Audit<br />

10th Jul, <strong>2019</strong><br />

Prepared by<br />

Rakin Amos<br />

Location<br />

St. Margaret's Episcopal School<br />

31641 La Novia Ave<br />

San Juan Capistrano, CA 92675<br />

United States<br />

(33.50503697619599, -117.65165807805732)<br />

Private & Confidential Page 1/8


Audit 100.00%<br />

CONTRACTOR AND PROJECT INFORMATION<br />

Contractor<br />

Anthony Torres<br />

Safety Manager<br />

Mayra Martinez<br />

Project Name<br />

St Margaret<br />

Project Number<br />

31641 La Novia<br />

Project Manager<br />

Timberline<br />

Superintendent<br />

John Torres<br />

Inspector of Record (IOR)<br />

N/A<br />

Today's Weather Conditions (include 5 day forecast)<br />

Clear<br />

— Photos<br />

Photo 1 Photo 2<br />

1. PROGRAM ADMINISTRATION<br />

A. Attach photo of Safety Program NO<br />

B. Attach photo of Weekly Safety Meeting NO<br />

C. Were any Safety Orientations performed today NO<br />

D. Safety Violation Notifications issued? NO<br />

Private & Confidential Page 2/8


E. Attach photos of Emergency Procedures including Emergency<br />

Contact list.<br />

NO<br />

F. Attach photos of OSHA required posters. NO<br />

G. Attach photos to identify contractor's on site First Aid and CPR<br />

certified workers.<br />

NO<br />

H. Did Owner's Safety Representative perform a job walk today? if<br />

so, list all safety concerns along with photos accompanied by your<br />

abated photos.<br />

NO<br />

I. Did the Inspector (IOR) have any safety concerns today? If so, list<br />

them and along with your abated photos.<br />

NO<br />

2. HEAT ILLNESS PREVENTION<br />

A. Attach photo of Heat Illness Plan (English & Spanish) N/A<br />

B. Is ample shade provided for workers? (80 degrees = 6 workers per<br />

canopy)<br />

N/A<br />

C. Are at least 2 Gallons of fresh cool drinking water available per<br />

worker with disposable cups? If not, what's in place for<br />

replenishing?(attach photo)<br />

N/A<br />

D. Attach the documented Pre-Shift 90 degree High Heat Training<br />

provided for workers with sign in sheet?<br />

N/A<br />

3. FIRE PREVENTION & PROTECTION<br />

A. OSHA approved metal gas containers N/A<br />

B. Fire extinguishers available and inspected N/A<br />

4. PERSONAL PROTECTIVE EQUIPMENT<br />

A. Approved hard hats N/A<br />

B. Safety glasses N/A<br />

Private & Confidential Page 3/8


C. Are face shields or goggles required? NO<br />

D. Are respirators being used? If so, attach medical<br />

evaluations been provided by company.<br />

N/A<br />

E. Proper foot wear N/A<br />

F. Proper clothing/hand protection/reflective vests N/A<br />

• Do you have hoists, cranes, derricks & rigging on your site?<br />

NO<br />

• Do you have heavy equipment in your site?<br />

YES<br />

6. HEAVY EQUIPMENT<br />

A. Seat belts used correctly N/A<br />

B. Operators properly trained and authorized N/A<br />

C. Daily pre-use inspections done and documented N/A<br />

D. Backup alarms and signal men N/A<br />

7. ELECTRICAL TOOLS<br />

A. Terminal boxes covered N/A<br />

B. Ground prong in place N/A<br />

C. 12-gauge cords placed along wall line or elevated 7 feet. Damage<br />

cords removed<br />

N/A<br />

D. Temp / permanent lighting adequate and protected N/A<br />

E. GFCI’s in place N/A<br />

F. Mechanical guards in place N/A<br />

G. Proper tools for each job N/A<br />

Private & Confidential Page 4/8


H. Powder actuated tools operated by qualified persons N/A<br />

I. Tools inspected. Defected tools removed from service N/A<br />

8. FALL PROTECTION<br />

A. Fall protection policy in effect (6’) N/A<br />

B. PFAS worn correctly N/A<br />

C. Inspection and maintenance of PFAS conducted N/A<br />

D. Employees trained in fall protection and fall hazard recognition N/A<br />

9. BARRICADES / GUARD RAILS / STAIRS<br />

A. Floor / wall openings covered & labeled N/A<br />

B. Roadways, walkways and stairs free of obstacles N/A<br />

C. Adequate lighting N/A<br />

D. Trenches and excavations N/A<br />

• Do you have ladders in your site?<br />

NO<br />

• Is their scaffolding on site?<br />

NO<br />

• Is welding or cutting being performed on site?<br />

NO<br />

• Are their any excavations or shoring on site?<br />

NO<br />

• Is their any concrete work being performed on site?<br />

YES<br />

14. CONCRETE CONSTRUCTION<br />

A. Forms properly installed and braced N/A<br />

B. Adequate shoring. Plumbed and cross-braced. N/A<br />

Private & Confidential Page 5/8


C. Traffic planned and routed N/A<br />

D. Tilt-up Checklist completed and on-file N/A<br />

E. Truck and crane signaling / flagging N/A<br />

F. Rebar caps in place N/A<br />

G. Silica Dust Plan being followed N/A<br />

• Is any steel erection work being performed on site?<br />

NO<br />

• Is their any mobile equipment on site?<br />

NO<br />

• Do you have any confined space work being performed on site?<br />

NO<br />

CONTRACTORS (List our client first)<br />

Please click "Add Contractor" button.<br />

Contractor<br />

Contractor 1<br />

Name of Contractor/Company<br />

Anthony Torres<br />

JHA Verified<br />

N/A<br />

Toolbox<br />

N/A<br />

Head Count<br />

N/A<br />

DAILY SAFETY NARRATIVE (DSN)<br />

Please put your Daily Safety Narrative here<br />

I arrived at approximately 11:00am, the crew departed and was complete for the day at 3141 La Novia<br />

Ave, San Juan Capistrano.<br />

COMPLETION AND SIGN-OFF<br />

Private & Confidential Page 6/8


Auditor<br />

Name and Signature<br />

Rakin Amos<br />

10th Jul, <strong>2019</strong> 1:12 PM PDT<br />

Private & Confidential Page 7/8


Photos<br />

2 Photos<br />

Photo 1<br />

Photo 2<br />

Private & Confidential Page 8/8


Anthony Torres Demolition / 15 Jul <strong>2019</strong> / Rakin<br />

Amos<br />

Safety Evaluation Report (SER)<br />

Complete<br />

Inspection score<br />

100.00%<br />

Failed items<br />

0<br />

Created actions<br />

0<br />

Client / Site<br />

Anthony Torres Demolition<br />

Date of Audit<br />

15th Jul, <strong>2019</strong><br />

Prepared by<br />

Rakin Amos<br />

Location<br />

100 N State College Blvd<br />

Anaheim, CA 92806<br />

United States<br />

(33.841508954563174, -117.88888868180861)<br />

Private & Confidential Page 1/20


Audit 100.00%<br />

CONTRACTOR AND PROJECT INFORMATION<br />

Contractor<br />

Anthony Torres<br />

Safety Manager<br />

Mayra Martinez<br />

Project Name<br />

Jack n the box<br />

Project Number<br />

100 N. State College<br />

Project Manager<br />

Abel Castro<br />

Superintendent<br />

John Torres<br />

Inspector of Record (IOR)<br />

N/A<br />

Today's Weather Conditions (include 5 day forecast)<br />

Clear<br />

— Photos<br />

Photo 1 Photo 2<br />

1. PROGRAM ADMINISTRATION<br />

Private & Confidential Page 2/20


A. Attach photo of Safety Program YES<br />

— Photos<br />

Photo 3 Photo 4<br />

B. Attach photo of Weekly Safety Meeting YES<br />

— Photos<br />

Photo 5<br />

C. Were any Safety Orientations performed today NO<br />

D. Safety Violation Notifications issued? NO<br />

E. Attach photos of Emergency Procedures including Emergency<br />

Contact list.<br />

YES<br />

— Photos<br />

Photo 6<br />

Private & Confidential Page 3/20


F. Attach photos of OSHA required posters. YES<br />

— Notes<br />

OSHA required posters available in Spanish and English<br />

— Photos<br />

Photo 7 Photo 8 Photo 9 Photo 10 Photo 11<br />

G. Attach photos to identify contractor's on site First Aid and CPR<br />

certified workers.<br />

YES<br />

— Photos<br />

Photo 12<br />

H. Did Owner's Safety Representative perform a job walk today? if<br />

so, list all safety concerns along with photos accompanied by your<br />

abated photos.<br />

YES<br />

I. Did the Inspector (IOR) have any safety concerns today? If so, list<br />

them and along with your abated photos.<br />

NO<br />

2. HEAT ILLNESS PREVENTION<br />

A. Attach photo of Heat Illness Plan (English & Spanish) SAFE<br />

— Photos<br />

Photo 13<br />

Private & Confidential Page 4/20


B. Is ample shade provided for workers? (80 degrees = 6 workers per<br />

canopy)<br />

SAFE<br />

C. Are at least 2 Gallons of fresh cool drinking water available per<br />

worker with disposable cups? If not, what's in place for<br />

replenishing?(attach photo)<br />

SAFE<br />

— Photos<br />

Photo 14<br />

D. Attach the documented Pre-Shift 90 degree High Heat Training<br />

provided for workers with sign in sheet?<br />

N/A<br />

3. FIRE PREVENTION & PROTECTION<br />

A. OSHA approved metal gas containers SAFE<br />

— Photos<br />

Photo 15<br />

Private & Confidential Page 5/20


B. Fire extinguishers available and inspected SAFE<br />

— Notes<br />

Fire extinguisher on site is Valid<br />

Inspected for:<br />

1.) Valid inspection date<br />

2.) Good condition with no damage<br />

3.) Safety pin in place & Secure<br />

4.) Pressure Gauge: Charged<br />

— Photos<br />

Photo 16 Photo 17 Photo 18 Photo 19<br />

4. PERSONAL PROTECTIVE EQUIPMENT<br />

A. Approved hard hats SAFE<br />

— Photos<br />

Photo 20 Photo 21<br />

B. Safety glasses SAFE<br />

D. Are respirators required for any work being performed on site? If<br />

so, were they provided by the employer in conjunction with the<br />

required controls listed on the Table 1 in Cal/OSHA Title 8 5144?<br />

N/A<br />

Are respirators voluntarily being used? If so, are worker trained on<br />

hazards associated with the environment?<br />

N/A<br />

E. Proper foot wear SAFE<br />

F. Proper clothing/hand protection/reflective vests SAFE<br />

Private & Confidential Page 6/20


• Do you have hoists, cranes, derricks & rigging on your site?<br />

NO<br />

• Do you have heavy equipment in your site?<br />

YES<br />

— Photos<br />

Photo 22<br />

6. HEAVY EQUIPMENT<br />

A. Seat belts used correctly SAFE<br />

B. Operators properly trained and authorized SAFE<br />

— Photos<br />

Photo 23<br />

C. Daily pre-use inspections done and documented SAFE<br />

D. Backup alarms and signal men SAFE<br />

7. ELECTRICAL TOOLS<br />

A. Terminal boxes covered N/A<br />

B. Ground prong in place N/A<br />

C. 12-gauge cords placed along wall line or elevated 7 feet. Damage<br />

cords removed<br />

N/A<br />

Private & Confidential Page 7/20


D. Temp / permanent lighting adequate and protected SAFE<br />

— Photos<br />

Photo 24<br />

E. GFCI’s in place N/A<br />

F. Mechanical guards in place N/A<br />

G. Proper tools for each job SAFE<br />

H. Power actuated tools operated by qualified persons N/A<br />

I. Tools inspected. Defected tools removed from service SAFE<br />

8. FALL PROTECTION<br />

A. Fall protection policy in effect (6’) N/A<br />

B. PFAS worn correctly N/A<br />

C. Inspection and maintenance of PFAS conducted N/A<br />

D. Employees trained in fall protection and fall hazard recognition N/A<br />

9. BARRICADES / GUARD RAILS / STAIRS<br />

A. Floor / wall openings covered & labeled SAFE<br />

— Photos<br />

Photo 25<br />

Private & Confidential Page 8/20


B. Roadways, walkways and stairs free of obstacles ABATED<br />

— Notes<br />

While I did the job walk l, I notice a rebar protruding out on to the walk way. I notify Abel Castro that’s a<br />

hazard and should be mitigate it.<br />

— Photos<br />

Photo 26 Photo 27 Photo 28 Photo 29 Photo 30<br />

C. Adequate lighting SAFE<br />

D. Trenches and excavations SAFE<br />

— Photos<br />

Photo 31 Photo 32<br />

• Do you have ladders in your site?<br />

YES<br />

10. LADDERS<br />

A. Secured to prevent slipping, sliding or falling SAFE<br />

B. Side rails extend 36” above top of landing, tied off and secured. N/A<br />

C. Step ladders fully open when in use. N/A<br />

• Is their scaffolding on site?<br />

NO<br />

• Is welding or cutting being performed on site?<br />

NO<br />

• Are their any excavations or shoring on site?<br />

NO<br />

Private & Confidential Page 9/20


• Is their any concrete work being performed on site?<br />

NO<br />

• Is any steel erection work being performed on site?<br />

NO<br />

• Is their any mobile equipment on site?<br />

NO<br />

• Do you have any confined space work being performed on site?<br />

NO<br />

CONTRACTORS (List our client first)<br />

Please click "Add Contractor" button.<br />

Contractor<br />

Contractor 1<br />

Name of Contractor/Company<br />

Anthony Torres<br />

JHA Verified<br />

Yes<br />

— Photos<br />

Photo 33<br />

Toolbox<br />

Yes<br />

Head Count<br />

6<br />

DAILY SAFETY NARRATIVE (DSN)<br />

Private & Confidential Page 10/20


Please put your Daily Safety Narrative here<br />

I arrived on site at 8:43am and met with Foreman Able Castro to preform the Safety Evaluation.<br />

He accompanied me and we proceeded to do a job walk. I discussed the weather with him and mentioned<br />

the heat will reach a high of 82 degrees today, and recommended getting additional water for the job site.<br />

I noted an impalement deficiency : Rebar protruding out of a walkway<br />

Corrective Action: A caution cone was placed over it to serve as a cap, to cover the exposed rebar.<br />

I reminded the employees to maintain their Personal Protective Equipment gloves on while working to<br />

avoid hand injuries.<br />

There were no injuries reported during the evaluation.<br />

COMPLETION AND SIGN-OFF<br />

Auditor<br />

Name and Signature<br />

Rakin Amos<br />

15th Jul, <strong>2019</strong> 9:30 AM PDT<br />

Private & Confidential Page 11/20


Photos<br />

33 Photos<br />

Photo 2<br />

Photo 1<br />

Photo 4<br />

Private & Confidential Page 12/20


Photo 3<br />

Photo 6<br />

Photo 5<br />

Photo 8<br />

Private & Confidential Page 13/20


Photo 7<br />

Photo 10<br />

Photo 12<br />

Photo 9<br />

Private & Confidential Page 14/20


Photo 11<br />

Photo 14<br />

Photo 16<br />

Photo 13<br />

Private & Confidential Page 15/20


Photo 15<br />

Photo 18<br />

Photo 17<br />

Photo 20<br />

Private & Confidential Page 16/20


Photo 19<br />

Photo 22<br />

Photo 21<br />

Photo 24<br />

Private & Confidential Page 17/20


Photo 26<br />

Photo 23<br />

Photo 25<br />

Photo 28<br />

Private & Confidential Page 18/20


Photo 27<br />

Photo 30<br />

Photo 29<br />

Photo 32<br />

Private & Confidential Page 19/20


Photo 31<br />

Photo 33<br />

Private & Confidential Page 20/20


Anthony Torres Demolition / 15 Jul <strong>2019</strong> / Rakin<br />

Amos<br />

Safety Evaluation Report (SER)<br />

Complete<br />

Inspection score<br />

97.37%<br />

Failed items<br />

1<br />

Created actions<br />

0<br />

Client / Site<br />

Anthony Torres Demolition<br />

Date of Audit<br />

15th Jul, <strong>2019</strong><br />

Prepared by<br />

Rakin Amos<br />

Location<br />

620 Camino de los Mares<br />

San Clemente, CA 92673<br />

United States<br />

(33.45939139749262, -117.65338738080771)<br />

Private & Confidential Page 1/19


Failed items<br />

1 Failed<br />

Audit / CONTRACTORS (List our client first) / Contractor / Contractor 1<br />

JHA Verified<br />

No<br />

— Notes<br />

JHA is incomplete<br />

— Photos<br />

Photo 25<br />

Private & Confidential Page 2/19


Audit 1 Failed 97.37%<br />

CONTRACTOR AND PROJECT INFORMATION<br />

Contractor<br />

Anthony Torres<br />

Safety Manager<br />

Mayra Martinez<br />

Project Name<br />

620 Camino De los Mares<br />

Project Number<br />

620 Camino De Los Mares<br />

Project Manager<br />

Sergio Duarte<br />

Superintendent<br />

John Torres<br />

Inspector of Record (IOR)<br />

N/A<br />

Today's Weather Conditions (include 5 day forecast)<br />

Cloudy<br />

— Photos<br />

Photo 1 Photo 2<br />

1. PROGRAM ADMINISTRATION<br />

Private & Confidential Page 3/19


A. Attach photo of Safety Program YES<br />

— Photos<br />

Photo 3 Photo 4<br />

B. Attach photo of Weekly Safety Meeting YES<br />

— Photos<br />

Photo 5<br />

C. Were any Safety Orientations performed today NO<br />

D. Safety Violation Notifications issued? NO<br />

E. Attach photos of Emergency Procedures including Emergency<br />

Contact list.<br />

YES<br />

— Photos<br />

Photo 6 Photo 7<br />

Private & Confidential Page 4/19


F. Attach photos of OSHA required posters. YES<br />

— Photos<br />

Photo 8 Photo 9<br />

G. Attach photos to identify contractor's on site First Aid and CPR<br />

certified workers.<br />

NO<br />

H. Did Owner's Safety Representative perform a job walk today? if<br />

so, list all safety concerns along with photos accompanied by your<br />

abated photos.<br />

NO<br />

I. Did the Inspector (IOR) have any safety concerns today? If so, list<br />

them and along with your abated photos.<br />

NO<br />

2. HEAT ILLNESS PREVENTION<br />

A. Attach photo of Heat Illness Plan (English & Spanish) SAFE<br />

— Photos<br />

Photo 10<br />

B. Is ample shade provided for workers? (80 degrees = 6 workers per<br />

canopy)<br />

SAFE<br />

— Photos<br />

Photo 11 Photo 12<br />

Private & Confidential Page 5/19


C. Are at least 2 Gallons of fresh cool drinking water available per<br />

worker with disposable cups? If not, what's in place for<br />

replenishing?(attach photo)<br />

SAFE<br />

— Photos<br />

Photo 13<br />

D. Attach the documented Pre-Shift 90 degree High Heat Training<br />

provided for workers with sign in sheet?<br />

N/A<br />

3. FIRE PREVENTION & PROTECTION<br />

A. OSHA approved metal gas containers N/A<br />

B. Fire extinguishers available and inspected SAFE<br />

— Photos<br />

Photo 14 Photo 15<br />

4. PERSONAL PROTECTIVE EQUIPMENT<br />

A. Approved hard hats SAFE<br />

— Photos<br />

Photo 16<br />

Private & Confidential Page 6/19


B. Safety glasses SAFE<br />

D. Are respirators required for any work being performed on site? If<br />

so, were they provided by the employer in conjunction with the<br />

required controls listed on the Table 1 in Cal/OSHA Title 8 5144?<br />

N/A<br />

Are respirators voluntarily being used? If so, are worker trained on<br />

hazards associated with the environment?<br />

N/A<br />

E. Proper foot wear SAFE<br />

F. Proper clothing/hand protection/reflective vests SAFE<br />

• Do you have hoists, cranes, derricks & rigging on your site?<br />

NO<br />

• Do you have heavy equipment in your site?<br />

NO<br />

7. ELECTRICAL TOOLS<br />

A. Terminal boxes covered N/A<br />

B. Ground prong in place N/A<br />

C. 12-gauge cords placed along wall line or elevated 7 feet. Damage<br />

cords removed<br />

N/A<br />

D. Temp / permanent lighting adequate and protected SAFE<br />

— Photos<br />

Photo 17 Photo 18<br />

E. GFCI’s in place N/A<br />

Private & Confidential Page 7/19


F. Mechanical guards in place SAFE<br />

— Photos<br />

Photo 19<br />

G. Proper tools for each job SAFE<br />

H. Powder actuated tools operated by qualified persons N/A<br />

I. Tools inspected. Defected tools removed from service SAFE<br />

8. FALL PROTECTION<br />

A. Fall protection policy in effect (6’) N/A<br />

B. PFAS worn correctly N/A<br />

C. Inspection and maintenance of PFAS conducted N/A<br />

D. Employees trained in fall protection and fall hazard recognition N/A<br />

9. BARRICADES / GUARD RAILS / STAIRS<br />

A. Floor / wall openings covered & labeled SAFE<br />

— Photos<br />

Photo 20<br />

Private & Confidential Page 8/19


B. Roadways, walkways and stairs free of obstacles SAFE<br />

— Photos<br />

Photo 21<br />

C. Adequate lighting SAFE<br />

D. Trenches and excavations N/A<br />

• Do you have ladders in your site?<br />

YES<br />

10. LADDERS<br />

A. Secured to prevent slipping, sliding or falling SAFE<br />

— Photos<br />

Photo 22 Photo 23 Photo 24<br />

B. Side rails extend 36” above top of landing, tied off and secured. N/A<br />

C. Step ladders fully open when in use. SAFE<br />

• Is their scaffolding on site?<br />

NO<br />

• Is welding or cutting being performed on site?<br />

NO<br />

• Are their any excavations or shoring on site?<br />

NO<br />

• Is their any concrete work being performed on site?<br />

NO<br />

Private & Confidential Page 9/19


• Is any steel erection work being performed on site?<br />

NO<br />

• Is their any mobile equipment on site?<br />

NO<br />

• Do you have any confined space work being performed on site?<br />

NO<br />

CONTRACTORS (List our client first)<br />

Please click "Add Contractor" button.<br />

Contractor<br />

Contractor 1<br />

1 Failed<br />

Name of Contractor/Company<br />

Anthony Torres Demolition<br />

JHA Verified<br />

No<br />

— Notes<br />

JHA is incomplete<br />

— Photos<br />

Photo 25<br />

Toolbox<br />

Yes<br />

— Photos<br />

Photo 26<br />

Head Count<br />

5<br />

DAILY SAFETY NARRATIVE (DSN)<br />

Private & Confidential Page 10/19


DAILY SAFETY NARRATIVE (DSN)<br />

Please put your Daily Safety Narrative here<br />

I arrived on site at 11:15am and met with Leadman Sergio Duarte to perform the Safety Evaluation on his<br />

site. He had all Safety Program documentation available including Safety Program in Spanish and<br />

English, Emergency Procedures, Heat Illness, and OSHA posters.<br />

I suggested to Sergio to remind his crew to maintain their Personal Protective Equipment, such as gloves,<br />

hard hat, and safety glasses while working to avoid hand and eye injuries.<br />

A safety concern was a Ladder/ Fall Hazard : A ladder was standing over broken pieces of concrete. The<br />

floor was not clear, and therefore made the ladder unstable and made the employees utilizing the ladder<br />

vulnerable to slipping.<br />

Another safety concern was the incomplete JHA: Each crew member was listed on the form, however all<br />

other sections were incomplete.<br />

I reminded the crew to not over stretch while on ladders.<br />

No incidents were reported during my evaluation.<br />

COMPLETION AND SIGN-OFF<br />

Auditor<br />

Name and Signature<br />

Rakin Amos<br />

15th Jul, <strong>2019</strong> 12:51 PM PDT<br />

Private & Confidential Page 11/19


Photos<br />

26 Photos<br />

Photo 2<br />

Photo 1<br />

Photo 4<br />

Private & Confidential Page 12/19


Photo 3<br />

Photo 6<br />

Photo 8<br />

Photo 5<br />

Private & Confidential Page 13/19


Photo 10<br />

Photo 7<br />

Photo 12<br />

Photo 9<br />

Private & Confidential Page 14/19


Photo 11<br />

Photo 14<br />

Photo 13<br />

Private & Confidential Page 15/19


Photo 15<br />

Photo 16<br />

Photo 17<br />

Photo 18<br />

Private & Confidential Page 16/19


Photo 20<br />

Photo 19<br />

Photo 22<br />

Private & Confidential Page 17/19


Photo 21<br />

Photo 24<br />

Photo 23<br />

Private & Confidential Page 18/19


Photo 25<br />

Photo 26<br />

Private & Confidential Page 19/19


Anthony Torres Demolition / Chick -fil-A / 16 Jul <strong>2019</strong><br />

/ Rakin Amos<br />

Safety Evaluation Report (SER)<br />

Complete<br />

Inspection score<br />

97.44%<br />

Failed items<br />

1<br />

Created actions<br />

0<br />

Client / Site<br />

Anthony Torres Demolition / Chick -fil-A<br />

Date of Audit<br />

16th Jul, <strong>2019</strong><br />

Prepared by<br />

Rakin Amos<br />

Location<br />

5426 Sierra Vista Ave<br />

Los Angeles, CA 90038<br />

United States<br />

(34.08950029543217, -118.3099947206797)<br />

Private & Confidential Page 1/22


Failed items<br />

1 Failed<br />

Audit / 6. HEAVY EQUIPMENT<br />

C. Daily pre-use inspections done and documented DEFICIENT<br />

— Notes<br />

Pre inspections are done before starting work but if they find problem with the equipment such as cracks,<br />

leaks, un stable conditions with the machinery then it is put to the side.<br />

Private & Confidential Page 2/22


Audit 1 Failed 97.44%<br />

CONTRACTOR AND PROJECT INFORMATION<br />

Contractor<br />

Anthony Torres Demolition<br />

Safety Manager<br />

Mayra Martinez<br />

Project Name<br />

Chick-fil-A<br />

Project Number<br />

5426 Sierra Vista<br />

Project Manager<br />

Sixtos Molina<br />

Superintendent<br />

John Torres<br />

Inspector of Record (IOR)<br />

N/A<br />

Today's Weather Conditions (include 5 day forecast)<br />

Clear<br />

— Photos<br />

Photo 1 Photo 2 Photo 3<br />

1. PROGRAM ADMINISTRATION<br />

Private & Confidential Page 3/22


A. Attach photo of Safety Program YES<br />

— Photos<br />

Photo 4 Photo 5<br />

B. Attach photo of Weekly Safety Meeting YES<br />

— Photos<br />

Photo 6<br />

C. Were any Safety Orientations performed today NO<br />

D. Safety Violation Notifications issued? NO<br />

E. Attach photos of Emergency Procedures including Emergency<br />

Contact list.<br />

YES<br />

— Photos<br />

Photo 7<br />

Private & Confidential Page 4/22


F. Attach photos of OSHA required posters. YES<br />

— Photos<br />

Photo 8 Photo 9<br />

G. Attach photos to identify contractor's on site First Aid and CPR<br />

certified workers.<br />

YES<br />

— Photos<br />

Photo 10 Photo 11 Photo 12<br />

H. Did Owner's Safety Representative perform a job walk today? if<br />

so, list all safety concerns along with photos accompanied by your<br />

abated photos.<br />

NO<br />

I. Did the Inspector (IOR) have any safety concerns today? If so, list<br />

them and along with your abated photos.<br />

NO<br />

2. HEAT ILLNESS PREVENTION<br />

A. Attach photo of Heat Illness Plan (English & Spanish) SAFE<br />

— Photos<br />

Photo 13 Photo 14<br />

Private & Confidential Page 5/22


B. Is ample shade provided for workers? (80 degrees = 6 workers per<br />

canopy)<br />

SAFE<br />

— Photos<br />

Photo 15 Photo 16 Photo 17<br />

C. Are at least 2 Gallons of fresh cool drinking water available per<br />

worker with disposable cups? If not, what's in place for<br />

replenishing?(attach photo)<br />

SAFE<br />

— Photos<br />

Photo 18 Photo 19 Photo 20<br />

D. Attach the documented Pre-Shift 90 degree High Heat Training<br />

provided for workers with sign in sheet?<br />

N/A<br />

3. FIRE PREVENTION & PROTECTION<br />

A. OSHA approved metal gas containers N/A<br />

B. Fire extinguishers available and inspected SAFE<br />

— Photos<br />

Photo 21 Photo 22<br />

4. PERSONAL PROTECTIVE EQUIPMENT<br />

Private & Confidential Page 6/22


A. Approved hard hats SAFE<br />

— Photos<br />

Photo 23 Photo 24<br />

B. Safety glasses SAFE<br />

D. Are respirators required for any work being performed on site? If<br />

so, were they provided by the employer in conjunction with the<br />

required controls listed on the Table 1 in Cal/OSHA Title 8 5144?<br />

N/A<br />

Are respirators voluntarily being used? If so, are worker trained on<br />

hazards associated with the environment?<br />

N/A<br />

E. Proper foot wear SAFE<br />

— Photos<br />

Photo 25 Photo 26<br />

F. Proper clothing/hand protection/reflective vests SAFE<br />

— Photos<br />

Photo 27<br />

• Do you have hoists, cranes, derricks & rigging on your site?<br />

NO<br />

Private & Confidential Page 7/22


• Do you have heavy equipment in your site?<br />

YES<br />

— Photos<br />

Photo 28<br />

6. HEAVY EQUIPMENT 1 Failed<br />

A. Seat belts used correctly SAFE<br />

— Photos<br />

Photo 29<br />

B. Operators properly trained and authorized SAFE<br />

— Photos<br />

Photo 30 Photo 31<br />

C. Daily pre-use inspections done and documented DEFICIENT<br />

— Notes<br />

Pre inspections are done before starting work but if they find problem with the equipment such as cracks,<br />

leaks, un stable conditions with the machinery then it is put to the side.<br />

D. Backup alarms and signal men SAFE<br />

7. ELECTRICAL TOOLS<br />

Private & Confidential Page 8/22


A. Terminal boxes covered N/A<br />

B. Ground prong in place N/A<br />

C. 12-gauge cords placed along wall line or elevated 7 feet. Damage<br />

cords removed<br />

N/A<br />

D. Temp / permanent lighting adequate and protected SAFE<br />

— Photos<br />

Photo 32<br />

E. GFCI’s in place N/A<br />

F. Mechanical guards in place N/A<br />

G. Proper tools for each job SAFE<br />

H. Powder actuated tools operated by qualified persons N/A<br />

I. Tools inspected. Defected tools removed from service SAFE<br />

8. FALL PROTECTION<br />

A. Fall protection policy in effect (6’) N/A<br />

B. PFAS worn correctly N/A<br />

C. Inspection and maintenance of PFAS conducted N/A<br />

D. Employees trained in fall protection and fall hazard recognition N/A<br />

9. BARRICADES / GUARD RAILS / STAIRS<br />

A. Floor / wall openings covered & labeled SAFE<br />

Private & Confidential Page 9/22


B. Roadways, walkways and stairs free of obstacles SAFE<br />

— Photos<br />

Photo 33<br />

C. Adequate lighting SAFE<br />

— Photos<br />

Photo 34<br />

D. Trenches and excavations N/A<br />

• Do you have ladders in your site?<br />

NO<br />

• Is their scaffolding on site?<br />

NO<br />

• Is welding or cutting being performed on site?<br />

NO<br />

• Are their any excavations or shoring on site?<br />

NO<br />

• Is their any concrete work being performed on site?<br />

NO<br />

• Is any steel erection work being performed on site?<br />

NO<br />

• Is their any mobile equipment on site?<br />

NO<br />

• Do you have any confined space work being performed on site?<br />

NO<br />

CONTRACTORS (List our client first)<br />

Please click "Add Contractor" button.<br />

Private & Confidential Page 10/22


Contractor<br />

Contractor 1<br />

Name of Contractor/Company<br />

Anthony Torres<br />

JHA Verified<br />

Yes<br />

— Photos<br />

Photo 35<br />

Toolbox<br />

Yes<br />

— Photos<br />

Photo 36<br />

Head Count<br />

4<br />

DAILY SAFETY NARRATIVE (DSN)<br />

Private & Confidential Page 11/22


Please put your Daily Safety Narrative here<br />

I arrived on Chick-fil-A's site at 10:37 am and I met with Foreman Sixtos Molina and his crew. We did a job<br />

walk together and their current scope of work is fine grading.<br />

I verified the certifications for the heavy machinery on site. Sixtos Molina and his crew are trained on the<br />

equipment.<br />

This is a 4 man crew today, they're all wearing the proper Personal Protective Equipment. Adequate water<br />

is on site : they have two 45 bottle cases of 16.9 oz water. This equates to over 2 gallons available per<br />

employee.<br />

Due to the work scope today's job does not need any electricity therefore there's no GFCI required.<br />

The crew will be experiencing a high of 86 degrees today, so I recommended the guys take adequate<br />

breaks in the shade.<br />

No Deficiencies were noted on the evaluation today.<br />

There were no injury or incident on site to report<br />

This concludes my narrative<br />

COMPLETION AND SIGN-OFF<br />

Auditor<br />

Name and Signature<br />

Rakin Amos<br />

16th Jul, <strong>2019</strong> 11:06 AM PDT<br />

Private & Confidential Page 12/22


Photos<br />

36 Photos<br />

Photo 2<br />

Photo 1<br />

Photo 4<br />

Private & Confidential Page 13/22


Photo 3<br />

Photo 6<br />

Photo 5<br />

Photo 8<br />

Private & Confidential Page 14/22


Photo 7<br />

Photo 10<br />

Photo 9<br />

Photo 12<br />

Private & Confidential Page 15/22


Photo 11<br />

Photo 14<br />

Photo 13<br />

Photo 16<br />

Private & Confidential Page 16/22


Photo 15<br />

Photo 18<br />

Photo 17<br />

Photo 20<br />

Private & Confidential Page 17/22


Photo 19<br />

Photo 22<br />

Photo 21<br />

Photo 24<br />

Private & Confidential Page 18/22


Photo 23<br />

Photo 26<br />

Photo 25<br />

Photo 28<br />

Private & Confidential Page 19/22


Photo 27<br />

Photo 30<br />

Photo 29<br />

Photo 32<br />

Private & Confidential Page 20/22


Photo 31<br />

Photo 34<br />

Photo 33<br />

Photo 36<br />

Photo 35<br />

Private & Confidential Page 21/22


Private & Confidential Page 22/22


Anthony Torres Demolition / Jack in the box / 18 Jul<br />

<strong>2019</strong> / Rakin Amos<br />

Safety Evaluation Report (SER)<br />

Complete<br />

Inspection score<br />

94.59%<br />

Failed items<br />

1<br />

Created actions<br />

0<br />

Client / Site<br />

Anthony Torres Demolition / Jack in the box<br />

Date of Audit<br />

18th Jul, <strong>2019</strong><br />

Prepared by<br />

Rakin Amos<br />

Location<br />

100 N State College Blvd<br />

Anaheim, CA 92806<br />

United States<br />

(33.84129391774353, -117.88868906981668)<br />

Private & Confidential Page 1/22


Failed items<br />

1 Failed<br />

Audit / 6. HEAVY EQUIPMENT<br />

C. Daily pre-use inspections done and documented DEFICIENT<br />

— Notes<br />

I spoke with Chris Mendoza regarding performing inspections on vehicles prior to use. He stated that<br />

workers never received vehicle inspection paperwork.<br />

I advised Chris to make sure to document and maintain a record of each inspection at the beginning of<br />

each shift.<br />

Subchapter 4. Construction Safety Orders Article 10. Haulage and Earth Moving<br />

§1593. Haulage Vehicle Operation.<br />

(d) All vehicles in use shall be checked at the beginning of each shift to assure that the following parts,<br />

equipment, and accessories are in safe operating condition and free of apparent damage that could<br />

cause failure while in use: service brakes, including trailer brake connections; parking system (hand<br />

brake); emergency stopping system (brake); tires; horn; steering mechanism; coupling devices; seat belts;<br />

operating controls; and safety devices. All defects affecting safe operation shall be corrected before the<br />

vehicle is placed in service. These requirements also apply to equipment such as lights, reflectors,<br />

windshield wipers, defrosters, fire extinguishers, etc., where such equipment is necessary.<br />

Private & Confidential Page 2/22


Audit 1 Failed 94.59%<br />

CONTRACTOR AND PROJECT INFORMATION<br />

Contractor<br />

Anthony Torres Demolition<br />

Safety Manager<br />

Mayra Martinez<br />

Project Name<br />

Jack in the box demo<br />

Project Number<br />

0000<br />

Project Manager<br />

Eric Ramos<br />

Superintendent<br />

Dudley Roberts<br />

Inspector of Record (IOR)<br />

N/A<br />

Today's Weather Conditions (include 5 day forecast)<br />

Clear<br />

— Photos<br />

Photo 1 Photo 2 Photo 3<br />

1. PROGRAM ADMINISTRATION<br />

Private & Confidential Page 3/22


A. Attach photo of Safety Program YES<br />

— Notes<br />

Both English and Spanish<br />

— Photos<br />

Photo 4<br />

B. Attach photo of Weekly Safety Meeting NO<br />

— Photos<br />

Photo 5<br />

C. Were any Safety Orientations performed today NO<br />

D. Safety Violation Notifications issued? NO<br />

E. Attach photos of Emergency Procedures including Emergency<br />

Contact list.<br />

YES<br />

— Photos<br />

Photo 6<br />

Private & Confidential Page 4/22


F. Attach photos of OSHA required posters. YES<br />

— Photos<br />

Photo 7 Photo 8 Photo 9 Photo 10 Photo 11<br />

G. Attach photos to identify contractor's on site First Aid and CPR<br />

certified workers.<br />

YES<br />

— Photos<br />

Photo 12 Photo 13<br />

H. Did Owner's Safety Representative perform a job walk today? if<br />

so, list all safety concerns along with photos accompanied by your<br />

abated photos.<br />

NO<br />

I. Did the Inspector (IOR) have any safety concerns today? If so, list<br />

them and along with your abated photos.<br />

NO<br />

2. HEAT ILLNESS PREVENTION<br />

A. Attach photo of Heat Illness Plan (English & Spanish) SAFE<br />

— Photos<br />

Photo 14<br />

Private & Confidential Page 5/22


B. Is ample shade provided for workers? (80 degrees = 6 workers per<br />

canopy)<br />

SAFE<br />

— Photos<br />

Photo 15 Photo 16<br />

C. Are at least 2 Gallons of fresh cool drinking water available per<br />

worker with disposable cups? If not, what's in place for<br />

replenishing?(attach photo)<br />

SAFE<br />

— Notes<br />

They have bottle water on site<br />

— Photos<br />

Photo 17<br />

D. Attach the documented Pre-Shift 90 degree High Heat Training<br />

provided for workers with sign in sheet?<br />

N/A<br />

3. FIRE PREVENTION & PROTECTION<br />

A. OSHA approved metal gas containers SAFE<br />

— Photos<br />

Photo 18<br />

Private & Confidential Page 6/22


B. Fire extinguishers available and inspected SAFE<br />

— Notes<br />

The monthly signature is on canister, inspection good on it.<br />

— Photos<br />

Photo 19 Photo 20<br />

4. PERSONAL PROTECTIVE EQUIPMENT<br />

A. Approved hard hats SAFE<br />

— Photos<br />

Photo 21<br />

B. Safety glasses SAFE<br />

— Photos<br />

Photo 22<br />

D. Are respirators required for any work being performed on site? If<br />

so, were they provided by the employer in conjunction with the<br />

required controls listed on the Table 1 in Cal/OSHA Title 8 5144?<br />

N/A<br />

Are respirators voluntarily being used? If so, are worker trained on<br />

hazards associated with the environment?<br />

N/A<br />

Private & Confidential Page 7/22


E. Proper foot wear SAFE<br />

— Notes<br />

Proper foot attire for site<br />

— Photos<br />

Photo 23<br />

F. Proper clothing/hand protection/reflective vests SAFE<br />

— Photos<br />

Photo 24<br />

• Do you have hoists, cranes, derricks & rigging on your site?<br />

NO<br />

• Do you have heavy equipment in your site?<br />

YES<br />

— Photos<br />

Photo 25 Photo 26 Photo 27<br />

6. HEAVY EQUIPMENT 1 Failed<br />

Private & Confidential Page 8/22


A. Seat belts used correctly SAFE<br />

— Photos<br />

Photo 28<br />

B. Operators properly trained and authorized N/A<br />

— Photos<br />

Photo 29 Photo 30<br />

C. Daily pre-use inspections done and documented DEFICIENT<br />

— Notes<br />

I spoke with Chris Mendoza regarding performing inspections on vehicles prior to use. He stated that<br />

workers never received vehicle inspection paperwork.<br />

I advised Chris to make sure to document and maintain a record of each inspection at the beginning of<br />

each shift.<br />

Subchapter 4. Construction Safety Orders Article 10. Haulage and Earth Moving<br />

§1593. Haulage Vehicle Operation.<br />

(d) All vehicles in use shall be checked at the beginning of each shift to assure that the following parts,<br />

equipment, and accessories are in safe operating condition and free of apparent damage that could<br />

cause failure while in use: service brakes, including trailer brake connections; parking system (hand<br />

brake); emergency stopping system (brake); tires; horn; steering mechanism; coupling devices; seat belts;<br />

operating controls; and safety devices. All defects affecting safe operation shall be corrected before the<br />

vehicle is placed in service. These requirements also apply to equipment such as lights, reflectors,<br />

windshield wipers, defrosters, fire extinguishers, etc., where such equipment is necessary.<br />

D. Backup alarms and signal men SAFE<br />

7. ELECTRICAL TOOLS<br />

Private & Confidential Page 9/22


A. Terminal boxes covered N/A<br />

B. Ground prong in place N/A<br />

C. 12-gauge cords placed along wall line or elevated 7 feet. Damage<br />

cords removed<br />

N/A<br />

D. Temp / permanent lighting adequate and protected N/A<br />

E. GFCI’s in place N/A<br />

F. Mechanical guards in place N/A<br />

G. Proper tools for each job SAFE<br />

— Photos<br />

Photo 31<br />

H. Powder actuated tools operated by qualified persons N/A<br />

I. Tools inspected. Defected tools removed from service SAFE<br />

8. FALL PROTECTION<br />

A. Fall protection policy in effect (6’) N/A<br />

B. PFAS worn correctly N/A<br />

C. Inspection and maintenance of PFAS conducted N/A<br />

D. Employees trained in fall protection and fall hazard recognition N/A<br />

9. BARRICADES / GUARD RAILS / STAIRS<br />

A. Floor / wall openings covered & labeled N/A<br />

Private & Confidential Page 10/22


B. Roadways, walkways and stairs free of obstacles SAFE<br />

— Photos<br />

Photo 32<br />

C. Adequate lighting SAFE<br />

— Photos<br />

Photo 33<br />

D. Trenches and excavations N/A<br />

• Do you have ladders in your site?<br />

NO<br />

• Is their scaffolding on site?<br />

NO<br />

• Is welding or cutting being performed on site?<br />

NO<br />

• Are their any excavations or shoring on site?<br />

NO<br />

• Is their any concrete work being performed on site?<br />

NO<br />

• Is any steel erection work being performed on site?<br />

NO<br />

• Is their any mobile equipment on site?<br />

NO<br />

• Do you have any confined space work being performed on site?<br />

Unanswered<br />

CONTRACTORS (List our client first)<br />

Please click "Add Contractor" button.<br />

Private & Confidential Page 11/22


Contractor<br />

Contractor 1<br />

Name of Contractor/Company<br />

Anthony Torres Demolition<br />

JHA Verified<br />

Yes<br />

— Photos<br />

Photo 34<br />

Toolbox<br />

Yes<br />

— Photos<br />

Photo 35<br />

Head Count<br />

3<br />

DAILY SAFETY NARRATIVE (DSN)<br />

Private & Confidential Page 12/22


Please put your Daily Safety Narrative here<br />

Arrived on Jack In the Box site at 9:20 Am and met up with the Foreman Teodocio Mendoza and crew. He<br />

accompany me on a job walk. He discuss his job scope for the day and understood some of the hazards<br />

that was with, such as heat awareness and body positioning.<br />

I did verify that Mr. Mendoza was trained on the heavy equipment<br />

This is a 3 man crew, to which no electricity will not be used today.<br />

Today’s weather forecast shows that it will be high of 79 degrees, I suggested to the crew is take frequent<br />

breaks and drink water.<br />

Each employee is wearing the proper personal equipment for the job.<br />

The was one deficiency : They do not have any paper work on the pre inspection of the heavy machinery.<br />

I recommend getting inspection check list out to them<br />

There was no injuries on site to report<br />

This concludes my narrative<br />

COMPLETION AND SIGN-OFF<br />

Auditor<br />

Name and Signature<br />

Rakin Amos<br />

18th Jul, <strong>2019</strong> 10:53 AM PDT<br />

Private & Confidential Page 13/22


Photos<br />

35 Photos<br />

Photo 2<br />

Photo 1<br />

Photo 4<br />

Private & Confidential Page 14/22


Photo 3<br />

Photo 5<br />

Photo 6<br />

Photo 7<br />

Photo 8<br />

Private & Confidential Page 15/22


Photo 9<br />

Photo 10<br />

Photo 12<br />

Photo 11<br />

Private & Confidential Page 16/22


Photo 13<br />

Photo 14<br />

Photo 15<br />

Photo 16<br />

Private & Confidential Page 17/22


Photo 17<br />

Photo 18<br />

Photo 19<br />

Photo 20<br />

Private & Confidential Page 18/22


Photo 21<br />

Photo 22<br />

Photo 24<br />

Photo 23<br />

Private & Confidential Page 19/22


Photo 25<br />

Photo 26<br />

Photo 27<br />

Photo 28<br />

Private & Confidential Page 20/22


Photo 29<br />

Photo 30<br />

Photo 31<br />

Photo 32<br />

Private & Confidential Page 21/22


Photo 33<br />

Photo 34<br />

Photo 35<br />

Private & Confidential Page 22/22


Anthony Torres Demolition / Joe Black House / 18<br />

Jul <strong>2019</strong> / Rakin Amos<br />

Safety Evaluation Report (SER)<br />

Complete<br />

Inspection score<br />

97.56%<br />

Failed items<br />

1<br />

Created actions<br />

0<br />

Client / Site<br />

Anthony Torres Demolition / Joe Black House<br />

Date of Audit<br />

18th Jul, <strong>2019</strong><br />

Prepared by<br />

Rakin Amos<br />

Location<br />

6 S Vista de la Luna<br />

Laguna Beach, CA 92651<br />

United States<br />

(33.493946722674956, -117.73285735400786)<br />

Private & Confidential Page 1/20


Failed items<br />

1 Failed<br />

Audit / 10. LADDERS<br />

B. Side rails extend 36” above top of landing, tied off and secured. DEFICIENT<br />

— Notes<br />

Improper use of ladder, wrong ladder. Need to use a extension ladder<br />

— Photos<br />

Photo 25<br />

Private & Confidential Page 2/20


Audit 1 Failed 97.56%<br />

CONTRACTOR AND PROJECT INFORMATION<br />

Contractor<br />

Anthony Torres Demolition<br />

Safety Manager<br />

Mayra Martinez<br />

Project Name<br />

Joe black<br />

Project Number<br />

0000<br />

Project Manager<br />

Eddy Somoza<br />

Superintendent<br />

Bryant Cruz<br />

Inspector of Record (IOR)<br />

N/A<br />

Today's Weather Conditions (include 5 day forecast)<br />

Clear<br />

— Photos<br />

Photo 1 Photo 2<br />

1. PROGRAM ADMINISTRATION<br />

Private & Confidential Page 3/20


A. Attach photo of Safety Program YES<br />

— Photos<br />

Photo 3<br />

B. Attach photo of Weekly Safety Meeting YES<br />

— Photos<br />

Photo 4 Photo 5<br />

C. Were any Safety Orientations performed today NO<br />

D. Safety Violation Notifications issued? NO<br />

E. Attach photos of Emergency Procedures including Emergency<br />

Contact list.<br />

YES<br />

— Photos<br />

Photo 6<br />

Private & Confidential Page 4/20


F. Attach photos of OSHA required posters. YES<br />

— Photos<br />

Photo 7 Photo 8 Photo 9 Photo 10<br />

G. Attach photos to identify contractor's on site First Aid and CPR<br />

certified workers.<br />

NO<br />

H. Did Owner's Safety Representative perform a job walk today? if<br />

so, list all safety concerns along with photos accompanied by your<br />

abated photos.<br />

NO<br />

I. Did the Inspector (IOR) have any safety concerns today? If so, list<br />

them and along with your abated photos.<br />

NO<br />

2. HEAT ILLNESS PREVENTION<br />

A. Attach photo of Heat Illness Plan (English & Spanish) SAFE<br />

— Photos<br />

Photo 11 Photo 12<br />

B. Is ample shade provided for workers? (80 degrees = 6 workers per<br />

canopy)<br />

SAFE<br />

— Photos<br />

Photo 13<br />

Private & Confidential Page 5/20


C. Are at least 2 Gallons of fresh cool labeled drinking water<br />

available per worker with disposable cups, trash can? (attach<br />

photo)<br />

SAFE<br />

— Photos<br />

Photo 14 Photo 15<br />

D. Attach the documented Pre-Shift 90 degree High Heat Training<br />

provided for workers with sign in sheet?<br />

N/A<br />

3. FIRE PREVENTION & PROTECTION<br />

A. OSHA approved metal gas containers N/A<br />

B. Fire extinguishers available and inspected SAFE<br />

— Photos<br />

Photo 16<br />

4. PERSONAL PROTECTIVE EQUIPMENT<br />

A. Approved hard hats SAFE<br />

— Photos<br />

Photo 17<br />

Private & Confidential Page 6/20


B. Safety glasses SAFE<br />

D. Are respirators required for any work being performed on site? If<br />

so, were they provided by the employer in conjunction with the<br />

required controls listed on the Table 1 in Cal/OSHA Title 8 5144?<br />

N/A<br />

Are respirators voluntarily being used? If so, are worker trained on<br />

hazards associated with the environment?<br />

N/A<br />

E. Proper foot wear SAFE<br />

F. Proper clothing/hand protection/reflective vests SAFE<br />

• Do you have hoists, cranes, derricks & rigging on your site?<br />

NO<br />

• Do you have heavy equipment in your site?<br />

NO<br />

7. ELECTRICAL TOOLS<br />

A. Terminal boxes covered N/A<br />

B. Ground prong in place N/A<br />

C. 12-gauge cords placed along wall line or elevated 7 feet. Damage<br />

cords removed<br />

N/A<br />

D. Temp / permanent lighting adequate and protected SAFE<br />

— Photos<br />

Photo 18<br />

E. GFCI’s in place N/A<br />

F. Mechanical guards in place N/A<br />

G. Proper tools for each job SAFE<br />

Private & Confidential Page 7/20


H. Powder actuated tools operated by qualified persons N/A<br />

I. Tools inspected. Defected tools removed from service SAFE<br />

8. FALL PROTECTION<br />

A. Fall protection policy in effect (6’) SAFE<br />

— Photos<br />

Photo 19<br />

B. PFAS worn correctly SAFE<br />

— Photos<br />

Photo 20<br />

C. Inspection and maintenance of PFAS conducted SAFE<br />

D. Employees trained in fall protection and fall hazard recognition SAFE<br />

— Notes<br />

No paperwork on site stating that they were all trained on fall system<br />

9. BARRICADES / GUARD RAILS / STAIRS<br />

Private & Confidential Page 8/20


A. Floor / wall openings covered & labeled SAFE<br />

— Photos<br />

Photo 21 Photo 22<br />

B. Roadways, walkways and stairs free of obstacles SAFE<br />

C. Adequate lighting SAFE<br />

— Photos<br />

Photo 23 Photo 24<br />

D. Trenches and excavations N/A<br />

• Do you have ladders in your site?<br />

YES<br />

10. LADDERS 1 Failed<br />

A. Secured to prevent slipping, sliding or falling N/A<br />

Private & Confidential Page 9/20


B. Side rails extend 36” above top of landing, tied off and secured. DEFICIENT<br />

— Notes<br />

Improper use of ladder, wrong ladder. Need to use a extension ladder<br />

— Photos<br />

Photo 25<br />

C. Step ladders fully open when in use. SAFE<br />

— Photos<br />

Photo 26<br />

• Is their scaffolding on site?<br />

NO<br />

• Is welding or cutting being performed on site?<br />

NO<br />

• Are their any excavations or shoring on site?<br />

NO<br />

• Is their any concrete work being performed on site?<br />

NO<br />

• Is any steel erection work being performed on site?<br />

NO<br />

• Is their any mobile equipment on site?<br />

NO<br />

• Do you have any confined space work being performed on site?<br />

NO<br />

CONTRACTORS (List our client first)<br />

Please click "Add Contractor" button.<br />

Contractor<br />

Private & Confidential Page 10/20


Contractor 1<br />

Name of Contractor/Company<br />

Anthony Torres Demolition<br />

JHA Verified<br />

Yes<br />

— Photos<br />

Photo 27<br />

Toolbox<br />

Yes<br />

— Photos<br />

Photo 28 Photo 29<br />

Head Count<br />

7<br />

DAILY SAFETY NARRATIVE (DSN)<br />

Private & Confidential Page 11/20


Please put your Daily Safety Narrative here<br />

Arrived at Joe Black house site 12: 53 pm and met up with the Foreman Jesus Pineda and crew. He<br />

accompany me on a job walk. He discuss his job scope for the day and understood some of the hazards<br />

that was with, such as heat awareness and body positioning, including fall hazards.<br />

This is a 7 man crew, to which no electricity will not be used today because there removing the roof<br />

sheets<br />

Today’s weather forecast shows that it will be high of 70 degrees, I suggested to the crew is take frequent<br />

breaks and drink plenty water.<br />

Each employee is wearing the proper personal equipment for the job.<br />

There was 1 deficiency: Improper use of ladder, wrong ladder used to get on the roof, was not at least 2-<br />

3ft above the landing.<br />

I just suggested they use a extension ladder<br />

There was no injuries on site to report<br />

This concludes my narrative<br />

COMPLETION AND SIGN-OFF<br />

Auditor<br />

Name and Signature<br />

Rakin Amos<br />

18th Jul, <strong>2019</strong> 1:46 PM PDT<br />

Private & Confidential Page 12/20


Photos<br />

29 Photos<br />

Photo 1<br />

Photo 2<br />

Photo 3<br />

Private & Confidential Page 13/20


Photo 4<br />

Photo 5<br />

Photo 6<br />

Photo 7<br />

Photo 8<br />

Private & Confidential Page 14/20


Photo 9<br />

Photo 10<br />

Photo 12<br />

Photo 11<br />

Private & Confidential Page 15/20


Photo 14<br />

Photo 13<br />

Photo 16<br />

Photo 15<br />

Private & Confidential Page 16/20


Photo 17<br />

Photo 18<br />

Photo 19<br />

Photo 20<br />

Private & Confidential Page 17/20


Photo 22<br />

Photo 21<br />

Photo 24<br />

Photo 23<br />

Private & Confidential Page 18/20


Photo 25<br />

Photo 26<br />

Photo 28<br />

Photo 27<br />

Private & Confidential Page 19/20


Photo 29<br />

Private & Confidential Page 20/20


EMPLOYEE<br />

CORRECTIVE<br />

MEASURES


Corrective Measures Summary<br />

<strong>July</strong> <strong>2019</strong><br />

EMPLOYEE CORRECTIVE MEASURES<br />

Infractions will receive an Employee Corrective Measures form. When an infraction is committed, a verbal<br />

warning will be issued, and the form will serve as a record. The 5 Keys implemented to assist and help<br />

with understanding are the following: 1.) Establish 2.) Enforce 3.) Monitor 4.) Train 5.) Assist.<br />

DATE & JOBSITE EMPLOYEE/WORKER VIOLATION<br />

1 7/15/<strong>2019</strong> Sergio Duarte<br />

Fire extinguisher did not have a dated tag.<br />

Incomplete Pre-Construction Hazard<br />

Analysis<br />

2 7/18/<strong>2019</strong> Jesus Pineda Improper use of an A-Frame Ladder on site.<br />

3<br />

4<br />

5<br />

6<br />

Prepared by The Price of Safety on behalf of Anthony Torres Demolition<br />

1485 Spruce St., Suite M, Riverside, CA 92507 | www.thepriceofsafety.com


Employee Corrective Measures (ECM) Report<br />

The ECM Report must be filled out by Management upon the notification of the infraction. Once it is completed please Email a copy<br />

to The Price of Safety to the following individuals: Safety Dept: info@thepriceofsafety.co; as well as a copy to the client contact<br />

WITHIN 24 HOURS.<br />

For assistance call (424) 744-1002<br />

Name of Worker/Employee<br />

Sergio Duarte<br />

Trade: Demolition<br />

Date and Time of Incident:<br />

June 15, <strong>2019</strong><br />

Name of Supervisor:<br />

John Torres<br />

Form Completed By:<br />

Mayra Martinez<br />

Project Name and #:<br />

Los Angeles<br />

Were there any witnesses?<br />

No<br />

Job Title:<br />

Demolition Foreman<br />

Location of Incident (Address):<br />

5426 Sierra Vista, Los Angeles CA<br />

Supervisor's Number:<br />

909.620.4884<br />

Number<br />

951.441.9230<br />

Was this incident in violation of a<br />

company policy?<br />

Name of Witness:<br />

Employer/Contractor:<br />

Anthony Torres Demolition<br />

Date Supervisor Notified:<br />

June 15,<strong>2019</strong><br />

Date THE PRICE OF SAFETY notified:<br />

June 17,<strong>2019</strong><br />

x YES q NO<br />

Name of Witness:<br />

Type of Violation:<br />

No PPE<br />

Improper use of fall arrest (PFAS)<br />

Improper use of equipment<br />

Lack of Documentation<br />

Missing Required Certification<br />

Improper use of a vehicle/heavy equipment<br />

Improper guards<br />

Improper PPE<br />

Unsafe Act/Condition<br />

Failure to Secure/Warn<br />

Other:<br />

Potential for<br />

Reoccurrence:<br />

Never<br />

Rare X<br />

Occasional Frequent<br />

Has Employee been trained<br />

in the area violated?<br />

xYES<br />

q NO<br />

q WARNED q SUSPEND q REMOVED FROM JOB SITE q DISCHARGED<br />

Date of Previous Warning: Days Suspended: Date Removed:<br />

X Verbal Notification<br />

Dates of Suspension<br />

Full description of incident: (Please describe the occurrence- remember, this section is for facts, not opinions)<br />

1.)Leadman Sergio Duarte had inadequate fire protection on site. The fire extinguisher did not have a valid dated tag.<br />

2.) Leadman Sergio Duarte did not have completed Pre-construction Hazard Analysis for the tasks.<br />

Worker's Statement:<br />

What Corrective Measures were taken/or suggested:<br />

Mayra Martinez contacted Mr. Duarte and reminded him to replace the fire extinguisher. Sandra Castillo<br />

confirmed he indeed replaced the fire extinguisher.<br />

What the situation defused or mitigated? Why or Why Not?<br />

Yes<br />

Signature:<br />

Date:<br />

Mayra Martinez June 15, <strong>2019</strong>


Employee Corrective Measures (ECM) Report<br />

The ECM Report must be filled out by Management upon the notification of the infraction. Once it is completed please Email a copy<br />

to The Price of Safety to the following individuals: Safety Dept: info@thepriceofsafety.co; as well as a copy to the client contact<br />

WITHIN 24 HOURS.<br />

For assistance call (424) 744-1002<br />

Name of Worker/Employee<br />

Jesus Pineda<br />

Trade: Demolition<br />

Date and Time of Incident:<br />

June 18, <strong>2019</strong><br />

Name of Supervisor:<br />

John Torres<br />

Form Completed By:<br />

Mayra Martinez<br />

Project Name and #:<br />

Joe’s Black House<br />

Were there any witnesses?<br />

No<br />

Job Title:<br />

Demolition Foreman<br />

Location of Incident (Address):<br />

6 Suite Vista De La Luna, Laguna Beach<br />

Supervisor's Number:<br />

909.620.4884<br />

Number<br />

951.441.9230<br />

Was this incident in violation of a<br />

company policy?<br />

Name of Witness:<br />

Employer/Contractor:<br />

Anthony Torres Demolition<br />

Date Supervisor Notified:<br />

June 18,<strong>2019</strong><br />

Date THE PRICE OF SAFETY notified:<br />

June 18,<strong>2019</strong><br />

x YES q NO<br />

Name of Witness:<br />

Type of Violation:<br />

No PPE<br />

Improper use of fall arrest (PFAS)<br />

Improper use of equipment<br />

Lack of Documentation<br />

Missing Required Certification<br />

Improper use of a vehicle/heavy equipment<br />

Improper guards<br />

Improper PPE<br />

Unsafe Act/Condition<br />

Failure to Secure/Warn<br />

Other:<br />

Potential for<br />

Reoccurrence:<br />

Never<br />

Rare X<br />

Occasional Frequent<br />

Has Employee been trained<br />

in the area violated?<br />

xYES<br />

q NO<br />

q WARNED q SUSPEND q REMOVED FROM JOB SITE q DISCHARGED<br />

Date of Previous Warning: Days Suspended: Date Removed:<br />

X Verbal Notification<br />

Dates of Suspension<br />

Full description of incident: (Please describe the occurrence- remember, this section is for facts, not opinions)<br />

Foreman Jesus Pineda was utilizing a ladder in a manner it was not designed for. An a-frame ladder would have been the<br />

appropriate ladder to complete the task at hand.<br />

Worker's Statement:<br />

Mr. Pineda stated he would make sure to obtain an a-frame ladder from the yard in the future.<br />

What Corrective Measures were taken/or suggested:<br />

Mayra Martinez contacted Mr. Pineda to ensure he was utilizing the correct ladder designed for their use.<br />

What the situation defused or mitigated? Why or Why Not?<br />

Yes<br />

Signature:<br />

Date:<br />

Mayra Martinez June 18, <strong>2019</strong>


INCIDENT LOGS


Prepared by The Price of Safety on behalf of Anthony Torres Demolition<br />

1485 Spruce St., Suite M, Riverside, CA 92507 | www.thepriceofsafety.com<br />

Incident Log <strong>July</strong> <strong>2019</strong><br />

SUMMARY:<br />

Employee Humberto Chavarria was involved in an incident on <strong>July</strong> 24, <strong>2019</strong>.<br />

Note:<br />

Please continue to encourage all of our employees to report minor incidents including cuts, scratches, and<br />

bruises. As well as major incidents such as slips, falls, sprains, and broken bones as soon as possible; ensure<br />

that all foreman have incident response packets available on hand at all times.<br />

Minor Incident example: scraped knee, puncture finger with staple gun.<br />

Major Incidents include: Fall from ladder, eye puncture, circular saw cut, property damage.<br />

OPEN INCIDENTS<br />

NAME OF EMPLOYEE DATE/TIME DESCRIPTION SEVERITY OF<br />

INJURIES/ILLNESS<br />

Humberto Chavarria <strong>July</strong> 25,<strong>2019</strong><br />

12:20pm<br />

Humberto’s hand was<br />

pinched between a<br />

waste trailer and a CAT<br />

232b (bobcat)<br />

Humberto’s fourth finger<br />

on his left hand received<br />

12 stitches. He was<br />

released to work with light<br />

duty restrictions.<br />

CLOSED INCIDENT<br />

NAME OF EMPLOYEE BRIEF DESCRIPTION SEVERITY OF INJURY/ILLNESS CLOSING<br />

DATE


TRAINING SUMMARY


Strategic Training Calendar<br />

<strong>2019</strong><br />

January February March<br />

OUR SAFETY IS OUR RESPONSIBILITY FALL PROTECTION AWARENESS WORKPLACE VIOLENCE PREVENTION<br />

INCIDENT RESPONSE PROCEDURE<br />

1. Incident Reporting (Review)<br />

2. Workplace Violence<br />

3. Safety Your Responsibility pt. 1<br />

(Review)<br />

4. Safety Is your Responsibility pt.2<br />

(Review)<br />

April May June<br />

ELECTRICAL SAFETY AWARENESS HEAT ILLNESS PREVENTION ERGONOMICS IN CONSTRUCTION<br />

5. Electrical Safety Awareness<br />

6. Electrical Safety Awareness pt.2<br />

7. Understanding Electrical<br />

Injuries<br />

8. OSHA Quick Card: Electrical<br />

Safety<br />

9. Preventing Electrical Hazards<br />

10. Types of Heat illness and<br />

common signs and symptoms<br />

11. Types of Heat Illness and<br />

commons signs and symptoms<br />

pt.2<br />

12. Protecting workers from<br />

Heat Illness<br />

13. Heat Illness Poster & Review<br />

14. Musculoskeletal Disorder and<br />

Ergonomics.<br />

15. Protecting Your Back<br />

16. Minimize Stress from Material<br />

Handling<br />

17. Stretch & Flex<br />

<strong>July</strong><br />

18. Flammable vs. Combustible<br />

19. Fire Classifications Pt. 1<br />

20. Fire Classifications Pt.2<br />

21. Fire Tetrahedron<br />

22. Responding to Fire Emergency<br />

August<br />

FIRE SAFETY HAZARD COMMUNICATION (HAZCOM) FORKLIFT SAFETY<br />

September<br />

October November December<br />

DEFENSIVE DRIVING BLOODBORNE PATHOGENS YEAR END REVIEW<br />

Prepared by The Price of Safety on behalf of Anthony Torres Demilition<br />

1485 Spruce St., Suite M, Riverside, CA 92507 | www.thepriceofsafety.com


Prepared by The Price of Safety on behalf of Anthony Torres Demolition<br />

Strategic Training Log: June <strong>2019</strong><br />

SUMMARY:<br />

This log chronicles all training provided for the required yearly training calendar according to OSHA. It also<br />

details training that will take place this month, based upon the failed items from the previous month.<br />

Please encourage all foreman to attend to scheduled trainings.<br />

Thank you for your support!<br />

TRAINING PROVIDED THIS PERIOD<br />

TITLE COURSE DATE/TIME DESCRIPTION NOTES<br />

Fire Safety Awareness 7/1/19-7/31/19 Topics covered:<br />

Flammable versus<br />

combustible materials,<br />

Fire classifications,<br />

Fire tetrahedron and<br />

responding to a fire<br />

emergency<br />

Weekly Toolbox meetings were sent<br />

out via email to<br />

admin@anthonytorresdemolition.com<br />

Received 7/1/19<br />

AWARENESS LEVEL NEEDED FOR JULY<br />

TRAINING COURSE BRIEF DESCRIPTION DATE/TIME CLOSING<br />

DATE<br />

Fire Safety Awareness<br />

Crystalline Silica<br />

Raise awareness of fire hazards<br />

and how to act safely in the<br />

event of an emergency fire<br />

situation.<br />

Awareness Level for the<br />

Foremen<br />

Weekly Toolbox Topic 7/31/19<br />

Foreman’s Monthly Meeting<br />

TBD<br />

PPE Refresher PPE for foremen/Workers Foremen's Monthly Meeting/<br />

On location<br />

TBD<br />

Machine Guarding TBD TBD


•<br />

Safety Meeting Attendance Rostei<br />

Topi~: Are Safe]; Flammable vs Combustible<br />

Jobs1te: ~ 5 . Th\::0 2f WnUi Instructor:<br />

Date: 07/01/<strong>2019</strong> Time: r :~D fl-)<br />

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Name'" Date' Signature<br />

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t<br />

C..<br />

Gracia• por :aslstlr a~ reunl6n d•~•gurldad, por_favor, higanos saber cOmo podemos mtJorar<br />

segu(ldad aqui en nuestro'sltio de trabaJo. sus pensamlentos Y sugerendas son muyJmportan~lra cuhura do<br />

1;0Mr ii• usted. Por tavor, al\ada at~n•• Inquietudes adlclonatesde securldad esy llOSru,tarf.l<br />

Graclas<br />

sa·fety Meeting Attendance Roster<br />

Topic:, Fire Safety: Fire Classifications pt 1.<br />

Instructor: ,Jrtsu.5 f',ned&.<br />

Jobsite: 1le.Jzde1 (.(<br />

Date: 07 /08[<strong>2019</strong> Time~ ; ?o tv-1<br />

Name<br />

Date<br />

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Signature<br />

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• 2,


Additional Services: <strong>July</strong> <strong>2019</strong><br />

BELOW IS A RECORD OF THE ADDITIONAL SUPPORT PROVIDED FOR YOUR SAFETY SERVICES.<br />

TITLE DATE DESCRIPTION NOTES<br />

Additional Safety<br />

Evaluation<br />

7/18/19 An additional<br />

evaluation was<br />

conducted on 7/18/19<br />

in Laguna Beach with<br />

Foreman Jesus<br />

Pineda<br />

Incident Investigation 7/24/19 Mayra Martinez<br />

accompanied<br />

employee Humberto<br />

Chavarria at the Care<br />

First Clinic in Ontario,<br />

CA on the day of his<br />

Incident.<br />

Incident Support 7/31/19 Mayra Martinez and<br />

Brittany Price<br />

accompanied<br />

employee Humberto<br />

Chavarria at his follow<br />

up appointment at<br />

Care First Clinic in<br />

Ontario, CA at<br />

3:34pm.<br />

Jesus Pineda received<br />

a score of 97.56% on<br />

his evaluation. A ladder<br />

deficiency was<br />

discussed. Mayra<br />

Martinez followed up<br />

with Jesus to ensure<br />

they had appropriate<br />

ladders for their task.<br />

Employee Humberto<br />

Chavarria was involved<br />

in an incident at Chickfil-a,<br />

which resulted in a<br />

laceration on his left<br />

hand, ring finger.<br />

Mr. Humberto’s injured<br />

finger was examined<br />

for any infections,<br />

cleaned, and covered.<br />

We spoke with the<br />

Doctor and translated<br />

for Humberto to ensure<br />

he was aware of the<br />

procedures.

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