ATD_July_2019
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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 />
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Photo 9<br />
Photo 10<br />
Photo 12<br />
Photo 11<br />
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Photo 13<br />
Photo 14<br />
Photo 15<br />
Photo 16<br />
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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 />
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Photo 29<br />
Photo 30<br />
Photo 31<br />
Photo 32<br />
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Photo 33<br />
Photo 34<br />
Photo 35<br />
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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 />
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Photo 9<br />
Photo 10<br />
Photo 12<br />
Photo 11<br />
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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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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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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.