--
Project Number: --
Project Manager: --
Project Manager Cell: --
Project Superintendent: --
Principal in Charge: --
Principal in Charge Cell: --
Site Safety Representative: --
Site Safety Representative Cell: --
Project Start Date: --
Estimated Finish Date: --
Today's Date:
Peak Manpowers:
First Aid:
First Aid Expiration Date:
First Aid:
First Aid Expiration Date:
Medical Facilities to be used:
Minor Injuries
Facility Name:
Address/Phone #:
Facility Name:
Address/Phone #:
Facility Name:
Address/Phone #:
Serious Injuries
Facility Name:
Address/Phone #:
Facility Name:
Address/Phone #:
Facility Name:
Address/Phone #:
Emergency Numbers
Police - 911:
Fire 911:
Ambulance 911:
Location of First Aid Kits:
Location of Fire Extinguishers:
Other:
Signs
Warning Signs
Required Postings
Other Signs
Overhead Protection
Entrances
Required Postings
Excavation / Trenches
Excavation / Trenches
Other Safeguards
Fall Protection
Fall Protection is required for work in areas where the fall hazards is greater than 10’.
Fall Protection
Power & Portable Saws
Heavy Equipment
Other
Housekeeping
Other Housekeeping
Potential Exposure to Toxic Chemicals & High Noise Levels
Confined Space
Location of Confined Space
Meeting
Date
Location
By Whom
Meeting 2
Date
Location
By Whom
Subcontractors On Site
Subcontractor
Safety Representative
Work Scope
Safety Program
Comments
Performance
Comments
Site Safety Plan
Comments
Meetings
Comments
Subcontractors On Site
Subcontractor
Safety Representative
Work Scope
Safety Program
Comments
Performance
Comments
Site Safety Plan
Comments
Meetings
Comments
Prepared By:
Date:
Project Manager:
Cell:
Project Superintendent:
Cell:
Principal in Charge:
Cell:
Site Safety Person:
Cell:
Safety Meetings:
Site Specific Safety Plan
Project Address:
Safety Person:
Cell:
First Aid / CPR Trained Personnel:
Cell:
Medical Facilities
For Serious Injuries
OR: Contact 911 & give them the project address
For Minor Injuries
Location of First Aid Kits
Location of Fire Extinguishers
Day of the Week:
Personal Protective Policies:
Safety Person: , the Safety Person for this project, will be responsible for development, implementation, and administration of Aldrich + Associates’ PPE policies for the --