Safety Score Card Sample
Safety Score Card Sample
Safety Score Card Sample
ADMINISTRATION
TOTALS 245
TOTAL 14
2 SAFETY & MEDICAL
RECORDKEEPING PRACTICES
A. Injury statistics tabulated and utilized to 2
identify positive / negative trends.
B. The previous years' statistics are available. 1
3 EMERGENCY PREPAREDNESS
A. The emergency plan is in writing. 3
TOTAL 17
4 HAZARD COMMUNICATION
PROGRAM
A. A written program, specific to the operation, 3
is in place and complete (i.e., training,
labeling, MSDS review, designated
coordinator, inventory listing, etc.)
B. Training is documented. 2
TOTAL 15
5 CONFINED SPACES
A. A confined space entry procedure, which 3
meets requirements, is in place.
B. Lighting and electrical tools used inside 3
confined spaces are 12 volt or GFCI
protected.
TOTAL 21
6 MOBILE EQUIPMENT
OPERATIONS
A. There is a maintenance schedule for all 1
mobile equipment and the schedule is
followed.
TOTAL 27
7 INSPECTION PROCEDURES
A. Regular safety inspections of the site / 3
operation are conducted and documented.
TOTAL 19
8 RESPIRATORY PROTECTION
A. There is a written respiratory protection 3
program which addresses the respiratory
protection exposure / need as required
B. Fit test is provided for all employees required 2
to wear respirators.
2 A carbon-monoxide alarm. 2
TOTAL 29
9 ENFORCEMENT AND DISCIPLINE
TOTAL 6
10 EDUCATION AND TRAINING
TOTAL 12
11 PERFORMANCE INDICATORS
TOTAL 17
12 ACCIDENT / INCIDENT
INVESTIGATION
TOTAL 16
13 CONTRACTORS
TOTAL 17
14 MANAGEMENT / SUPERVISION
TOTAL
PENALTY
* REPEATED DEFICIENCY (X) ** IDLH (X) ASSESSORS COMMENTS
DETAILED ASSESSMENT SCORE SUMMARY
FIELD EXECUTION
4 Hand Tools 9
5 Powder Actuated Tools 18
6 Power Tools and Power Equipment 19
7 Hot Work (Welding, Heating, Burning) 54
8 Electrical 41
9 Equipment Operations 114
10 Excavation and Trenching 30
11 Steel Erection and Floor and Wall Opening 47
12 Material Handling Storage 18
13 Signs, Signals, Barricades 10
14 Fire Prevention and Protection 42
15 Ladders, Scaffolds and Elevated Work Platforms 100
19 Community Exposure 9
TOTALS 680
TOTAL 13
2 WORK AREA LIGHTING
TOTAL 11
3 PERSONAL PROTECTIVE
EQUIPMENT (P.P.E.)
A. Head Protection
B. Eye Protection 2
1 Worn where required. 2
D. Hearing Protection
TOTAL 68
4 HAND TOOLS
TOTAL 9
5 POWDER ACTUATED TOOLS
TOTAL 18
6 POWER TOOLS AND POWER
EQUIPMENT
TOTAL 19
7 HOT WORK (Welding, Heating,
Burning)
A. Hot work in or near areas or processes that 4
involve flammable, combustible or explosive
materials or chemicals is performed under a
safe work or hot work permit.
TOTAL 54
8 ELECTRICAL
TOTAL 41
9 EQUIPMENT OPERATIONS
A. Crane Operations
1 Load charts are posted and utilized. 3
2 The swing radius of the counter weight is 3
barricaded.
3 The crane is operated level with all out riggers 3
fully extended.
4 Moving and travel practices are utilized to 3
include the use of a flagman.
C. Haulage Operations
D. Rigging Equipment
E. Warning Methods
F. Equipment Inspections
TOTAL 114
10 EXCAVATION AND TRENCHING
TOTAL 30
11 STEEL ERECTION AND FLOOR
AND WALL OPENING
TOTAL 47
12 MATERIAL HANDLING STORAGE
TOTAL 18
13 SIGNS, SIGNALS, BARRICADES
TOTAL 10
14 FIRE PREVENTION AND
PROTECTION
TOTAL 42
15 LADDERS, SCAFFOLDS AND
ELEVATED WORK PLATFORMS
A. Ladders
B. Scaffolds
1 Provided with required access and egress. 3
2 Has a standard guard rail (106 cm top rail, 53 3
cm midrail, and 10 cm toe board) whenever
possible.
a. Approved design. 3
b. Approved life lines are provided. 4
TOTAL 100
16 CONCRETE, CONCRETE FORMS,
SHORING, MASONRY
TOTAL 22
17 DEMOLITION
TOTAL 15
18 HIGH-PRESSURE WATER
CLEANING
A. Operators are wearing rain suits, gloves, face 3
shields, hard hats, safety glasses with side
shields, rubber steel toe boots or metatarsal
guards.
TOTAL 40
19 COMMUNITY EXPOSURE
TOTAL 9
SAFETY AUDIT
DETAILED ASSESSMENT SCORE SUMMARY
HOUSEKEEPING
1 Housekeeping 50
TOTALS 50
SCORE PENALTY
MAXIMU ACTUAL * REPREATED ** IDLH (X)
M SCORE DEFICIENCY (X)
POSSIBL
E
1 HOUSEKEEPING
TOTAL 50
ASSESSORS
COMMENTS
RY
REDUCTION
* REPEAT ** IDLH
DEFICIENCY
ASSESSORS
COMMENTS