Contractor Safety Checklist & Orientation

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Office of Environmental Health & Safety
CONTRACTOR SAFETY CHECKLIST & ORIENTATION
CONTRACTOR INFORMATION
Contractor Name:
Project Services Planned:
Duration of Project Services:
Application Date:
Contractor’s On-Site Responsible Representative:
Name:
Method(s) of communication:
Signature:
Pager
Cell
On-Site Office
Other:
Pager
Cell
On-Site Office
Other:
Olin College Representative/Host:
Method(s) of communication:
Instructions: Check “yes” when requirements are applicable and arrangements/details have been discussed/
reviewed. Check “no” if not applicable to work area or scope of project/service. Orientation must be completed
before work begins.
Distribution: Please forward this Contractor Safety Checklist form to the Assistant Director of Facilities Services
via email [email protected] or bring the completed form to the Campus Center, Suite 332.
1
Building Access?
Yes
No
Parking?
Yes
No
Security/Access?
Yes
No
Restricted Area(s)?
Yes
No
2
Emergency Procedures, Signals, Assembly areas?
Yes
No
3
Spill/Leak reporting procedures?
Yes
No
4
MSDS’s for all Hazardous materials are available?
Yes
No
5
Restrooms/Lunch Facilities/Storage facilities?
Yes
No
Work Area Isolation?
6
Including but not limited to safe routing and Placement of cords, hoses, equipment,
and tools
Yes
No
7
Welding/Cutting/Open flames? (Review Hot Work/Permit Procedures)
Yes
No
8
Hazardous tools to be used: (Power equipment, etc., Compressed gas
cylinders? Describe:
Yes
No
9
Personal protective equipment needed to enter work area?
Yes
No
10
Work in confined space(s) (Program review required)?
Yes
No
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Office of Environmental Health & Safety
CONTRACTOR SAFETY CHECKLIST & ORIENTATION
11
Lock out/tag out? (Program review required)?
Yes
No
12
Demolition Activities?
Yes
No
13
Work area/activities requiring Fall Protection?
Yes
No
14
Heavy lifting/Hoisting/Rigging?
Yes
No
15
Work on electrical systems/equipment?
Yes
No
16
Removal of excess materials/wastes (hazardous or otherwise)?
Yes
No
17
Clearance or check in with IT required?
Yes
No
18
Ladder(s)/Platform(s)/staging/Lift(s) to be used?
Yes
No
19
Work effecting fire detection/suppression equipment (alarms/sprinklers/
fire pump)?
Yes
No
Yes
No
Note: Coordinate as appropriate with Needham Fire Department & Facilities
Services.
20
Interruption of emergency equipment use/accessibility?
(Eyewashes/showers, Exhaust ventilation, Phone service, Egress routes)
21
Describe potential impacts & accommodations (noise, dust, odors, etc.) associated with the project/work:
SIGNATURES
The undersigned have reviewed & participated in the contractor safety checklist and orientation concerning hazards
in the facilities in which work is to be performed. The opportunity to review Material Safety Data Sheets (MSDS’s)
for hazardous materials in work areas has been provided. MSDS’s for materials associated with the work will be
made available on site and have been discussed.
The scope and schedule of services to be performed have been reviewed and discussed to minimize the potential for
accidents, injuries, impacts to the environment, and workplace disruptions & interruptions.
Individuals below have received & reviewed information regarding the location of emergency safety equipment as
well as the procedures to follow in the event of an emergency evacuation.
i
Name
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Signature
Employer
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Office of Environmental Health & Safety
Name
i
Signature
Employer
Add additional sheet(s) as necessary
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