Safety Checklist - DOC

							       Mn/DOT Pre-Construction Meeting
              Safety Checklist
S.P. # ___________________                          T.H. # ___________________


    Minnesota Department of Transportation Standard Specifications For
     Construction (1706 Employee Health & Welfare) The Contractor shall
     be responsible to comply with all applicable State, Federal, and local
     safety and health codes and regulations.

    The contractor is responsible to ensure all contractor’s sub-contractors
     and suppliers comply with 1706 Employee Health & Welfare.

    Provide documentation for A Workplace Accident Injury Reduction
     (AWAIR) Act program, which requires a written safety, and health
     program.

    Emergency phone numbers and procedures shall be posted on site.

    Supply the following for the Project record.

     General contractor’s Safety Director’s name and phone number –

     ______________________________ Phone # ____________________

     General contractor’s on-site safety representative’s name/title/phone # -

     ______________________________ Title: _______________________

     Cell Phone Number: _________________________________________
     If applicable

     General Contractor’s Insurance Company name and phone number –

     ______________________________ Phone # _____________________
    Does your company hold periodic Safety Meetings on the project? How
     Often?
     ___________________________________________________________
     MnDOT requests that the contractor will involve/invite Mn/DOT personnel
     to participate in any project specific safety training such as mobile earth
     moving equipment safety training. In addition, we request that periodic or
     weekly Safety Meeting attendance rosters and minutes be submitted to
     the Project Engineer on a regular basis.


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 Identify what Personal Protective Equipment will be required at all times on
  this project. Check those that are required by the prime contractor.
      ____Hard Hat
      ____High Visibility Vest
      ____Eye Protection
      ____Foot Protection
      ____Other, specify____________________________________________
      Comments: _________________________________________________
      ___________________________________________________________


     Identify project specific safety measures that will be taken by the
      contractor during the different phases of the project construction related to
      hazards such as related to:

      ____Fall exposures over six (6) feet.
      ____Excavation protective measures.
      ____Mobile heavy earth moving equipment.
      ____Work zone traffic control.
      ____Confined space protective measures.
      ____Other,specify____________________________________________
      Comments:
      ___________________________________________________________
      ___________________________________________________________
      ___________________________________________________________
      ___________________________________________________________
      ___________________________________________________________
      ___________________________________________________________
      ___________________________________________________________
      ___________________________________________________________
      ___________________________________________________________
      ___________________________________________________________
      ___________________________________________________________

      Signed by:

      ________________________________                 Date: ________________
      Contractor’s Representative



      Revised 4/27/07 rjs




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