Pre-Project Safety Assessment Form

Revision Date: 05/26/2022 Page 1 of 5

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Pre-Project Hazard Assessment

Project:

Project Manager (PM):

Building:

General Contractor (GC):

Contractor responsible to communicate all hazard information to all workers at all sub-contract tiers.

No project work shall start without each of the permit items in hand.

Permitting

⎕ Building permit (attach to notes)

⎕ Owner hazardous materials (hazmat) survey

(attach to notes)

⎕ DEP demolition permit (AQ06) (attach to notes)

⎕ Cambridge/Boston Fire Department (C/BFD)

demolition permit (attach to notes)

Fall Protection

⎕ Ladders

⎕ Scaffolding

⎕ Roof Work

⎕ Other (add details to notes)

Notes:

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Hot Work

⎕ Permits - C/BFD Hot Work letter ⎕ Fire Watch (C/BFD/Contractor) (as required by C/BFD,

contractor minimum)

Notes:

Hazardous Materials

Hazardous Materials Identified? ⎕ Yes ⎕ No

Check all that apply:

⎕ Asbestos

⎕ Lead

⎕ Presumed-PCBs

⎕ Universal Waste

⎕ Soil

⎕ Laboratory space clean (chemical/radiation)

⎕ Report any new findings to Project Manager and EH&S

Notes:

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Cranes

⎕ Fill out/receive inspection reports, etc.

⎕ Other: Personal Lifts

⎕ Police Detail (C/BPD/HUPD)

⎕ C/BPD by contractor, HUPD by E&C

Notes:

Housekeeping

⎕ Dust Control HEPA Filters

⎕ Mopping

⎕ Lab Sink Protection

⎕ Fans

⎕ Noise Control Odor Control

⎕ Trash Removal/Pest

Mitigation

Notes:

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Electrical Safety

⎕ Lockout Tagout

⎕ GFCI

⎕ Temp Lighting

⎕ Cord Caps

⎕ No Live Work

Notes:

Other

⎕ Fire Alarm Shutdowns

⎕ Other Shutdowns

⎕ Confined Spaces (add

details to notes)

⎕ Excavation Safety

⎕ Proper Penetration Sealing

⎕ Sprinkler Shutdowns

⎕ Personal Protective

Equipment (PPE) required

⎕ Structural Modification (add

details to notes/PE review)

⎕ Injury/Incident Notification

⎕ Other (add details to notes)

Notes:

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Pre-Project Review Meeting Attendees and Distribution

Meeting Date:

Name

Signature

Date

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.

• Please circle attendee number to identify Competent Person.

• Hazard Note should include reference to hazard specific Competent Person.

• Contractor to manage ongoing safety communication as project conditions develop or change.