REPORT OF UNSAFE ACTS AND CONDITIONS Description

1 REPORT OF UNSAFE ACTS AND CONDITIONSD escriptionThe REPORT provides an easy way to record UNSAFE acts and CONDITIONS found on aconstruction site. Accompanying it are instructions and an example that describe andillustrate its use. Standardized descriptors describe site CONDITIONS , potential accident orinjury, number of people affected, seriousness, cause, source, recommended fix, andactual fix. Accident/injury descriptors coincide with nationally reported constructionaccident/injury classes. Standardized abbreviations provide a shorthand way to describeand classify observations. They are also useful for recording, analyzing, transmitting, andreporting data in a computer can use the REPORT including journeymen, foremen, superintendents, and projectmanagers; employed by anyone including prime contractors; subcontractors, owners,architects, and engineers; on any type of construction site.

2 It may be used by those withauthority over the work. Others may use it to describe UNSAFE acts and CONDITIONS andalert supervision of their existence. Recording the actual fix (or lack of fix) documentsactions taken to remove UNSAFE acts and file contains the following: REPORT of UNSAFE Acts and CONDITIONS Example of completed REPORT Instructions for Filling Out REPORT is part of the effort of the Safety Action Group of the Labor, Owner,Contractor Summit of Southeast Michigan. The authors welcome feedback (includingsamples) from users and suggestions for I. Carr, , of Civil EngineeringDepartment of Civil and Environmental Engineering2340 G.

3 G. BrownUniversity of MichiganAnn Arbor, MI 48109-2125(734) 764-9420 Fax: 764-4292 Email: A. HenryAssistant Executive Vice PresidentAssociated General Contractors of AmericaGreater Detroit Chapter, Northwestern Highway, Suite 150 Southfield, MI 48075-2579(248) 948-7000 Fax: 948-7008 Email: 1998 by R. I. Carr and F. A. Henry. The REPORT of UNSAFE Acts and CONDITIONS may befreely printed, copied, and of UNSAFE Acts and ConditionsProject:Company:By: Date:Dry/Wet/Snow/Ice: wiNdy/Calm: Temperature: of UNSAFE Act/Condition (weather, date) (how fixed)1234567891011121314151617181920 Comments:UAC 4/15 , <6'; Fall>6'; Slip/Trip; struck BY; struck AGainst; CAUGHT in/between; LIFTing; overEXERT; TOXic substances; SUFfocation; ELEC tric shock; eXplosion; FIRE; Vehicle injury; OTHerrough estimate1 to 5 (1= not serious, 5 = very serious)CaReLeSs; UNaware; SAFEty equipment.

4 Construction EQuipment; MATerial; inSTRuction; WoRKeRs; TIME; COST; iNconvenient; work SourceRecommended FixActual FixME; MY company; GC; CM; OWner; trade Contractor; Supplier; OTher (name); Unknown DO; STOP; RePLace; RePaiR; Obtain/add; inSTRuct; COMmunicate; Test/inspect; Guard; Mark/sign; reASsigN; MOVEFiXeD (identify);TeMPorary fix (identify); REPorted; ACCeptable condition; NOThing done Potential Accident or InjuryNumber of People AffectedSeriousnessCauseReport of UNSAFE Acts and ConditionsSAMPLES (shown in italics)Project: Towers BuildingCompany: BIGBy: J. DoeJ. Doe Date: Feb 8, 1999 Dry/Wet/Snow/Ice: D wiNdy/Calm: N Temperature.

5 30 of UNSAFE Act/Condition (weather, date) (how fixed)1ladder not tied off (tied off)F>6'252 CRLSGCDO FXD2delivery drivers don't wear hardhatsBY12 NSCOMNOT3unbraced formsBY54 UNCSTRNOT4unshielded arc weldingTOX202 NCDOREP5work in 10' unsupported trench (stopped work, got shield)SUF45 COSTCDOFXD6walking too close to trucks (need barricade) (sawhorses)V203 SAFEGCMTMP7unguarded roof openings 4'x4': 12 (cleared roof)F>6'124 CRLSCGTMP8uncovered rebar ends, vertical, 100AG204 NCGNOT9ice on stairs (D/C/35o, Feb 9, 99)S/T404 COSTGCDONOT10steel bands from boxes litter walkway (cleaned up) S/T202 INCDOFXD11paint spray and fumesTOX103 SAFECONOT122nd floor guard rail is broken (replaced rail)F>6'204 CRLSGCRPRFXD13trash is thrown off 2nd floor (well barricaded)BY103 CRLSCSTOPACC14151617181920 Comments.

6 (7) Need to get plywood to guard roof openings(2) Need better site check-in system so visitors/ vendors wear hard hats.(11) Painters say they will not wear 4/15 , Accident or InjuryNumber of People AffectedSeriousnessCauseSourceRecommende d FixActual FixME; MY company; GC; CM; OWner; trade Contractor; Supplier; OTher (name); Unknown DO; STOP; RePLace; RePaiR; Obtain/add; inSTRuct; COMmunicate; Test/inspect; Guard; Mark/sign; reASsigN; MOVEFiXeD (identify);TeMPorary fix (identify); REPorted; ACCeptable condition; NOThing done Fall<6'; Fall>6'; Slip/Trip; struck BY; struck AGainst; CAUGHT in/between; LIFTing; overEXERT; TOXic substances; SUFfocation; ELEC tric shock; eXplosion; FIRE; Vehicle injury.

7 OTHerrough estimate1 to 5 (1= not serious, 5 = very serious)CaReLeSs; UNaware; SAFEty equipment; construction EQuipment; MATerial; inSTRuction; WoRKeRs; TIME; COST; iNconvenient; work UAC 4/15 , HenryINSTRUCTIONS FOR FILLING OUT REPORT1. Who should use this REPORT : This REPORT may be used by any person on a jobsite, from a journeyman to aproject manager. It is an easy way to describe UNSAFE acts and CONDITIONS and alert supervision of their existence. Ifyou do not have authority to correct an UNSAFE act or condition, give this REPORT to someone who can takeappropriate Background Information: In the top left corner of the REPORT , enter the name of the project, the companyemploying you, your name, the date you made the REPORT , and weather CONDITIONS at the work area where theunsafe act/condition exists.

8 Dry = D, wiNdy = Describe the UNSAFE Act or Condition: In the rows 1 through 20, briefly describe UNSAFE acts or one UNSAFE act/condition per line. If you need additional space for an act/condition use more than one weather and/or date if different from Background Information. Actual fix can be described, in Fill in the Columns: On the right half of the form in the same row that you described the UNSAFE act/condition,give additional information about the act/condition by filling in each of the seven columns. Select from the optionsdescribed at the bottom of each column. Use the bold-faced letters in each option as the abbreviation for thatoption.

9 The columns ask you to identify a) the potential accident/injury, b) the number of people exposed to theact/condition, c) the seriousness of the potential injury/accident, d) the cause, e) the source, f) your recommendedfix, and g) the actual (a). Potential Accident or Injury: From the list at the bottom of this column, select the most likely accident orinjury that could result from the UNSAFE act/condition and mark its abbreviation in the column. The abbreviationconsists of the bold-faced letters. Fall less than 6 ft. = F<6; slip/trip = (b). Number of People Affected: Give a rough estimate of the number of persons who would be injured if theunsafe condition results in an (c).

10 Seriousness: On a scale of 5 (1 = not serious, 5 = very serious), how serious is the potential accident?4(d). Cause: From the list at the bottom of this column, select the most likely cause of the accident that couldresult from the UNSAFE act/condition, and mark its abbreviation in the column. CaReLeSs = (e). Source: From the list at the bottom of this column, select the person or company to whom you attributethe existence of the UNSAFE act or condition, and mark its abbreviation. Mark ME if you are the source ofthe UNSAFE act/condition. Your company = MY, general contractor = GC, construction manager = CM, architect= OT(arch), Mr.