SITE-SPECIFIC SAFETY PROGRAM (SSSP) Project Name and Number General Client: Date Prepared: Project: Site Address: Project Description Project Start/End Dates Project Location General Scope of Work, Project Description, Identification of Stakeholders Logical Sequence of Work Schedule Proposed Start Date: Duration: Working Hours: Overtime Hours: Access to Work Area Description of parking, entrances, and other work areas. Include any restrictions, areas prohibited, etc. Project Support Features, Site Control, and Logistics Check all of the following facilities and equipment that are required for safe completion of work. Facility/Equipment Description, Locations, Quantity ☐ Project Office ☐ Materials Receiving Location ☐ Portable Restrooms/Wash Stations ☐ Supplementary Illumination ☐ Emergency Eyewash/Shower ☐ First Aid Supplies ☐ Fire Extinguishers ☐ Hazardous Material Storage ☐ Spill Containment/Clean-up ☐ Other: [Enter Type] Purpose of the SSSP Safety Responsibilities All persons will: All project managers will ensure: All subcontractors shall: Incident reporting: Hazard Communication SDS Location: Method of Notifying Employees: Site Control/Logistics Task/location Specify task-specific site control/access control measures below Toolbox Talks, Meetings, and Observations Toolbox talk location, time, frequency: Who will conduct observations and supervisor walks? Frequency of supervisor walks and project management safety walks? First Aid, Emergency, and Treatment Arrangements Trained Person First Aid Kit Location Additional Information Clinics/Urgent Care Facilities Identified for This Project (Add more lines if needed) Emergency Medical Facilities Identified for This Project General Scopes of Work (Examples) Identify the hazards in the next section (e.g., mobilization, excavations, concrete, structural steel erection, dry-walling, electrical install, painting, roofing, landscaping). General Scope of Tasks to Be Performed on This Project Mobilization Site clearing Installation of underground utilities The unloading of any and all materials associated with this project Heavy machinery operation, including cranes Aggregate pile installation Excavating Concrete form work, rebar installation, and embed placement Concrete placement Erecting structural steel and miscellaneous metals Anticipated Start Date Welding, cutting, fitting, and grinding of steel as required Installation of cold formed metal framing Installation of roofing, gutters, and exterior concrete and masonry wall and soffit panels Installation of windows and curtain wall Elevated work, including scaffolding, boom lifts, and scissor lifts Installation of all electrical components, equipment, and appurtenances Installation of all mechanical and plumbing Masonry work Installation of interior finishes, including installation, sheet rock, paint, flooring, and millwork Grading of site Installation of site paving, sidewalks Installation of landscaping Subcontractor Required Training/Qualifications Identify the activities involved on your project that have OSHA-required training. Yes No ☐ ☐ Asbestos activities ☐ ☐ Aerial life operation ☐ ☐ Crane operation ☐ ☐ Confined space entry ☐ ☐ Electrical work requiring NFPA 70E provisions ☐ ☐ Electrical work requiring CPR-trained second worker ☐ ☐ Excavation ☐ ☐ Fall protection equipment ☐ ☐ Forklift operation/powered industrial truck use ☐ ☐ Heavy equipment operation ☐ ☐ Ladder use ☐ ☐ Lock-out/tag-out ☐ ☐ Noisy operations requiring hearing conservation training ☐ ☐ Scaffolding erection use ☐ ☐ Respirator use ☐ ☐ Powdered actuated tool (PAT) Required Site-Specific Training ☐ ☐ SSSP Orientation ☐ ☐ Hazard Communication Task # Enter Hazard/Activity With Specific Based Control Measures Subcontractor-Specific Hazard Controls Identification Competent Person Required? Standard Number Permit Required Y/N Copy of Subcontractor SSSP Attached Y/N Competent Persons Identify the activities in which a designated and documented competent person according to OSHA standards will be assigned. Add more rows if needed. Activity Standard Pre-Hazard Assessment Task Hazard PPE Required 
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