1 Source Safety and Health Observations Report

• Audit Title

• Client

• Jobsite Name

• Location
  Address

• Select date

  Date

• Superintendent

• Safety Representative

• Audit Conducted By

Jobsite Office

• Safety Manual & HazCom Program

  Yes

  No

  N/A

• Subcontractors' Safety Manual & HazCom Program

  Yes

  No

  N/A

• Fire Extinguisher

  Yes

  No

  N/A

• First Aid & Bloodborne Pathogens Kit

  Yes

  No

  N/A

• OSHA Posters

  Yes

  No

  N/A

• OSHA 300 Log (Feb-April)

  Yes

  No

  N/A

• Visitor PPE Available

  Yes

  No

  N/A

Program Administration

• Emergency Action Plan

  Yes

  No

  N/A

• Emergency Procedures

  Select EVAC Route Notifications/Communications Rally Points Posted Conspicuously

  • EVAC Route
  • Notifications/Communications
  • Rally Points
  • Posted Conspicuously

• Emergency Numbers & Locations

  Select Occupational Health Clinic Hospital ER Police/Fire/Ambulance

  • Occupational Health Clinic
  • Hospital ER
  • Police/Fire/Ambulance

• Safety Meetings

  Select Tool Box Talks New Hire Orientation Site Safety Meetings

  • Tool Box Talks
  • New Hire Orientation
  • Site Safety Meetings

• Safety Audits Completed

  Yes

  No

  N/A

• Pre-Task Hazard Assessments Conducted

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Aerial Lifts

• Daily Inspections

  Yes

  No

  N/A

• Operator Certification

  Yes

  No

  N/A

• Proper Fall Protection

  Yes

  No

  N/A

• Chain Latched / Gate Closed

  Yes

  No

  N/A

• Platform Free of Debris

  Yes

  No

  N/A

• Feet Firmly on Platform

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Barricades

• Setup, Maintained & Removed (end of work)

  Yes

  No

  N/A

• Signage In Place

  Yes

  No

  N/A

• Roadways, Sidewalks, & Stairs Protected

  Yes

  No

  N/A

• Traffic Controls in Place

  Yes

  No

  N/A

• Floor & Wall Openings

  Yes

  No

  N/A

• Unattended Trenches & Excavations

  Yes

  No

  N/A

• Special Hazards Work Protected

  Yes

  No

  N/A

• Other

  Safe

  At Risk

  N/A

Demolition

• Written Plan In Place

  Yes

  No

  N/A

• Emergency Egress Maintained

  Yes

  No

  N/A

• Dust & Falling Debris Control

  Yes

  No

  N/A

• Adjacent Structures Shored or Guarded

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Electrical & Utilities

• Live Electrical Panels Labeled "HOT"

  Yes

  No

  N/A

• Energized Parts Protected

  Yes

  No

  N/A

• GFCI Protection Utilized at Power Source

  Yes

  No

  N/A

• LO/TO Procedures Utilized

  Yes

  No

  N/A

• Insulation and Prongs Intact

  Yes

  No

  N/A

• Extension Cords Out of Walkways / Suspended by Non-Conductive Material

  Yes

  No

  N/A

• Temporary Lighting Guarded & All Bulbs in Place

  Yes

  No

  N/A

• Temporary Lighting Suspended by Mounting Point on Cage with Non-Conductive Material

  Yes

  No

  N/A

• Adequate Lighting Provided

  Yes

  No

  N/A

• Safely Working Around Power Lines

  Yes

  No

  N/A

• Underground Utilities Marked

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Fall Protection

• Fall Protection Plan in Place (Precast/Residential)

  Yes

  No

  N/A

• 100% PFAS Utilized

  Yes

  No

  N/A

• PFAS in Good Working Condition

  Yes

  No

  N/A

• Sufficient Anchorage Points

  Yes

  No

  N/A

• Fall Protection Methods in Accordance to Roof Pitch

  Yes

  No

  N/A

• Leading Edges Protected

  Yes

  No

  N/A

• Guardrails Constructed Properly

  Yes

  No

  N/A

• Perimeter Cable Installed in Compliance & Flagged Every 6'

  Yes

  No

  N/A

• Warning Lines Properly Installed

  Yes

  No

  N/A

• Floor Holes Covered, Marked & Secured

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Fire Prevention/Protection

• Fire Extinguishers Every 3,000 sq.ft, within 50 ft. Horizontally, Locaded in Stairways

  Yes

  No

  N/A

• Fire Extinguisher Readily Available for Hot Work Operations

  Yes

  No

  N/A

• Fire Extinguishers Inspected Annually & Monthly

  Yes

  No

  N/A

• Sprinkler System Live

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Hand & Power Tools

• Proper Tool for the Job

  Yes

  No

  N/A

• Tools in Good Operating Condition

  Yes

  No

  N/A

• Mechanical Guards in Place

  Yes

  No

  N/A

• Tools Inspected Prior to Use

  Yes

  No

  N/A

• Manufacturer's Recommended PPE In Use

  Yes

  No

  N/A

• Cords in Good Condition

  Yes

  No

  N/A

• Tools Properly Stored

  Yes

  No

  N/A

• Air Compressors have Pressure Reducing Device

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Housekeeping & Sanitation

• Site Free of Slip, Trip, Fall Fall Hazards

  Yes

  No

  N/A

• Trash in Containers

  Yes

  No

  N/A

• Aisle, Stairs and Passageways Clear

  Yes

  No

  N/A

• Enclosed Chute Used for Drops > 20'

  Yes

  No

  N/A

• 1 Toilet Per 10 Employees. Sanitation Station Available.

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Ladders & Stairways

• Correct Ladder and Properly Used for the Task

  Yes

  No

  N/A

• Ladders in Good Condition

  Yes

  No

  N/A

• Extension Ladders Extend at Least 36' Above the Upper Landing

  Yes

  No

  N/A

• Secured and at a 4:1 Pitch

  Yes

  No

  N/A

• Spreader Bars Fully Open

  Yes

  No

  N/A

• Steps or Ramps at Elevation Breaks >19"

  Yes

  No

  N/A

• Rails at Stairs and Landings with 4 or More Risers or 30" High

  Yes

  No

  N/A

• Risers are Uniform Height

  Yes

  No

  N/A

• Platforms Extend at Least 20" Past Door Swing Radius

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Material Storage

• 10' From Exterior & 6' From Interior Leading Edges

  Yes

  No

  N/A

• Material Stacked to Prevent Sliding, Falling, or Collapse

  Yes

  No

  N/A

• Materials No Closer than 3' of Live Electrical Equipment

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Personal Protective Equipment

• Hard Hats - Overhead Hazard

  Yes

  No

  N/A

• Safety Glasses - Task Specific

  Yes

  No

  N/A

• Faceshield - Task Specific

  Yes

  No

  N/A

• Work Boots Worn

  Yes

  No

  N/A

• Gloves Worn - Different Types Available Per Task

  Yes

  No

  N/A

• Hearing Protection Available/Utilized

  Yes

  No

  N/A

• High Visibility Clothing

  Yes

  No

  N/A

• Respirators or Dust Masks Utilized

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Scaffolds

• Competent Supervision: Erecting, Altering, & Dismantling

  Yes

  No

  N/A

• Scaffold Tagging Procedure Utilized

  Yes

  No

  N/A

• All Parts is Good Condition

  Yes

  No

  N/A

• Locking Wheels, Base Plates or Mud Sills Provided

  Yes

  No

  N/A

• Plumb & Square with all Bracing

  Yes

  No

  N/A

• Toprails & Midrails in Adequate and Ends Protected

  Yes

  No

  N/A

• Working Deck Complete & Correctly Erected

  Yes

  No

  N/A

• Plank Cracks/ Splits No Longer than the Width

  Yes

  No

  N/A

• Working Areas Free of Debris, Snow & Ice

  Yes

  No

  N/A

• Falling Object Protection Provided

  Yes

  No

  N/A

• Proper Access to Platforms

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Training

• Did Contractors receive safety/health/environmental orientation?

  Yes

  No

  N/A

• Workers know how to report an incident?

  Yes

  No

  N/A

Additional Contractor Notes

• #1 Other

  Yes

  No

  N/A

• #2 Other

  Yes

  No

  N/A

• #3 Other

  Yes

  No

  N/A

Additional Subcontractor Notes

• #1 Other

  Yes

  No

  N/A

• #2 Other

  Yes

  No

  N/A

• #3 Other

  Yes

  No

  N/A

• Inspection Reviewed With

  Sign

• Audit Completion

  Date