20.4a Elevator Service Site Safety Audit

• Job Name / Number

• Conducted on

  Date

• Audit Performed By

• Location Address
  Address

• Forman/Mechanic-in-Charge

• Work being performed

The intent of this survey is to create a safe work place for your employees. If a hazard is found, mark it as "At Risk" and note the remediation in the comments section. Also, document the violation by photograph and insert into this survey. Be sure to inform the building owner of any safety issues involving his building. Forward a copy of this survey to FQA (Ivan Andrews) and to your local Safety committee chairman.

• If you understand these instructions mark "yes" and begin the survey.

  Yes

  No

  N/A

Property Work Areas

• Is the work area lighting adequate?

  Yes

  No

  N/A

• Is the work area clean, free of unnecessary tripping hazards?

  Yes

  No

  N/A

• Is there safe access to all machines and equipment?

  Yes

  No

  N/A

• Are disconnects clearly marked and able to be locked out if required?

  Yes

  No

  N/A

• Lockout/Tagout Accessible?

  Yes

  No

  N/A

• Are barricades being used?

  Yes

  No

  N/A

• Are barricades clean and in proper working order?

  Yes

  No

  N/A

• Are machines and equipment properly grounded?

  Yes

  No

  N/A

• Are all guards to machines in place?

  Yes

  No

  N/A

• Are machine room doors self-closing?

  Yes

  No

  N/A

• Are work area floors clean from grease and oil?

  Yes

  No

  N/A

• Are all lubricants and flammable liquids clearly marked and safely stored?

  Yes

  No

  N/A

• Are used rags, oil, cleaners, and paints properly disposed of?

  Yes

  No

  N/A

• Hazardous material containment area clean and records meet required standards?

  Yes

  No

  N/A

• Are MSDS sheets available for reference?

  Yes

  No

  N/A

• IIPP Manual and MSDS sheets up to date?

  Yes

  No

  N/A

• Has the Owner/Property Manager created any hazards?

  Yes

  No

  N/A

Employee

• Does Employee(s) have company issued safety bag?

  Yes

  No

  N/A

• Does safety bag contain company issued safety devices (e.g. hard hat, fall protection, eye protection, hearing protection)?

  Yes

  No

  N/A

• Is Employee wearing eye protection when required?

  Yes

  No

  N/A

• Is Employee wearing gloves when required?

  Yes

  No

  N/A

• Is Employee wearing appropriate work shoes?

  Yes

  No

  N/A

• Is Employee wearing Company issued shirt?

  Yes

  No

  N/A

• Are Employee tools in good condition?

  Yes

  No

  N/A

• Are assigned power tools and cords in good condition?

  Yes

  No

  N/A

Additional Job Specific Notes

• Enter any additional comments here