4X Industrial Safety Inspection

• Document No.

• Client / Site

  Select

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General

• Project / Site Name

• Supervisor / Foreman at time of this inspection

• Select site weather conditions at time of this inspection (select all that apply)

  Select Clear Sky Cloudy Raining Windy Hazy Snow / Hail OTHER

  • Clear Sky
  • Cloudy
  • Raining
  • Windy
  • Hazy
  • Snow / Hail
  • OTHER

• Describe weather conditions on site today

• Minimum temperature today?

• Maximum temperature today?

• Current activities being undertaken on site (select all that apply)

  Select Excavation Open Flame Hot Work IHE De-Energize/Re-Energize Lifting and Rigging Working at Heights Confined Space Entry OTHER

  • Excavation
  • Open Flame Hot Work
  • IHE De-Energize/Re-Energize
  • Lifting and Rigging
  • Working at Heights
  • Confined Space Entry
  • OTHER

• Describe activities being undertaken on site

Site Safety Inspection

First Aid Facilities 1910.266(d)(2)(iv)

• Are first aid facilities to be inspected in this audit?

  Yes

  No

  N/A

• Are first aid kits and contents clean and stocked? 1910.266(d)(2)(iv)

  Yes

  No

  N/A

• No first aid contents past their expiration date?

  Compliant

  Non-Compliant

  N/A

• Is there easy access to first aid kits?

  Yes

  No

  N/A

• Employees aware of location of first aid kit?

  Yes

  No

  N/A

• Are the Certified First-Aid/CPR employees listed or known? 1910.151(b)

  Yes

  No

  N/A

• Are emergency numbers displayed?

  Yes

  No

  N/A

Fire Prevention & Emergency Response 1910.157 & 1910.38

• Are fire and emergency procedures to be inspected in this audit?

  Yes

  No

  N/A

• Evacuation plan understood by all employees?

  Yes

  No

  N/A

• Evacuation procedures discussed regularly?

  Yes

  No

  N/A

• Extinguishers in place, clearly marked for type of fire?

  Yes

  No

  N/A

• Extinguishers recently serviced? (check punch mark on tabs)

  Yes

  No

  N/A

• Extinguishers clear of obstructions?

  Yes

  No

  N/A

Site Security

• Is site security to be inspected in this audit?

  Yes

  No

  N/A

• Are site entry and exit points clearly designated?

  Yes

  No

  N/A

• Is clear signage requiring visitors to check in posted?

  Yes

  No

  N/A

• Is site perimeter fenced off appropriately with required site public signage posted?

  Yes

  No

  N/A

• If applicable, are site alarm systems functioning as expected?

  Yes

  No

  N/A

Personal Protective Equipment (PPE) 1910.132

• Is Personal Protective Equipment to be inspected in this audit?

  Yes

  No

  N/A

• Is head protection worn correctly and where required? 1910.135(a)(1)

  Yes

  No

  N/A

• Is eye protection worn where required? 1910.133(a)(1)(2)(3)(4)(5)

  Yes

  No

  N/A

• Are the correct forms of eye protection worn for tasks being completed?

  Yes

  No

  N/A

• Is hearing protection worn in designated areas? 1910.95(i)(1)

  Yes

  No

  N/A

• Are the correct forms of hand protection worn for manual tasks? 1910.138(a)

  Yes

  No

  N/A

• Is respiratory protection worn where dust, mist or fumes are present? 1910.134

  Yes

  No

  N/A

• Is footwear in good condition and of correct type? 1910.136<br>

  Yes

  No

  N/A

• Are high-vis vests or clothing worn at all times outside of equipment? MUTCD-FHWA (Section 6E.02

  Yes

  No

  N/A

• Is additional PPE used where required?

  Yes

  No

  N/A

• Are employees aware of correct PPE for tasks they are trained to perform?

  Yes

  No

  N/A

Critical Tasks

• Are there Critical Task being performed?

  Yes

  No

  N/A

• Select Critical Task.

  Select Excavation Open Flame Hot Work IHE De-Energize/Re-Energize Lifting and Rigging Working at Heights Confined Space Entry OTHER

  • Excavation
  • Open Flame Hot Work
  • IHE De-Energize/Re-Energize
  • Lifting and Rigging
  • Working at Heights
  • Confined Space Entry
  • OTHER

• Underground utilities are visibly marked and locates on site?

  Yes

  No

  N/A

• Excavation equipment maintains minimum clearances from overhead obstructions and leading edges?

  Yes

  No

  N/A

• Excavation deeper than 1.2 meters (4 feet) have access and egress?

  Yes

  No

  N/A

• Hot work has been evaluated for Isolation of Hazardous Energy (IHE) requirements?

  Yes

  No

  N/A

• Is the atmosphere within limits for entry? Oxygen: 19.5% - 23.5%, LEL: <10%, H2S: < 5 ppm, Other gas: None

  Yes

  No

  N/A

• All combustible materials removed, covered, or drenched?

  Yes

  No

  N/A

• Firefighting equipment has been inspected and is at hot work site?

  Yes

  No

  N/A

• Heat, slag, or sparks contained?

  Yes

  No

  N/A

• Dedicated Fire Watch in place?

  Yes

  No

  N/A

• Are isolation points identified per plan?

  Yes

  No

  N/A

• Are isolation points locked, tagged, and are keys controlled by authorized personnel or supervisor?

  Yes

  No

  N/A

• Equipment operator and rigger qualified to do the lifting and rigging task?

  Yes

  No

  N/A

• Load is within the range of the equipment's safe working limit?

  Yes

  No

  N/A

• Lifting and rigging equipment is certified, inspected, and rated for the task?

  Yes

  No

  N/A

• Plan is in place to prevent and mitigate: Load shifts, Dropped objects, Load path obstructions, Overhead obstructions, or Working under suspended loads?

  Yes

  No

  N/A

• Fall protection equipment is certified, inspected, and rated for the task?

  Yes

  No

  N/A

• Fall protection equipment is adjusted to fit the worker?

  Yes

  No

  N/A

• Worker tied off 100% of the time to approved anchorage point(s)?

  Yes

  No

  N/A

• Rescue plan has been reviewed with work crew and rescue equipment is available?

  Yes

  No

  N/A

• The atmosphere is within allowed limits for entry? O2: 19.5% - 23.5%, LEL: <10%, H2S: <5 PPM, Other Gas: 0%/PPM

  Yes

  No

  N/A

• Gas testing frequency has been established?

  Yes

  No

  N/A

• Entry watch has been assigned and communication plan agreed to?

  Yes

  No

  N/A

• Entrants are wearing rescue equipment required in rescue plan?

  Yes

  No

  N/A

• What is the hazardous action taking place?

  Yes

  No

  N/A

• Are mitigation tactics in place to prevent injusry?

  Yes

  No

  N/A

Housekeeping

• Is site housekeeping to be inspected in this audit?

  Yes

  No

  N/A

• Are all walking-working surfaces well maintained? 1910.22(a)

  Yes

  No

  N/A

Trip and Fall Safety

• Trip and fall safety to be inspected in this audit?

  Yes

  No

  N/A

• Are floor surfaces even and uncluttered?

  Yes

  No

  N/A

• Are entry and walkways kept clear?

  Yes

  No

  N/A

• Are stairs and risers kept clear?

  Yes

  No

  N/A

• Are appropriate measures in place to prevent falls? ie. barriers (preferred) or harnesses? 1910.140

  Yes

  No

  N/A

• Is all fall protection equipment visually inspected prior to use? 1910.140(c)(18)

  Yes

  No

  N/A

• Is all work above 4 Ft., or within 2 FT. of an edge being done safely? 1910.28(b)(6)(ii)

  Yes

  No

  N/A

• Are all floor openings fully barricaded or are protected with a secured cover and labelled?

  Yes

  No

  N/A

• Are personnel below protected from falling materials (i.e. tools, bolts, etc.)? 1926.759

  Yes

  No

  N/A

Hand and Power Tools 1910.242

• Hand and power tools to be inspected in this audit?

  Yes

  No

  N/A

• Are all tool guards in place and operable?

  Yes

  No

  N/A

• Are power cords in good condition?

  Yes

  No

  N/A

• Are all tools double insulated or have a ground plug?

  Yes

  No

  N/A

• Are ground fault circuit interrupters in place at the source of electricity?

  Yes

  No

  N/A

• Are all power tools in good condition?

  Yes

  No

  N/A

• Are defective pieces of equipment and tools red tagged and removed from service?

  Yes

  No

  N/A

• Are tools stored correctly and in the right place when not in use?

  Yes

  No

  N/A

• Are employees using the proper tool for the task they are performing?

  Yes

  No

  N/A

• Are hand tools manufactured to standard?

  Yes

  No

  N/A

• Are employees using two hand on tools that are designed to do so?

  Yes

  No

  N/A

Ladders 1910.23

• Ladders to be inspected in this audit?

  Yes

  No

  N/A

• Are all ladders Industrial strength? (Non Household rated, check label.)

  Yes

  No

  N/A

• Are ladders in good condition?

  Yes

  No

  N/A

• If used for electrical work are ladders non conductive? (wood or fibre glass.)

  Yes

  No

  N/A

• Are ladders being used according to instructions?

  Yes

  No

  N/A

• For extension ladders: are ropes, pulleys and treads in a good state of repair?

  Yes

  No

  N/A

• Are ladders not used to access heights when higher order controls should be used?

  Yes

  No

  N/A

Hazard Communication 1910.1200

• Chemical safety to be inspected this audit?

  Yes

  No

  N/A

• Have risk assessments been completed for hazardous substances?

  Yes

  No

  N/A

• Are Safety Data Sheets available for all chemicals?

  Yes

  No

  N/A

• Are all containers labelled correctly?

  Yes

  No

  N/A

• Are unused substances disposed of?

  Yes

  No

  N/A

• If applicable are special storage conditions followed?

  Yes

  No

  N/A

• Are workers trained in the use of hazardous substances?

  Yes

  No

  N/A

• Is adequate ventilation provided?

  Yes

  No

  N/A

• Are eye washes and showers available and easily accessible?

  Yes

  No

  N/A

• Are spill kits or other clean up arrangements available?

  Yes

  No

  N/A

Incident, Injury & Accident Procedures

• Incident, Injury & Accident Procedures to be inspected this audit?

  Yes

  No

  N/A

• Are Incident, Accident, Near Miss and Injury procedures in place?

  Yes

  No

  N/A

• Are adequate reporting forms for for these events in place?

  Yes

  No

  N/A

• Are Corrective Actions then implemented?

  Yes

  No

  N/A

• Is AXIOM Medical number available?

  Yes

  No

  N/A

General Comments

• Any further comments or recommendations arising from this inspection?

• Add any additional relevant photos

  Media

• Have all required corrective actions been added as Actions to this inspection?

  Yes

  No

  N/A

• Please add any corrective actions to the appropriate questions above before completing this report

Sign Off

• Name & Signature of Inspector

  Sign

• Name & Signature of Site Supervisor / Foreman

  Sign