ACI Asphalt Jobsite Safety Inspection

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Safety Basics

• 1.1. MSDS (SDS) available on site for chemicals in use

  Safe

  At Risk

  N/A

• 1.2. First-aid kit is readily available and properly supplied

  Safe

  At Risk

  N/A

• 1.3. Fire extinguisher is readily accessible and in operating condition

  Safe

  At Risk

  N/A

• 1.4 Utilities Marked/Identified

  Safe

  At Risk

  N/A

• Yes

  No

  N/A

2. Personal Protective Equipment

• 2.1 High Visibility Vests are in Use & Clean

  Safe

  At Risk

  N/A

• 2.2 Hearing Protection is in Use During High Noise Operations

  Safe

  At Risk

  N/A

• 2.3 Safety Glasses are in Use

  Safe

  At Risk

  N/A

• 2.4 Hard Hats are Being Worn When Needed

  Safe

  At Risk

  N/A

• 2.5 Gloves are used for Required Tasks When Needed

  Safe

  At Risk

  N/A

• 2.6 Proper footwear is Being Worn

  Safe

  At Risk

  N/A

• 2.7 Filtering Facepieces are available during Dusty Operations (Saw-cutting or Routing)

  Safe

  At Risk

  N/A

3. DOT Compliance

• 3.1 Drivers have their driver's license and current medical exam card

  Safe

  At Risk

  N/A

• 3.2Driver's have completed their DVIR (Daily Inspection)

  Safe

  At Risk

  N/A

• 3.3 There are no apparent vehicle defects (Lights, Tires, Brakes, Load)

  Safe

  At Risk

  N/A

• 3.4 Equipment is being transported using proper Load Securement

  Safe

  At Risk

  N/A

4. Manual Tasks

• 4.1. Safe Lifting & Safe Materials Handling

  Safe

  At Risk

  N/A

• 4.2. Lockout/Tagout - Blocking/Chocking In Use during Equipment Repairs

  Safe

  At Risk

  N/A

• 5.1. Unsafe storage of chemicals?

  Safe

  At Risk

  N/A

• 5.2 Safety Data Sheets not accessible on site?

  Safe

  At Risk

  N/A

5. Equipment Operations

• 5.1 All Equipment is Operating Properly

  Safe

  At Risk

  N/A

• 5.2 Guards are in Place

  Safe

  At Risk

  N/A

• 5.3 Back-up Alarms are Working

  Safe

  At Risk

  N/A

• 5.4 Seat Belts are in Use

  Safe

  At Risk

  N/A

• 5.5 No Cell Phones In Use During Operation

  Safe

  At Risk

  N/A

• 5.6 Three (3) Points of Contact Use for Entering / Exiting Equipment

  Safe

  At Risk

  N/A

• 5.7 Backup Alarms are Operational

  Safe

  At Risk

  N/A

• 5.8 Leaks, Tires, Greased, Lights, Fluids, Filters in Good Condition

  Safe

  At Risk

  N/A

6. Traffic Management

• 6.1 Lack of, or inadequate Traffic Control Measures?

  Safe

  At Risk

  N/A

• 6.2 Inadequate controls for public safety? (physical barriers, bollards, speed limits, flashing lights, spotters, etc)

  Safe

  At Risk

  N/A

• 6.3 Trained Flaggers with Proper Equipment Available If Needed

  Safe

  At Risk

  N/A

• 7.1. Lack of, or inadequate PPE (including sun protection)

  Safe

  At Risk

  N/A

• 7.2. Lack of system to issue, inspect, replace and monitor PPE?

  Safe

  At Risk

  N/A

• 7.3. Lack of training in safe use, clean-up and inspection of PPE?

  Safe

  At Risk

  N/A

Rating System

• Provide a rating in the comment section selected from A, B, C, D, or F

  Safe

  At Risk

  N/A

Sign Off

• On site representative

  Sign

• Auditor's signature

  Sign