Acorn Industrial Safety and Risk Assessment

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Previous Inspection

• Previous Inspection reviewed by PM and Project Superintendent

  Yes

  No

  N/A

• Any Corrective Actions still open

  Yes

  No

  N/A

Pre-Work

• Job Safety Analysis (JSA) completed, understood and signed by each employee in assigned work area?

  Yes

  No

  N/A

• JSA posted in conspicuous place at task area?

  Yes

  No

  N/A

• MSDS Sheets obtained, reviewed and understood?

  Yes

  No

  N/A

• All required permits obtained and signed off?

  Yes

  No

  N/A

• Lock Out / Tag Out needed / completed for work to be performed?

  Yes

  No

  N/A

Personal Protective Equipment (PPE)

• Hard Hats worn by all employees

  Safe

  At Risk

  N/A

• Face Shields: Grinding / Overhead Drilling / Splash Hazards etc.

  Safe

  At Risk

  N/A

• Appropriate gloves for task(s)

  Safe

  At Risk

  N/A

• Safety Glasses - No shaded / tinted glasses indoors.

  Safe

  At Risk

  N/A

• Hearing Protection

  Safe

  At Risk

  N/A

• Appropriate work boots

  Safe

  At Risk

  N/A

• Reflective Vest or High Visibility Clothing

  Safe

  At Risk

  N/A

Fall Protection

• Fall Exposures greater than 6 feet

  Safe

  At Risk

  N/A

• Personal Fall Arrest System properly worn / inspected

  Safe

  At Risk

  N/A

• Floor openings greater than 2 inches in diameter protected with appropriate cover, secured and labeled "HOLE"

  Safe

  At Risk

  N/A

• Guardrail System in place, inspected and installed correctly

  Safe

  At Risk

  N/A

• Leading edge protected, controlled access zone set up 6 feet from edge, warning markers clearly visible and "FALL PROTECTION REQUIRED BEYOND THIS POINT" signage in place. Monitor with sign in / out log posted.

  Safe

  At Risk

  N/A

• Horizontal Life lines installed / used properly

  Safe

  At Risk

  N/A

• Wall openings guarded

  Safe

  At Risk

  N/A

Ladders and Scaffolding

• Ladder(s) in good condition, no accumulation of mud, oil, grease or other hazardous material

  Safe

  At Risk

  N/A

• Area at base of ladder(s) kept clear

  Safe

  At Risk

  N/A

• Extension Ladder(s) set up properly (4:1 ratio), secured (cleated, if need be and tied off), and if used as access to next level, extends 3 feet above platform or grab rails installed.

  Safe

  At Risk

  N/A

• Step ladder(s) used only in open, locked position

  Safe

  At Risk

  N/A

• Scaffold(s) complete

  Safe

  At Risk

  N/A

• Scaffold(s) inspected, current date and signed off by competent person

  Safe

  At Risk

  N/A

• Scaffold(s) in good repair, no damaged components or improper planking

  Safe

  At Risk

  N/A

• Access to scaffold(s) adequate

  Safe

  At Risk

  N/A

Housekeeping

• Material stacked and orderly

  Safe

  At Risk

  N/A

• Trash cans in work area(s), emptied daily or when full

  Safe

  At Risk

  N/A

• Debris removed

  Safe

  At Risk

  N/A

• Nails or other hazardous protrusions removed or hammered back to eliminate hazard(s)

  Safe

  At Risk

  N/A

• Cords, hoses, leads or other tripping hazards off the floor (7 feet up) or set up in such a way to not create a tripping hazard or damage cords

  Safe

  At Risk

  N/A

• Access / egress maintained.

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Hot Work / Welding / Cutting / Grinding

• Proper permits obtained, complete and signed off

  Safe

  At Risk

  N/A

• Fire extinguisher no more than 10 feet away from work area, inspected, properly charged and correct type

  Safe

  At Risk

  N/A

• Adjacent work protected

  Safe

  At Risk

  N/A

• Hard Hats with Welding Hoods and Safety Glasses

  Safe

  At Risk

  N/A

• Combustibles removed / protected

  Safe

  At Risk

  N/A

• Burning goggles

  Safe

  At Risk

  N/A

• Grinding: full face shield with safety glasses

  Safe

  At Risk

  N/A

• Adequate ventilation

  Safe

  At Risk

  N/A

• Proper gas storage / protected

  Safe

  At Risk

  N/A

• Equipment in good condition

  Safe

  At Risk

  N/A

Mobile Equipment

• Operator(s) certified / trained on particular equipment being used

  Safe

  At Risk

  N/A

• Equipment inspected

  Safe

  At Risk

  N/A

• Fall Protection / seat belts used properly

  Safe

  At Risk

  N/A

• Work area below barricaded

  Safe

  At Risk

  N/A

• Spotters used

  Safe

  At Risk

  N/A

• Other

  Safe

  At Risk

  N/A

Excavations

• Competent person on site

  Safe

  At Risk

  N/A

• Excavation Daily Report Complete

  Safe

  At Risk

  N/A

• Employee(s) trained

  Safe

  At Risk

  N/A

• Shored / sloped / benched properly based on soil type and condition

  Safe

  At Risk

  N/A

• Proper access / egress

  Safe

  At Risk

  N/A

• Ladder(s) within 25 feet of all exposed employees

  Yes

  No

  N/A

• Spoils piles and materials 2 feet back from top of excavation

  Safe

  At Risk

  N/A

• Excavation barricaded and signs posted

  Safe

  At Risk

  N/A

• Excavation illuminated if left open overnight in a pedestrian area

  Safe

  At Risk

  N/A

• Excavation atmosphere tested? Results:

  Safe

  At Risk

  N/A

Electrical

• Cords inspected and properly color coded for month

  Safe

  At Risk

  N/A

• GFCI(s) inspected and monthly record on file

  Safe

  At Risk

  N/A

• Cords routed to not create a trip hazard or 7 feet off ground

  Safe

  At Risk

  N/A

• Cords exposed to mobile equipment

  Safe

  At Risk

  N/A

• Cords hung by conductive materials such as nails, tie wire or welding rods

  Safe

  At Risk

  N/A

First Aid Facilities

• Are First Kit(s) / Cabinets clean and orderly and properly stocked

  Yes

  No

  N/A

• Contents expired

  Yes

  No

  N/A

• First Aid Kit(s) / Cabinets readily accessible

  Yes

  No

  N/A

• Are trained First Aid Personnel on site

  Yes

  No

  N/A

• Are emergency numbers / maps / locations displayed

  Yes

  No

  N/A

Work Environment

• Adequate amenities (toilets, break areas, etc)

  Safe

  At Risk

  N/A

• Proper ventilation

  Safe

  At Risk

  N/A

• Access / egress to work area adequate. (no change in elevation greater than 19", adequate exits)

  Yes

  No

  N/A

• Stairways / emergency exits clear

  Safe

  At Risk

  N/A

• Insufficient lighting

  Safe

  At Risk

  N/A

• Sound Level

  Safe

  At Risk

  N/A

Corrective Actions and Date(s) to complete by

Sign Off

• Inspection Performed By:

  Sign

• On Site Representative

  Sign