Information
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Foreman
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Location (nearest town)
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Location (specific)
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Cooperative or Client
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Work being performed
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Conducted on
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Inspector name
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Audit Guidance: -All unsafe acts shall be stopped immediately. -Field Observations shall include photos for both safe and unsafe operations. Photos should be annotated with what the observer is focused on at the time of the audit. -Any item marked as a deficiency shall have a photo (if possible) and a detailed description. -All comments should identify those crew members performing the task correctly and/or incorrectly. -Equipment being inspected shall be listed and/or have a photo with the unit number displayed. -All audits shall be reviewed with the PIC prior to departure from the site. Corrective actions shall be assigned with due dates and noted on the audit. -Any audits being forwarded to the client shall be reviewed by more than one safety team member prior to being sent.
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All audit findings shall have an assigned weight (1-4) assigned per the below matrix. Document the weighted number rating in the comment section associated with the applicable question.
Communication
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When was the last time you were coached from a member of management on safety?
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Do we discuss the Likelihood of an incident or the consequences of an incident?
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Cell phone use by Supervision only?
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Proper use of hand signals and flagging techniques? Spotters used appropriately?
Procedures and Documents
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Tailboard/Job Hazard analysis completed?
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Weekly/Daily inspection sheets complete and up to date?
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Are SDS available for all hazardous chemicals on site ?
Displays and Labels
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Is the work site properly marked and/or barricaded? (open troughs, trenches, stationary objects, around cranes, spoil piles marked 10' from leading edge).
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One call complete and adequate?
Environmental
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Holes being left open overnight properly barricaded and covered?
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Spill kits available and stocked? Spill response understood and practiced? Spills reported?
Schedule
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fatigue management addressed?
Work Practices
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Proper pole control, experienced persons handling butt of poles?
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Drop Zones properly barricaded when aerial work is being performed?
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Truck grounds being barricaded?
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Proper Cover up and PPE being used?
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Are proper lifting/carrying techniques utilized?
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Are proper pushing/pulling techniques utilized?
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Are employees using 3 points of contact when ascending, descending, and climbing?
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Is employee mindful of line of fire and pinch points?
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Proper rigging, lifting, hand signals, and good communication being utilized?
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Is 3-part communication properly used ?
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Has circuit testing, tagging and proper use of grounds been performed properly?
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Animals, plants and insects mitigated?
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Have phasing sticks been used when jumpering multiple phases?
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Is the housekeeping good?
Work Planning
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Job Plan (does everyone know duties)?Have the job hazards been identified, prioritized, and documented?Work area clearly defined on JSA?Has an effective control/mitigation plan for identified hazards been developed?
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Severe weather contingency plan discussed and documented?
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Has the emergency plan been documented and understood? (evacuation plan in place)
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Is fall protection equipment in good condition and rescue plan in place?
Supervision
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Emphasis of schedule exceeding safe work?
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Supervision interfacing with workers?
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Supervision verifying the job hazard analysis/job plan is being followed?
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Crew lead demonstrated leadership ability?
Training/Qualification
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Crew Members qualified for task being performed?
Change Management
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JSA updated periodically and whenever work task changes? Scope changes time stamped?
External Influence
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Weather conditions discussed and documented?
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Heat/cold mitigation plan in use and documented?
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Public encrouchment on job site discussed and documented on JSA?
System/Equipment Operation
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Has the company dispatch been notified of LOTO for circuits being worked?
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Are fall protection and rubber PPE/Cover-up being stored properly?
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Are seat belts being used on applicable equipment while in operation?
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Are rubber goods and plastic cover up in date? Are they being inspected and replaced when rejected?
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All PPE in good order and utilized? hard hat, eye protection, hearing protection, vest, footwear, gloves, face shield, chaps etc.
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Cut resistant gloves utilized when stripping, cutting conduit or anytime sharp objects are present?
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Arc flash protection being utilized (correct class)?
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Are work boots ASTM F2413-11 compliant?
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If applicable, 100% fall protection being utilized?
Personnel and Materials Management
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Sufficient personnel assigned to task?
Equipment Selection and use
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Is all equipment set up for safe use (outriggers set up properly as applicable)?
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Are fire extinguishers on site, within date, and in good working order?
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Skinning and Stripping tools utilized and in good condition?
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Hot Sticks/Shotguns inspected and in good, working condition?
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Hot Sticks/shotguns inspected and in good condition?
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Are grounds cleaned and inspected before use?
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Slings, rigging and kellum grips being inspected daily and rejected when needed?
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Chocks and cones being used?
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Hoists, hand lines, or anything with hooks have safety latches in place?
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Are the proper tools for the job being utilized, and are tools in good condition with no modifications?
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Eye wash station or solution in good working order and readily available?
Management
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Short service employee's identified?
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Timely response to known problems?
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Policies, practices, procedures properly defined?
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incidents/near misses reported in a timely manner?
Machine Maintenance/Testing
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Unit photos
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Has the crew performed and documented an inspection of the equipment prior to work to assure equipment is in safe operating condition?
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Are safety/medical/first aid equipment/ goods on site and within date?
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Di-electric testing on booms completed?
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Back up alarms working properly
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Is equipment damage/malfunctions recorded?
Design Configuration
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Equipment properly barricaded when work is performed near live voltage or when grounded?
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Are appropriate DOT signs and cones in place?
Summary and signatures
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Positive observations. List crew members and specific items they are doing correctly:
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Number of personnel and printed names
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Number of trucks checked
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Number of trucks on site
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Inspectors signature
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Crew lead signature
