Information
-
Audit Title
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Personnel
-
General Data:
-
Office
-
Supervisor
-
Work description
-
Subcontractors Onsite
-
Subs name
General Area
-
JSA complete and reviewed with workers
-
Workers instructed on site hazards and controls
-
Toolbox meeting conducted
-
Observations being conducted
-
Workers properly trained
-
Workers know Emergency Action Plan
-
Sufficient supply of PPE
-
SDS available or accessible
-
First Aid on site, workers know location
-
Fire Extinguisher Onsite
-
Workers have Health Bridge Number
-
Underground utilities identified by one call
Electrical
-
All extension cords inspected and tagged
-
Generators grounded
-
GFCI in use
-
LOTO equipment available
Equipment
-
Equipment inspections completed and documented
-
All guards installed
-
Derricks/booms lowered while moving equipment
-
Chains, tie downs, ropes inspected
-
Have PM's been completed on all equipment
-
Equipment is sufficient distance (min 20') from overhead lines
Personal Protective Equipment
-
Are all employees wearing required amount
-
Is it being worn correctly
-
Is it clean and in good order
-
Is it appropriate for the hazards
-
Working near navigation waterways
-
Respirators required
Hand Safety
-
Are employees aware of hazards
-
Have employees been trained in hand safety
-
The appropriate gloves available
-
Pinch points identified on JSA
-
During cutting activities are Kevlar gloves on non cutting hand
Fall protection
-
Equipment inspections completed
-
Fall plan required
-
Rescue plan verified
-
Is equipment appropriate
Excavation
-
Competent person on site
-
Excavation inspection completed
-
Excavation guarded appropriately
-
Adequate means of entry and egress
-
Excavation site secured
Confined Space Entry
-
Permit required?
-
Permit in place and completed?
-
Gas monitor available and calibrated
-
Rescue plan in place
Vehicle Safety
-
DOT logbooks up to date
-
Pre trip inspection completed
-
Vehicles clean and orderly
Other
-
Anything removed from service
-
Items requiring repair
-
Safety concerns
-
Comments
Sign Off
-
On site representative
-
Auditor's signature