All Star Electric, LLC

• PO #

• Customer/Project Description

• Conducted on

  Date

• Prepared by

• Prepared by: Signature

  Sign
• Project Location
  Address

• Personnel

• Tool Box Talk safety logs up to date?

  Yes

  No

  N/A

• Weekly project safety inspections conducted and noted during weekly safety talk?

  Yes

  No

  N/A

House Keeping

• Work areas neat?

  Safe

  At Risk

  N/A

• Waste containers provided?

  Safe

  At Risk

  N/A

• Cords and leads off the floor?

  Safe

  At Risk

  N/A

• Are Stairways clear?

  Safe

  At Risk

  N/A

• Is wire or jet line creating tripping hazards?

  Safe

  At Risk

  N/A

• Are there any rolling hazards?

  Safe

  At Risk

  N/A

Safety Pre-Plan (JSA)

• Is it filled out in detail?

  Safe

  At Risk

  N/A

• Has the foreman or lead person signed off on the JSA?

  Safe

  At Risk

  N/A

Hand and Power Tools

• Have they been inspected? (assured grounding)

  Safe

  At Risk

  N/A

• Is the right tool for the right job being used?

  Safe

  At Risk

  N/A

• Is the tool being used properly?

  Safe

  At Risk

  N/A

First Aid Kits / D.P. Postings

• Is there a first aid kit on site?

  Safe

  At Risk

  N/A

Electrical

• Ground fault interrupters being used?

  Yes

  No

  N/A

• Panels clearly identified and secured?

  Yes

  No

  N/A

• Panel Schedules updated:

  Yes

  No

  N/A

• Only qualified electricians allowed access?

  Yes

  No

  N/A

• Terminal boxes equipped with required covers?

  Yes

  No

  N/A

• Temporary cords with bare wires or missing ground prongs taken out of service?

  Yes

  No

  N/A

Lock Out Tag Out

• Has the employee been trained to perform LOTO?

  Safe

  At Risk

  N/A

• Locks with individual keys given to each electrician?

  Safe

  At Risk

  N/A

• Personalized danger tags provided to each person?

  Safe

  At Risk

  N/A

• Lock out system being utilized will reduce power to a zero-energy state?

  Safe

  At Risk

  N/A

• All personnel test to verify and confirm zero energy?

  Safe

  At Risk

  N/A

• Has the LOTO log been filled out and correspond with the lock that is installed?

  Safe

  At Risk

  N/A

Lighting

• Illumination sufficient for work being performed?

  Yes

  No

  N/A

• All temporary lighting originated from a separate branch circuit?

  Yes

  No

  N/A

• Temporary lighting fixture cages closed?

  Yes

  No

  N/A

• Temporary Lighting supported every 10 feet?

  Yes

  No

  N/A

• Temporary lighting installed at appropriate height?

  Yes

  No

  N/A

Fork Lift

• Is the operator trained?

  Safe

  At Risk

  N/A

• Is the operator using the seatbelt?

  Safe

  At Risk

  N/A

• Are there any distractions such as talking on the phone or a radio on board?

  Safe

  At Risk

  N/A

• Is the operator using a safe travel path and obeying speed limits?

  Safe

  At Risk

  N/A

Excavations and Trenching

• Has the person been trained to be working in an excavation?

  Safe

  At Risk

  N/A

• Does the excavation need any safety shoring, benching or sloping?

  Safe

  At Risk

  N/A

• Is there egress within 25' of employees?

  Yes

  No

  N/A

• Is the trench or excavation red barricaded off and maintained?

  Safe

  At Risk

  N/A

• Equipment is at a safe distance from edge of trench or excavation?

  Safe

  At Risk

  N/A

• Materials and spoil are stored at least 2' away from trench?

  Safe

  At Risk

  N/A

Ladders

• Have the ladders been inspected and maintained?

  Safe

  At Risk

  N/A

• Are the ladders being used properly?

  Safe

  At Risk

  N/A

• Is the extension ladder secure 3' above the working surface?

  Safe

  At Risk

  N/A

• Are the stickers legible? (duty rating and safety)

  Yes

  No

  N/A

• Are tools being stored on top of the ladder?

  Safe

  At Risk

  N/A

• Is the set up of the ladder on a stable surface and clear of debris underneath?

  Safe

  At Risk

  N/A

• Three points of contact when ascending / descending?

  Safe

  At Risk

  N/A

• Proper Ratio (4:1)

  Safe

  At Risk

  N/A

Fall Protection

• Is fall protection being used at heights of 6' and greater?

  Safe

  At Risk

  N/A

• Has the fall protection been inspected?

  Safe

  At Risk

  N/A

• Are floor holes covered and clearly marked?

  Safe

  At Risk

  N/A

• Safety rails and cables secured properly?

  Safe

  At Risk

  N/A

• Harnesses worn properly?

  Safe

  At Risk

  N/A

• 100% use while in aerial lifts and bucket trucks?

  Safe

  At Risk

  N/A

Personnel Lifts (Scissors and Boom)

• Has the employee been trained to operate a lift?

  Safe

  At Risk

  N/A

• Is the area safe to be operating a lift? (uneven surfaces, leading edges, debris)

  Safe

  At Risk

  N/A

Scaffolding

• All scaffolding inspected daily?

  Yes

  No

  N/A

• Erected on sound rigid foothing?

  Yes

  No

  N/A

• Tied to structure as required?

  Yes

  No

  N/A

• Guardrails, intermediate rails, toe boards and screens in place?

  Yes

  No

  N/A

• Planking is sound and sturdy?

  Yes

  No

  N/A

• Employees below protected from falling objects?

  Yes

  No

  N/A

Assured Grounding

• Are all company power tools clearly marked with the proper color code (1st quarter White, 2nd quarter Green, 3rd quarter Red, 4th quarter Orange)

  Safe

  At Risk

  N/A

• Are the assured grounding records on site?

  Safe

  At Risk

  N/A

PPE

• Are the employees wearing Z87 safety glasses?

  Safe

  At Risk

  N/A

• Are the employees wearing a hard hat?

  Safe

  At Risk

  N/A

• Are the employees wearing the right glove for the job?

  Safe

  At Risk

  N/A

• Are the employees wearing a Hi-Vis vest?

  Safe

  At Risk

  N/A

• Hearing protection being worn when required?

  Safe

  At Risk

  N/A

Comments:

• Supervisor's Signature Acknowledgment of Audit Findings

  Sign

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• Yes

  No

  N/A