Information
-
Document No.
-
Audit Title
-
Client / Site
-
Conducted on
-
Prepared by
-
Location
-
Personnel
-
Contract Manager/ Supervisor
-
PPE Required
- Hardhat
- Headlamp
- Safety Glasses
- Hearing Protection
- High Visibilty Vest
- Steel toe boots
-
PPE Notes
-
Ergonomic Hazards
- Tight Area
- Working above head
- Pinch points identified
- Repetitive twisting motion
- Pulling wire
- Heavy awkward lifting
-
Ergonomic hazards notes
-
Environmental Hazards
- Weather extreme temperatures
- Chemical exposure MSDS
- Housekeeping tripping hazards
- Dust or muddy ice or snow
- Railings cards off unguarded openings uneven floors
- Limited ventilation
- Poor lighting
- Other workers in area
- Workers working at height
- Foreign objects in eyes
- Diesel fumes carbon monoxide
- No machine guards
- conveyor belts
- Rebar
-
Environmental hazards notes
-
Excavation Hazards: open holes, trenches
- Spoil pile less than two feet back
- Not cut back at proper angle
- No ladder for access overall 6 feet deep
- Soil unstable
- Water leaking into trench
-
Excavation hazards notes: unstable soil, no ladder, cutback, not ribboned off, something in trench
-
Electrical Hazards
- Live electrical equipment
- Potential electrical back feeds
- Hi pot megger testing
- Energized overhead lines
- Stored energy
- Lockout tagout verified energized d energized
- Locked and properly tagged
- Multimeter operation verified fuse leads battery
- Improperly labeled panel
- Equipment old, damaged or in otherwise pour condition
- No single line diagram, incorrect, incomplete or inaccurate information
-
Electrical hazards notes4
-
Permits Required
- Energized electrical work permit
- Confined space
- Hot work
- Excavation
- Other
-
Permits required notes
-
Activity Hazards
- Grinding cutting drilling face shield required
- Mobile Equipment other vehicles
- Major lifts
- Driving on site
-
Activity hazards notes: lifts where load is shifting
-
Emergency response, access/egress
- Exit blocked or unknown
- Muster point not identified
- No communication device in area
- No fire extinguisher, hose in area
-
Emergency responseAccess /egress notes
-
Overhead Work Hazards
- Low ceiling
- Ceiling space dark
- Overhead powerlines
- Overhead Crane
- ceiling fans
- Garage door
-
Overhead work hazards notes: lifts where load might shift, live overhead lines
-
Arc Flash Gear
- Helmet shield glasses ear plugs missing or damaged
- Balaclava leather gloves holes, tears
- Rubber Gloves past testing date, obvious damage
- Holes, wear on coveralls
- Wearing jewelry
-
Arc flash gear notes
-
Harness and Lanyard
- Webbing, hardware, stitching damaged, writing on material
- Cannot read labels
- No fall protection plan in place
- Working above (6 feet, 10 feet) or above opening or pit or beside conveyor
- Working of of scaffold
- No guardrails
-
Harness and lanyard notes
-
Boom/ Scissor lift
- No manual on board
- Leaking fluids
- Tires damaged
- Deck is messy
- Controls safety device not working or removed
- Battery or fuel level low
- Does not operate properly
-
Boom and scissor lift notes
-
Confined Space Hazards
- Class a confined space immediate danger to workers life or health
- Classic B confined space does not present immediate danger to workers life or health but restricted access potential for change and conditions in space
- Class C confined space extremely low hazard potential and unlikely to change or be affected by other work areas
- Poor air quality
- Chemical exposure
- Engulment
- Fire or explosion
- Process related hazards
-
Confined space notes
-
Tools and Equipment
- Ladders steps rails damaged
- Electrical cords frayed cut ends
- Tools chipped worn out
- Scaffolding not tagged for use
-
Tools and equipment notes: not using chop saw, sawzall correctly, no faceshield
-
Media
-
Drawings
-
Hazard Assessment Done By
-
Hazard Assessment Reviewed By
