Apollo Leading Indicators Inspection

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

PROJECT START UP

START UP ITEMS

• Pre-start checklist completed

  Yes

  No

  N/A

• Pre-Task and Form book on site

  Yes

  No

  N/A

• Required posters posted

  Yes

  No

  N/A

• AISH manual on site

  Yes

  No

  N/A

• Emergency action plan posted

  Yes

  No

  N/A

• Occupational medical maps posted

  Yes

  No

  N/A

• Emergency Numbers posted

  Yes

  No

  N/A

• Occupational medical facility posted

  Yes

  No

  N/A

• First aid kits

  Yes

  No

  N/A

• PPE available

  Yes

  No

  N/A

• Eye wash stations

  Yes

  No

  N/A

• Fire extinguisher

  Yes

  No

  N/A

PLANNING

Planning Tools

• Plan to remove debris from site developed

  Yes

  No

  N/A

• Job started on time

  Yes

  No

  N/A

• Job safe analysis conducted

  Yes

  No

  N/A

• Short interval schedule complete and posted or communicated

  Yes

  No

  N/A

• Construction schedule complete and posted

  Yes

  No

  N/A

• Pre-task plans filled out prior to work starting

  Yes

  No

  N/A

• Fall protection plan developed

  Yes

  No

  N/A

• Daily white board meeting (sub contractor)

  Yes

  No

  N/A

• Material stored off ground

  Yes

  No

  N/A

• Material handling planned and executed

  Yes

  No

  N/A

• Site map developed with lay down yard established

  Yes

  No

  N/A

• Pre-task plans covers all scopes of work being performed

  Yes

  No

  N/A

• Pre-task plans filled out

  Yes

  No

  N/A

• Phased hazard analysis completed

  Yes

  No

  N/A

• Weekly progress meetings being conducted and or attended

  Yes

  No

  N/A

• Internal kick off meeting conducted prior to work starting

  Yes

  No

  N/A

• Go No Go meeting conducted or attended

  Yes

  No

  N/A

• Daily supervisor meeting (foreman)

  Yes

  No

  N/A

• Storm water plan developed

  Yes

  No

  N/A

TRAINING

KEY SUPERVISOR

• 10 hour OSHA trained

  Yes

  No

  N/A

• First aid CPR

  Yes

  No

  N/A

• Pick director

  Yes

  No

  N/A

• Confined spaces

  Yes

  No

  N/A

• Fall protection

  Yes

  No

  N/A

• Pressure testing and flushing

  Yes

  No

  N/A

• Excavation competent person

  Yes

  No

  N/A

• Rigging and signal

  Yes

  No

  N/A

• Respiratory protection

  Yes

  No

  N/A

CRAFT AND CREW

• Aerial lift

  Yes

  No

  N/A

• Forklift

  Yes

  No

  N/A

• Fall protection

  Yes

  No

  N/A

• Excavation competent person

  Yes

  No

  N/A

• Respiratory protection

  Yes

  No

  N/A

• Rigging and Signal

  Yes

  No

  N/A

• Ladder use

  Yes

  No

  N/A

• Pressure testing and flushing

  Yes

  No

  N/A

• Pipe installation

  Yes

  No

  N/A

• Trained on specific tool

  Yes

  No

  N/A

INSPECTIONS

Inspection Process

• Daily inspection of job site conducted

  Yes

  No

  N/A

• Fall protection equipment inspected and documented

  Yes

  No

  N/A

• Rigging equipment inspected

  Yes

  No

  N/A

• Daily equipment inspection

  Yes

  No

  N/A

• Weekly documented with crew member

  Yes

  No

  N/A

• Correct tool for the job

  Yes

  No

  N/A

• Daily excavation inspected and documented

  Yes

  No

  N/A

• Quarterly assured grounding completed

  Yes

  No

  N/A

• Monthly equipment inspection completed and documented

  Yes

  No

  N/A

• Initial equipment inspection completed and documented

  Yes

  No

  N/A

• Quarterly assessment by project manager

  Yes

  No

  N/A

CULTURE

Culture

• Project management or superintendent lead stretch and flex

  Yes

  No

  N/A

• First aid cases reported and investigated

  Yes

  No

  N/A

• Near misses recorded and investigated

  Yes

  No

  N/A

• Supervisory attending leadership meeting

  Yes

  No

  N/A

• Project management discussing safety at weekly meeting

  Yes

  No

  N/A

• Project management discussing safety with crew

  Yes

  No

  N/A

• Foremen conducting Pre-Task plans

  Yes

  No

  N/A

• Foreman conducting weekly safety meeting

  Yes

  No

  N/A

• Employee concerns documented and corrected

  Yes

  No

  N/A

SIGNATURE BLOCK

• Signature

  Sign