Apollo Mechanical Site Safety Inspection

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Postings/Notices/Signage/Bulletins

• 1.1 EEO, State/Federal Postings Visible To Employees,Medical Facilities Available And Posted, Emergency Action Plan, Medical Facilities Available And Posted

  Yes

  No

  N/A

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• 1.2 Material Safety Data Sheets (MSDS) Available

  Yes

  No

  N/A

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• 1.3 Office First-Aid Station Available/Stocked, Office Fire Extinguisher(s) Available and Up To Date

  Yes

  No

  N/A

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Housekeeping/Material Storage/Chemical Storage/Sanitation

• 2.1 Chemical/Fuel Storage (Gasoline, Diesel, Combustibles stored in Metal Safety Cans), Oxygen/Acetylene Stored Properly (Upright and Secured/20 Feet apart or 30 minute Fire Barrier In Place<br>

  Safe

  At Risk

  N/A

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• 2.2 Lumber/Material Storage/Properly Stacked, Scrap Material Free Of Nails/Hazardous Protrusions Or Properly Stockpiled/Barricaded/Caution Taped

  Safe

  At Risk

  N/A

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• 2.3 Access Passageways/Ladders Clear Of Debris, Walkways/Work Areas Clear Of Debris

  Safe

  At Risk

  N/A

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• 2.4 Covered Trash Receptacles Available For General Debris/Non-Hazardous Material

  Yes

  No

  N/A

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• 2.5 Loose/Light Material Secured Against Displacement From Wind/Unprotected Edges/Overhead Locations

  Yes

  No

  N/A

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• 2.6 Appropriate Number of Toilets For Number Of Employees (1 per 20 Employees or Fraction Thereof of Each Sex)

  Yes

  No

  N/A

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• 2.7 Wash Station Available For Each Toilet Facility (Wash Station Located Outside or Separate From Toilet Facility)

  Yes

  No

  N/A

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3. Ladders/Ramps/Work Area Access

• 3.1 Ladders Properly Positioned/Secured At 4:1 Ratio (1` From Wall For Every 4` in Elevation), Ladder Extends Minimum 3` Above Landing

  Yes

  No

  N/A

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• 3.2 Step Ladders Used Only with Legs Fully Extended (Not To Be Used As Single Ladder)

  Yes

  No

  N/A

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• 3.3 Manufactured Ladders In Serviceable Condition Or Tagged And Removed From Service

  Yes

  No

  N/A

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4. Personal Protective Equipment

• 4.1 All Employees Wearing Proper Protective Eye Wear For Task Performed (Safety Eyewear Required)

  Yes

  No

  N/A

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• 4.2 All Employees Wearing Hard Hats (Hard Hats Required)

  Yes

  No

  N/A

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• 4.3 All Employees Wearing Minimum Class II High Visibility Clothing (Or Site Specific High Vis Clothing)

  Yes

  No

  N/A

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• 4.4 Hearing Protection As Required

  Yes

  No

  N/A

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• 4.5 Appropriate Footwear, Steel-Toe Shoe or Toe-Caps/Metatarsal Guards (When Using Impact Equipment i.e. Jackhammer, Compaction Equipment)

  Yes

  No

  N/A

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• 4.6 Gloves/Appropriate Hand Protection For Assigned Task

  Yes

  No

  N/A

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• 4.7 Proper Respiratory Protection As Required (Use, Care, Cleaning)

  Yes

  No

  N/A

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5. Fall Protection/Standard Guardrails

• 5.1 Full Body Harnesses Properly Fitted/Lanyards/Positioning Devices (Use, Condition, Daily Inspection)

  Safe

  At Risk

  N/A

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• 5.2 Fall Protection Devices (Retractable Lifelines, Horizontal Lifelines, Connecting Devices) In Serviceable Condition

  Safe

  At Risk

  N/A

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• 5.3 Proper Anchor Points In Use (Support 5000 lb. Per Person Attached w/Lanyard, Support 3000 lb. For Retractable Lifeline)

  Safe

  At Risk

  N/A

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• 5.4 Proper Connecting Devices In Use/In Serviceable Condition (D-Rings, Straps, Concrete Anchors, Wood Anchors)

  Safe

  At Risk

  N/A

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• 5.5 Standard Guardrails Installed At All Walking/Working Locations Over 6` High

  Yes

  No

  N/A

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• 5.6 Uprights, Top and Mid-Rails Properly Installed (Uprights Spaced 8' Max, Top Rail Between 42"-45" From Floor/Platform/Ramp, Mid-Rail Half Way In Between)

  Yes

  No

  N/A

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• 5.7 Toe-Boards Properly Installed Over Walking/Working Areas Below Elevated Locations

  Yes

  No

  N/A

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6. Excavations

• 6.1 Excavations Sloped/Benched/Shored Properly

  Yes

  No

  N/A

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• 6.2. All Trenches, Boxes, Shields/Excavations Inspected/Documented By Competent Person Prior To Entry By Employees

  Yes

  No

  N/A

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• 6.3. Excavations Over 20' Designed/Stamped By Registered Engineer

  Yes

  No

  N/A

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• 6.4 Ladder Access Within 25' Of Employees In Trenches Over 4` Deep

  Yes

  No

  N/A

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• 6.5Trenches/Excavations/Shafts/Drill Holes/Pits Properly Barricaded/Covered/Protected As Needed

  Yes

  No

  N/A

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• 6.6. Spoils/Tools/Equipment Properly Placed Not Less Than 2` From Top Edge Of Excavation

  Yes

  No

  N/A

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• 6.7. Air Sampling Performed In All Excavations Greater Than 4` Deep Where Hazardous Atmospheres May Exist (Landfills, Waste Treatment Plants, Etc.)

  Yes

  No

  N/A

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• 6.8 Above-Ground/Sub-Surface Installations Protected, Supported Or Removed

  Yes

  No

  N/A

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• 6.9. Walkways/Bridges w/Standard Guardrails Installed Where Employees Must Cross Excavations Over 6` Deep and 30" Wide

  Yes

  No

  N/A

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7. Scaffolds

• 7.1 Scaffold Systems Installed/Inspected by Competent Person

  Yes

  No

  N/A

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• 7.2 Only Scaffold Grade Plank Utilized, Minimum 20" Walkway Provided,

  Yes

  No

  N/A

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• 7.3 Standard Guardrails In Place, Walkway, Ladder or Other Safe Means Provided For Access To Scaffold

  Yes

  No

  N/A

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• 7.4 Planks Shall Not Extend Less than 6" No More Than 18" Beyond Support Member

  Yes

  No

  N/A

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• 7.5 Scaffold Ends Shut Off With Standard Guardrails (Unless Utilized For Proper Access)

  Yes

  No

  N/A

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8. Hoisting and Lifting Equipment

• 8.1 Cranes/Boom Trucks Documented Daily Inspection Complete

  Yes

  No

  N/A

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• 8.2 Cranes/Boom Trucks Properly Set Up (Outriggers, Crane Pads/Mats, Swing Radius)

  Yes

  No

  N/A

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• 8.3 Rigging/Hardware Inspected By Competent Person

  Yes

  No

  N/A

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• 8.4 All Rigging/Crane Signaling Performed By Qualified Riggers/Signal Persons

  Yes

  No

  N/A

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• 8.5 Softeners Used As Needed For Sharp Edges

  Yes

  No

  N/A

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• 8.6 All Rigging Properly Marked With Capacity Information, Etc., Rigging Not In Use Properly Stored, Unserviceable Rigging Tagged Or Destroyed<br>

  Yes

  No

  N/A

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• 8.7 Overhead Power Lines Identified/Marked

  Yes

  No

  N/A

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• 8.8 Tag Lines In Use Where Required

  Yes

  No

  N/A

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9. Material Handling Equipment/Powered Industrial Trucks

• 9.1 Back-Up Alarms Operational

  Yes

  No

  N/A

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• 9.2 Seat Belts In Serviceable Condition, Seat Belts In Use

  Yes

  No

  N/A

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• 9.3 Bucket/Attachment Pins Attached/In Use

  Yes

  No

  N/A

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• 9.4 Equipment Attachments In Serviceable Condition

  Yes

  No

  N/A

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• 9.5 Equipment Operators Are Qualified/Certified

  Yes

  No

  N/A

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• 9.6. Haul Roads Maintained, Properly Marked

  Yes

  No

  N/A

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10. Tools And Equipment

• 10.1 Hand Tools Maintained In Safe Condition (Striking Surfaces, Handles, etc.)

  Safe

  At Risk

  N/A

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• 10.2 Power Tools Maintained In Safe Condition (Electrical Cord, Safety Guards, Handles, etc.)

  Safe

  At Risk

  N/A

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• 10.3 Pneumatic Tools Maintained In Safe Condition (Air Hose Connections, Safety Devices, etc.)

  Yes

  No

  N/A

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• 10.4 Gas Powered Tools Maintained In Safe Condition (Guards, Handles, etc.)

  Yes

  No

  N/A

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• 10.5 Powder Actuated Tools Maintained In Safe Condition (Guards, Handles, Loads Safely Stored)

  Yes

  No

  N/A

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• 10.6 Gas Operated Tools Maintained In Safe Condition (Paslode Nail Gun)

  Yes

  No

  N/A

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• 10.7 Specialty Tools (Falsework Jacks, Plates, etc.)

  Yes

  No

  N/A

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11. Electrical

• 11.1 Extension Cords Maintained In Safe Condition (Grounding Pins, Insulation, etc.)

  Yes

  No

  N/A

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• 11.2 Cords Protected Against Vehicular/Equipment Traffic

  Yes

  No

  N/A

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• 11.3 Ground Fault Circuit Interruptors (GFCI) Working

  Yes

  No

  N/A

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• 11.4 Junction Boxes Maintained In Safe Condition

  Yes

  No

  N/A

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12. Welding/Cutting/Fire Protection

• 12.1 Welding Leads/Torch Hoses Maintained In Safe Condition, Back Flow Preventers Installed On Torch Setups

  Yes

  No

  N/A

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• 12.2 Combustibles/Flammables Stored Away From Hot Work

  Yes

  No

  N/A

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• 12.3 Regulators/Gauges Properly Installed/Maintained

  Yes

  No

  N/A

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• 12.4 Fire Extinguishers/Water Cans Located Near Hot Work

  Yes

  No

  N/A

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• 12.5 Fire Extinguishers Up To Date/Properly Maintained

  Yes

  No

  N/A

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13. Traffic Control

• 13.1 Safe Pedestrian Access Provided

  Yes

  No

  N/A

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• 13.2 Construction Area Signs Properly Maintained

  Yes

  No

  N/A

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• 13.3 Temporary Traffic Control/Flaggers/Flagger Stations Properly Set Up/Maintained

  Yes

  No

  N/A

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• 13.4 Safe Construction Area Access Provided

  Yes

  No

  N/A

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• 13.5 Crash Cushions/Reflectors Properly Maintained

  Yes

  No

  N/A

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• Audit conclusions

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• Apollo on Site Representative

  Sign

• Apollo Safety Representative

  Sign