Appalachian Safety Consultants

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

General Construction Area - Secured Access/After Hours

• Warning signs in place?

  Yes

  No

  N/A

• Visitor directions in place to prevent I orientated personnel from entering the construction area?

  Yes

  No

  N/A

• Open ditches barricaded or otherwise protected??

  Yes

  No

  N/A

• Utility ditches flagged or otherwise identified and protected?

  Yes

  No

  N/A

• Leading edges and drop-offs protected?

  Yes

  No

  N/A

• Ladders lowered?

  Yes

  No

  N/A

• Hazard warning lights utilized?

  Yes

  No

  N/A

• Equipment and tools secured?

  Yes

  No

  N/A

General Jobsite / Work Area

• Are posters and safety signs/warnings in place?

  Yes

  No

  N/A

• Are safety meetings being conducted periodically?

  Yes

  No

  N/A

• Are jobsite related safety orientations and training being completed?

  Yes

  No

  N/A

• Is there an adequately stocked first aid kit readily available?

  Yes

  No

  N/A

• Is there an accident reporting procedure established?

  Yes

  No

  N/A

• If yes, is the plan documented?

  Yes

  No

  N/A

• Is this plan readily accessible to all employees and supervisors?

  Yes

  No

  N/A

• Is there a on-site EMS provider for first aid & triage?

  Yes

  No

  N/A

• If yes, do employees know where to locate the provider and facility location?

  Yes

  No

  N/A

• If no, has an offsite provider been established?

  Yes

  No

  N/A

• Can emergency care be provided by an offsite provider within 15 minutes?

  Yes

  No

  N/A

• Is there a substance abuse policy is place?

  Yes

  No

  N/A

• Are injuries and accident records being kept?

  Yes

  No

  N/A

Emergency Action Plan

• Is there a written emergency action plan in place?

  Yes

  No

  N/A

• Is emergency contact information posted and provided to everyone on site?

  Yes

  No

  N/A

• Is employee emergency contact information kept current and on file?

  Yes

  No

  N/A

• Is there a written evacuation plan in place?

  Yes

  No

  N/A

• Are employees trained in evacuation procedures and rally locations?

  Yes

  No

  N/A

• Are rally points clearly posted for easy identification by everyone on site ?

  Yes

  No

  N/A

• Are communications established and understood for on site personnel accountability?

  Yes

  No

  N/A

• Have local EMS providers toured the site to preplan possible emergency response and rescue plans?

  Yes

  No

  N/A

• Are local EMS providers being kept aware of any changing conditions on site as work progresses?

  Yes

  No

  N/A

Housekeeping, Environment, & Employee Health & Sanitation

Housekeeping

• Are work areas neat and orderly?

  Yes

  No

  N/A

• Is there regular disposal of waste & trash?

  Yes

  No

  N/A

• Are adequate trash receptacles provide throughout the site?

  Yes

  No

  N/A

• If yes, are these trash receptacles being used and no trash on the floor near them?

  Yes

  No

  N/A

• Are accesses, egresses, stairways, and walkways clear from materials and obstruction?

  Yes

  No

  N/A

• Are boards, debris, and other materials neatly stored and free from protruding nails, wires, etc.?

  Yes

  No

  N/A

Environmental

• Has an environmental risk assessment been completed prior to work beginning?

  Yes

  No

  N/A

• Are streams and run-offs protected from foreign substances entering them?

  Yes

  No

  N/A

• Are silt fences up (where needed)?

  Yes

  No

  N/A

• Have noise producing areas and processes been identified and clearly marked?

  Yes

  No

  N/A

• Has adequate lighting been provided?

  Yes

  No

  N/A

• Are there combustible dusts produced and/or in the work area?

  Yes

  No

  N/A

• Is there uncontrolled dusts in work area?

  Yes

  No

  N/A

• Is there an acceptable dust control system or procedure in place?

  Yes

  No

  N/A

• If yes, are these procedures being followed?

  Yes

  No

  N/A

• Are there any other environmental concerns?

  Yes

  No

  N/A

• List concerns and recommended corrective actions here.

Employee Health & Sanitation

• Is there a pest control program in place?

  Yes

  No

  N/A

• If yes, has this plan been implemented and conducted in accordance with local, state, national, EPA laws and regulations?

  Yes

  No

  N/A

• Are there any signs of pests or rodents near employee eating facilities or work areas?

  Yes

  No

  N/A

• If yes, has the issue been addressed (I.e. traps or other removal means)?

  Yes

  No

  N/A

• Are work areas, break rooms, and eating facilities free from trash and food particles in cracks, crevices, and floors?

  Yes

  No

  N/A

• Are sanitary facilities adequate and clean?

  Yes

  No

  N/A

• Are adequate hand wash stations or other such facilities been provided?

  Yes

  No

  N/A

• Has potable water been provided in strategic locations near where employees are working?

  Yes

  No

  N/A

• Are cups provided?

  Yes

  No

  N/A

• Is there a trash receptacle near by?

  Yes

  No

  N/A

• Are emergency eyewash/shower locations provided and clearly identifiable?

  Yes

  No

  N/A

Hazard Communication

• Is there a written hazard communication plan?

  Yes

  No

  N/A

• Is there a written hazardous materials handling policy in place?

  Yes

  No

  N/A

• Are employees trained in hazard communication?

  Yes

  No

  N/A

• Are SDSs available for hazardous substances present on site?

  Yes

  No

  N/A

• Are SDSs available and posted near affected area?

  Yes

  No

  N/A

• Have all hazardous substances stored on site been reported to the proper officials in the event of an emergency ( I.e. EMS, EPA, etc.)?

  Yes

  No

  N/A

• Have all employees been made aware of all hazardous substances on site, and properly trained in emergency procedures in the event of a spill or inadvertent contact?

  Yes

  No

  N/A

• Are correct storage procedures being followed for hazardous substances on site?

  Yes

  No

  N/A

• Are all hazardous substances clearly labeled in accordance with the GHS?

  Yes

  No

  N/A

• Is an up-to-date hazardous substance log being maintained on site?

  Yes

  No

  N/A

Fire Prevention

• Is the fire department phone number posted?

  Yes

  No

  N/A

• Are there an adequate number and type of fire extinguisher(s) available?

  Yes

  No

  N/A

• Are fire extinguishers locations clearly identifiable by means of signs?

  Yes

  No

  N/A

• Are all employees trained in fire prevention and fire extinguisher use?

  Yes

  No

  N/A

• Are fire extinguisher inspections conducted monthly?

  Yes

  No

  N/A

• Are all fire extinguishers annually re-certified by a professional fire service company?

  Yes

  No

  N/A

• Is a fire extinguisher provided for all vehicles and equipment on site?

  Yes

  No

  N/A

• Is there a fire detection or alarm system in place?

  Yes

  No

  N/A

• If yes, is this system tested periodically to ensure that it is working properly?

  Yes

  No

  N/A

• Is all equipment shut off during refueling?

  Yes

  No

  N/A

• Is the equipment properly grounded to the fuel truck prior to refueling?

  Yes

  No

  N/A

• Are "No Smoking" signs posted and enforced at all refueling locations?

  Yes

  No

  N/A

• Are all fire hydrants clear from obstructions?

  Yes

  No

  N/A

Flammable Liquids / Materials

• Are all containers removed?

  Yes

  No

  N/A

• Are only approved containers being used?

  Yes

  No

  N/A

• Are all containers stored in approved and appropriate areas?

  Yes

  No

  N/A

• Do all outside storage areas have secondary containment in place?

  Yes

  No

  N/A

• Do all storage tanks have correct grounding, bonding, and pressure relief provided?

  Yes

  No

  N/A

• Are all cylinders stored/secured in the upright position?

  Yes

  No

  N/A

Electrical

• Do all electrical devices have current inspection and coding?

  Yes

  No

  N/A

• Is electrical equipment properly maintained?

  Yes

  No

  N/A

• Is there an assured grounding program in place?

  Yes

  No

  N/A

• Is GFCI being used and tested where required?

  Yes

  No

  N/A

• Are fuses provided where necessary?

  Yes

  No

  N/A

• Are electrical hazards clearly posted?

  Yes

  No

  N/A

• Are fire extinguishers of the proper type provided an their location clearly identifiable?

  Yes

  No

  N/A

• Are terminal boxes equipped with required covers?

  Yes

  No

  N/A

• Are circuits clearly identified and labeled for emergency disconnect and supply panel location?

  Yes

  No

  N/A

Personal Protective Equipment

• Has hazard analysis and risk evaluation been conducted?

  Yes

  No

  N/A

• Is the selected PPE adequate for the exposures during the work procedure and work area?

  Yes

  No

  N/A

• Have employees been issued PPE as required?

  Yes

  No

  N/A

• Is the PPE being used?

  Yes

  No

  N/A

• Are employees trained in the correct use of their PPE?

  Yes

  No

  N/A

• Are inspections being accomplished periodically and before/after use?

  Yes

  No

  N/A

• Is adequate maintenance and sanitary storage available and being used?

  Yes

  No

  N/A

• Is adequate fall protection equipment provided?

  Yes

  No

  N/A

• Eye protection provided?

  Yes

  No

  N/A

• Face Protection (shields, welding shields, etc)?

  Yes

  No

  N/A

• Is proper hearing protection being provided?

  Yes

  No

  N/A

• Are respirators and particulate masks provided and used where necessary?

  Yes

  No

  N/A

• Has a respiratory hazard analysis been completed to determine the correct respiratory protection selection? (I.e. combustible dust, fumes, vapors, and mists)

  Yes

  No

  N/A

• Has correct head protection been provided?

  Yes

  No

  N/A

• Is correct hand protection being used and provided (where required)?

  Yes

  No

  N/A

• Are there any special PPE requirements that have not been addressed (SCBA, Tyvek Suits, etc.)?

  Yes

  No

  N/A

Hand Tools

• Are the proper hand tools being used for the task at hand?

  Yes

  No

  N/A

• Are proper maintenance procedures being followed?

  Yes

  No

  N/A

• Are tools being used in good condition and free from any physical damage?

  Yes

  No

  N/A

• Are tools inspected before and after each use?

  Yes

  No

  N/A

• Are damaged tools red-tagged, taken out of service, and removed from the work area immediately?

  Yes

  No

  N/A

• Are there any defective tools remaining in the work area?

  Yes

  No

  N/A

• Is there a designated tool storage area?

  Yes

  No

  N/A

• If yes, are all tools logged and accounted for by a sign-out/sign-in log?

  Yes

  No

  N/A

• Are all tools returned to the tool storage area by end-of-shift?

  Yes

  No

  N/A

• Are all cords supplied with ground plugs or double insulated?

  Yes

  No

  N/A

• Are all guards, handles, in place and in good operating condition?

  Yes

  No

  N/A

• Have employees been trained on the tools they are using?

  Yes

  No

  N/A

Ladders

• Are ladders inspected and in good order?

  Yes

  No

  N/A

• Is the correct ladder being used for the application observed?

  Yes

  No

  N/A

• Are ladders being used secured to prevent slipping, sliding, and falling?

  Yes

  No

  N/A

• Are side rails extending 36" past the platform being accessed?

  Yes

  No

  N/A

• Are ladders spliced or otherwise unsafely connected to extend user reach?

  Yes

  No

  N/A

• Are rungs or cleats not over 12" on center?

  Yes

  No

  N/A

• Are ladders properly maintained and stored correctly to prevent damage or distortion?

  Yes

  No

  N/A

• Are ladders painted?

  Yes

  No

  N/A

• Are ladders over 20' provided with fall protection?

  Yes

  No

  N/A

• Are ladders rated for the task being performed?

  Yes

  No

  N/A

Scaffolds

• Are scaffolds being erected under the direction of a competent person, and to the specifications of 29 CFR 1926.451 & 29 CFR 1926.452?

  Yes

  No

  N/A

• Are all structural members free from defects and meet the applicable safety factor?

  Yes

  No

  N/A

• Are all connections secure?

  Yes

  No

  N/A

• Are scaffolds erected on solid footing with mud-sills (unless on concrete) to prevent displacement or tipping?

  Yes

  No

  N/A

• Are guys, ties, and braces installed according to 29 CFR 1926.451(c)(1)?

  Yes

  No

  N/A

• Are working platforms free from debris, dirt, snow, ice, grease and oils, or unsecured materials?

  Yes

  No

  N/A

• Has debris netting or plywood backing been installed to prevent falling objects?

  Yes

  No

  N/A

• Are scaffolds square, plumb and have diagonal bracing when/where required?

  Yes

  No

  N/A

• Are all guard rails in place and installed according to 29 CFR 1926.451?

  Yes

  No

  N/A

• Are pull ropes, wheel wells, or other lifting devices installed on the scaffold in such a way to prevent failure of the device or scaffold?

  Yes

  No

  N/A

• Is fall protection provided (where needed) and being used correctly?

  Yes

  No

  N/A

• Are scaffolds inspected prior to each shift, and after any incident that may affect the integrity of the scaffold?

  Yes

  No

  N/A

• Are mobile scaffolds properly constructed and maintained?

  Yes

  No

  N/A

• Are mobile scaffolds rideable while being manual or mechanically propelled?

  Yes

  No

  N/A

• Is this indicted on the scaffold tag?

  Yes

  No

  N/A

• Are suspension scaffolds being erected and maintained under a certified erector?

  Yes

  No

  N/A

Excavation and Shoring

• Are holes, cuts, and tenches over 5' deep shored, sloped, or trench boxes used?

  Yes

  No

  N/A

• Operation directed by a competent person?

  Yes

  No

  N/A

• Spoil banks at least 2 feet from edges of cut?

  Yes

  No

  N/A

• Are ladders placed to ensure no greater than 25' of lateral travel by worker?

  Yes

  No

  N/A

• Are ladders properly secured?

  Yes

  No

  N/A

• Are adjacent structures properly shored?

  Yes

  No

  N/A

• Is shoring and sheathing correct for soil depth?

  Yes

  No

  N/A

• Are sidewalks and roads supported and protected?

  Yes

  No

  N/A

• Excavation barricaded and lighting provided?

  Yes

  No

  N/A

• Are equipment ramps adequate?

  Yes

  No

  N/A

• Have underground utilities been identified and secured from damage?

  Yes

  No

  N/A

• Required professional engineer design/approval accomplished (when needed)?

  Yes

  No

  N/A

• Confined space permit acquired an completed prior to entry?

  Yes

  No

  N/A

• Are daily inspections of the cut made by a competent person?

  Yes

  No

  N/A

Tunneling

• Atmospheric testing completed?

  Yes

  No

  N/A

• Electric approved for hazardous locations?

  Yes

  No

  N/A

• Adequate fire prevention?

  Yes

  No

  N/A

• Rescue plan?

  Yes

  No

  N/A

• Confined space entry permit in place?

  Yes

  No

  N/A

• Adequate ventilation provided?

  Yes

  No

  N/A

Hoist, Cranes, and Derricks

• Are annual inspections complete?

  Yes

  No

  N/A

• Are operators properly tested and physical exams current?

  Yes

  No

  N/A

• Are operator daily inspections complete?

  Yes

  No

  N/A

• Power lines deactivated, removed, or warning signs posted indicating at least a10' clearance from overhead power lines (50 kv <)?

  Yes

  No

  N/A

• Hoist designed by professional engineer?

  Yes

  No

  N/A

• Proper loading of capacity at lifting radius?

  Yes

  No

  N/A

• Operation in accordance with manufacturer's recommendations?

  Yes

  No

  N/A

• Competent person inspecting crane at required intervals?

  Yes

  No

  N/A

• Equipment properly lubricated and maintained?

  Yes

  No

  N/A

• Load testing completed?

  Yes

  No

  N/A

• Certified signalman/riggers?

  Yes

  No

  N/A

• Alarms working and audible?

  Yes

  No

  N/A

• Outriggers used?

  Yes

  No

  N/A

Heavy Equipment

• Regular inspection and maintenance?

  Yes

  No

  N/A

• Seat belts provided and used in vehicles with ROPS?

  Yes

  No

  N/A

• Backup alarms in place and audible?

  Yes

  No

  N/A

• No employees riding without proper seating?

  Yes

  No

  N/A

• Lights, breaks, and warning signals operative?

  Yes

  No

  N/A

• Parked vehicles chocked?

  Yes

  No

  N/A

• Haul roads maintained and laid out correctly?

  Yes

  No

  N/A

• Equipment secured when not in use?

  Yes

  No

  N/A

• Noise arresters used?

  Yes

  No

  N/A

• Spark arresters used when necessary?

  Yes

  No

  N/A

Motor Vehicles

• Regular maintenance and inspections?

  Yes

  No

  N/A

• Qualified operators?

  Yes

  No

  N/A

• Lights, breaks, and warning signals operative?

  Yes

  No

  N/A

• Backup alarms in place and audible?

  Yes

  No

  N/A

• No employees riding without proper seating?

  Yes

  No

  N/A

• Equipment secured when not in use?

  Yes

  No

  N/A

• Fire extinguisher installed?

  Yes

  No

  N/A

• Seat belts worn?

  Yes

  No

  N/A

Garages and Workshops

• Fire hazards controlled?

  Yes

  No

  N/A

• Oily rag containers used and emptied daily?

  Yes

  No

  N/A

• Good housekeeping?

  Yes

  No

  N/A

• Adequate lighting?

  Yes

  No

  N/A

• Adequate ventilation?

  Yes

  No

  N/A

• Are fuels and lubricants in proper containers?

  Yes

  No

  N/A

• Are fire extinguishers provided and of the proper type?

  Yes

  No

  N/A

• Ample absorbent materials available and in use?

  Yes

  No

  N/A

Barricades

• Roadways and sidewalks protected?

  Yes

  No

  N/A

• Adequate lighting provided?

  Yes

  No

  N/A

• Barricades or covers provided for floor openings ( marked with "hole" on it), shafts, wall openings, stairways, stairwells, trenches, outriggers, etc.?

  Yes

  No

  N/A

• Are barricades marked with hi-vis paint to enhance employee recognition of them?

  Yes

  No

  N/A

Material Handling & Storage

• Materials are properly stored or stacked?

  Yes

  No

  N/A

• Are materials stored near leading edges and elevated surfaces protected by plywood or debris netting from creating a falling object hazard?

  Yes

  No

  N/A

• Are passageways clear?

  Yes

  No

  N/A

• Sufficient employees to ensure job safety and lifting?

  Yes

  No

  N/A

• Correct lifting procedures followed?

  Yes

  No

  N/A

• Materials protected from weather?

  Yes

  No

  N/A

• Traffic control in storage area?

  Yes

  No

  N/A

• Employees protected by designated walkways?

  Yes

  No

  N/A

• Correct rigging procedures being followed?

  Yes

  No

  N/A

• Racks have weight capacity rating clearly marked and legible?

  Yes

  No

  N/A

• Racks are not overloaded and are in good condition (no bent metal, cracked welds, etc.)

  Yes

  No

  N/A

• Employees are trained in safe material handling & storage?

  Yes

  No

  N/A

Demolition

• Engineering survey in writing?

  Yes

  No

  N/A

• Are material chutes provided and used correctly?

  Yes

  No

  N/A

• Are operations planned ahead?

  Yes

  No

  N/A

• Is there shoring of adjacent structures?

  Yes

  No

  N/A

• Utilities shut off?

  Yes

  No

  N/A

• Hazardous materials/chemicals removed from any pipes, tanks, or equipment?

  Yes

  No

  N/A

• Chutes provided for disposing of material above 20'?

  Yes

  No

  N/A

Blasting

• Contractor qualifications and credentials checked?

  Yes

  No

  N/A

• Explosive inventory completed and accounted for at all times?

  Yes

  No

  N/A

• Stray electrical currents checked?

  Yes

  No

  N/A

• Blasting mats used when required?

  Yes

  No

  N/A

• All signs, warning signals, and protective equipment I place?

  Yes

  No

  N/A

• Non-essentials removed from area?

  Yes

  No

  N/A

• Radio transmissions limited?

  Yes

  No

  N/A

• Misfire handling procedure in place?

  Yes

  No

  N/A

• Explosives properly stored?

  Yes

  No

  N/A

• Is black powder prohibited?

  Yes

  No

  N/A

• Experienced and trained personnel handling explosives?

  Yes

  No

  N/A

• Detonators tested before each shot?

  Yes

  No

  N/A

• Area inspection after each shot?

  Yes

  No

  N/A

• Proper disposal of wrappings, waste, and scrap?

  Yes

  No

  N/A

• Operations suspended during electrical storms or when lightning is with in 10 miles?

  Yes

  No

  N/A

• All blasting operations done during daylight hours?

  Yes

  No

  N/A

Welding and Cutting

• Are operators qualified?

  Yes

  No

  N/A

• Screens and shields in place?

  Yes

  No

  N/A

• Are oxygen and acetylene bottles stored and secured in the upright position, and with caps on when not in use?

  Yes

  No

  N/A

• Proper PPE provided and used?

  Yes

  No

  N/A

• Fire extinguisher in place of the proper type?

  Yes

  No

  N/A

• Is a fire watch in place?

  Yes

  No

  N/A

• Is the hot work permit valid and posted?

  Yes

  No

  N/A

• Are valves closed and caps replaced overnight?

  Yes

  No

  N/A

• Flashback arresters placed on oxygen and acetylene hoses?

  Yes

  No

  N/A

• Electrical equipment grounded properly?

  Yes

  No

  N/A

• Area inspected for fire hazards and free from combustible materials?

  Yes

  No

  N/A

• Gas lines and cables protected and in good shape?

  Yes

  No

  N/A

• Proper ventilation in place?

  Yes

  No

  N/A

Steel Erection

• Correct PPE?

  Yes

  No

  N/A

• Safety nets or planked floors?

  Yes

  No

  N/A

• Tag lines for controlling loads?

  Yes

  No

  N/A

• Floor openings covered?

  Yes

  No

  N/A

• Fall arrest system in place?

  Yes

  No

  N/A

• Hoisting and lifting operation coordinated?

  Yes

  No

  N/A

• Correct rigging and signaling?

  Yes

  No

  N/A

Concrete Construction

• Forms properly installed and braced?

  Yes

  No

  N/A

• Adequate shoring, plumbed, and crossbraced?,

  Yes

  No

  N/A

• Proper cutting period and procedures used?

  Yes

  No

  N/A

• Proper PPE?

  Yes

  No

  N/A

• Caps on all rebar?

  Yes

  No

  N/A

• Automatic shutoff on power operated trowels?

  Yes

  No

  N/A

• Nailed removed from stripped forms and materials?

  Yes

  No

  N/A

• Debris and other materials removed from work area?

  Yes

  No

  N/A

Masonry

• Proper scaffolding?

  Yes

  No

  N/A

• Masonry saws properly equipped, dust protection provided?

  Yes

  No

  N/A

• Safe hoisting equipment?

  Yes

  No

  N/A

• Correct PPE?

  Yes

  No

  N/A

• Are controlled access zones established?

  Yes

  No

  N/A

Work Permits

• Safe work permit issued?

  Yes

  No

  N/A

• Hot work permit in place?

  Yes

  No

  N/A

• Excavation permit in place?

  Yes

  No

  N/A

• LOTO?

  Yes

  No

  N/A

• Confined Space Permit in place?

  Yes

  No

  N/A

• Are there any other permits required for task observed?

  Yes

  No

  N/A

• If yes, enter permit(s) required here.

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