Art C. Klein Construction, Inc.

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• GENERAL

TRAINING & PLANNING

• Copy of current OSHA standards, ACK Safety manual on site

  Yes

  No

  N/A

• Have all new hires completed the new hire orientation?

  Yes

  No

  N/A

• Weekly tool box meeting held for ACK Employees and subs?

  Yes

  No

  N/A

• Copy of ACK job specific Safety plan on site and up to date?

  Yes

  No

  N/A

• Emergency evacuation plan in place?

  Yes

  No

  N/A

• THA's completed and adequate for tasks being performed?

  Yes

  No

  N/A

MEDICAL & FIRST AID

• Onsite ACK employee(s) trained in first aid/CPR on site?

  Yes

  No

  N/A

• Are first aid supplies adequate?

  Yes

  No

  N/A

POSTING & RECORDKEEPING

• OSHA 300 form being completed/posted?

  Yes

  No

  N/A

• Safety and health poster posted?

  Yes

  No

  N/A

• Emergency telephone numbers posted?

  Yes

  No

  N/A

• Medical clinic posted?

  Yes

  No

  N/A

HAZARD COMMUNICATION/MSDS

• Copy of written program (ACK & Sub's)

  Yes

  No

  N/A

• List of hazardous materials on site (ACK & Sub's)

  Yes

  No

  N/A

• MSDS current for all contractors on site

  Yes

  No

  N/A

• Labels on containers

  Yes

  No

  N/A

STRUCTURE ENTRANCE

• Overhead protection at entrances where overhead work on-going?

  Yes

  No

  N/A

• Signs Posted PPE Required beyond this point

  Yes

  No

  N/A

PUBLIC PROTECTION

• Public protection adequate including warning signs?

  Yes

  No

  N/A

• All Gates and Openings Secured IE Doors/Slide Gates to keep public out

  Yes

  No

  N/A

HOUSEKEEPING & SANITATION

• Housekeeping: aisles clean, scrap removed, no protruding nails.

  Yes

  No

  N/A

• Select from range

• Adequate supply of water or water jugs, cups and trash containers?

  Yes

  No

  N/A

• Adequate toilet facilities and clean?

  Yes

  No

  N/A

PERSONAL PROTECTIVE & LIFE SAVING EQUIPMENT

• Head,eye, face, and hand protection worn?

  Yes

  No

  N/A

• Respiratory protection worn when needed/required?

  Yes

  No

  N/A

• Written program:<br>medical evaluations completed?<br>Documentation of fit test and training for respirators?

  Yes

  No

  N/A

• Safety harnesses, lifelines and lanyard worn when needed/required?

  Yes

  No

  N/A

FIRE PROTECTION & PREVENTION

• Fire extinguishers/stand pipe installed<br>clear access?<br>Fire extinguishers identified, charged and inspected monthly?

  Yes

  No

  N/A

• Flammable & combustible liquids in approved containers only?

  Yes

  No

  N/A

• "No smoking" posted and enforced where needed?

  Yes

  No

  N/A

• Fuel tanks protected and min 20 ft from bldgs w/ 20B fire exiting w/in 50 ft?

  Yes

  No

  N/A

ELECTRICAL

• Guarding of live parts by cabinets or other enclosures?

  Yes

  No

  N/A

• Warning signs posted (Danger high voltage)?

  Yes

  No

  N/A

• GFCI receptacle used including when using permanent power?

  Yes

  No

  N/A

• GFCI's tested w/ test documented?

  Yes

  No

  N/A

• Temporary lighting adequate and bulbs protected?

  Yes

  No

  N/A

• Breaker boxes and switches properly labeled?

  Yes

  No

  N/A

• Lockout/Tagout being used?

  Yes

  No

  N/A

• Extension cords?

  Yes

  No

  N/A

TOOLS

• Proper tool being used for job?

  Yes

  No

  N/A

• All tools inspected at least daily?

  Yes

  No

  N/A

• Damaged tools repaired or replaced promptly?

  Yes

  No

  N/A

• Are tools being used properly?

  Yes

  No

  N/A

• Guards in place?

  Yes

  No

  N/A

• Pneumatic tools/air hoses have proper safeguards, secured connections?<br>

  Yes

  No

  N/A

• Powder Actuated Tools:<br>Operators trained/spot check cards?<br>Tools and charges protected from unauthorized use?

  Yes

  No

  N/A

STAIRWAYS AND LADDERS

• Stairway/ladder/ramp used where 19 inch break in elev.

  Yes

  No

  N/A

• Stairways clean and free of trip hazards w/ adequate lighting?

  Yes

  No

  N/A

• Handrails in stairways and guardrails at landing?

  Yes

  No

  N/A

• Metal pan stairs poured, filled or barricaded from use?

  Yes

  No

  N/A

• Ladders properly secured to prevent slipping, sliding or falling?

  Yes

  No

  N/A

• Do straight ladders extend 36" above top of landing?

  Yes

  No

  N/A

• Offset protection at top ladder entrance?

  Yes

  No

  N/A

• Stepladders fully open when in use; no standing on top two steps?

  Yes

  No

  N/A

• Metal ladders not used

  Yes

  No

  N/A

• Trestle ladders not used?

  Yes

  No

  N/A

• Proper maintenance and storage of ladders?

  Yes

  No

  N/A

SCAFFOLDING

• Is scaffold equipment in good working order?

  Yes

  No

  N/A

• Inspected by competent person daily before use?

  Yes

  No

  N/A

• Erected on solid, level footing?

  Yes

  No

  N/A

• Guardrails on open sided and end more than 6 ft above the ground?

  Yes

  No

  N/A

• 2x4 top rail, mid-rail & toe board?

  Yes

  No

  N/A

• Tightly planked platform for full width and secured in place?

  Yes

  No

  N/A

• Is the scaffold plump and square, with cross-bracing?

  Yes

  No

  N/A

• Access ladder provided?

  Yes

  No

  N/A

• Maximum height = four (4) times minimum base diminsion?

  Yes

  No

  N/A

• Suspended scaffold

  Yes

  No

  N/A

• Hooks, clamps, outriggers properly anchored and tiebacks installed?

  Yes

  No

  N/A

• Counterweights attached to outriggers with weights marked?

  Yes

  No

  N/A

• Tiebacks have rigging thimble with loop, secured with min. 3 fist grip clamps?

  Yes

  No

  N/A

• Independent lifeline for each worker on platform, rope protected abrasion?

  Yes

  No

  N/A

• Safety dept. notified if welding is to take place on suspended scaffold?

  Yes

  No

  N/A

FALL PROTECTION

• Floor opening covered/guardrails in place?

  Yes

  No

  N/A

• Open-sided floors/wall opening have guardrails & toe boards?

  Yes

  No

  N/A

• Roof edge adequately guarded?

  Yes

  No

  N/A

• Leading edge protection & signage utilized where required?

  Yes

  No

  N/A

• 100% fall tie off for all heights above 6 ft with proper anchor points?

  Yes

  No

  N/A

• All horizontal lifeline systems engineered?

  Yes

  No

  N/A

AERIAL MANLIFTS/SCISSORS LIFTS

• All personnel tied off?

  Yes

  No

  N/A

• Safety chains in place on scissors lifts?

  Yes

  No

  N/A

• Employee training verified?

  Yes

  No

  N/A

• Glazing kits used when setting glass?

  Yes

  No

  N/A

HOISTS AND CRANES

• Slings and chains , hooks and eyes in good condition and tagged/marked?

  Yes

  No

  N/A

• Equipment firmly supported?

  Yes

  No

  N/A

• Outriggers used if needed and proper cribbing in place?

  Yes

  No

  N/A

• Power lines inactive, removed or at a safe distance?

  Yes

  No

  N/A

• Hoist operator trained? Check for card?

  Yes

  No

  N/A

• Signalmen where needed & hand/verbal signals understood? Hand signal poster?

  Yes

  No

  N/A

• Are inspection and maintenance logs maintained/current (this includes hoists)?

  Yes

  No

  N/A

• Crane annual certification on file? This includes ACK and sub equipment?

  Yes

  No

  N/A

• Load charts posted in cab? Proper loading for capacity at lifting radius?

  Yes

  No

  N/A

• Fire extinguisher installed (cranes and hoists)?

  Yes

  No

  N/A

HEAVY EQUIPMENT

• Regular inspection and maintenance logs complete?

  Yes

  No

  N/A

• Lights, brakes, horn, back up alarm operative?

  Yes

  No

  N/A

• Haul roads well maintained and laid out properly?

  Yes

  No

  N/A

• Seat belts being used?

  Yes

  No

  N/A

• Fire extinguisher installed?

  Yes

  No

  N/A

HANDLING & STORAGE OF MATERIALS

• Materials properly stored or stacked?

  Yes

  No

  N/A

• Stacks on firm footings not too high?

  Yes

  No

  N/A

• Are loads lifted correctly? Proper number of men or equipment used?

  Yes

  No

  N/A

• Material secured if high winds approaching?

  Yes

  No

  N/A

• Use trash chute for debris drop over 20 feet?

  Yes

  No

  N/A

• Adequate scraping arounds stored stacked material?

  Yes

  No

  N/A

EXCAVATION AND SHORING

• Competent person(s) designated?

  Yes

  No

  N/A

• Underground utilities located/private service used if neccessary?

  Yes

  No

  N/A

• Is Dig Alert Permit Posted?

  Yes

  No

  N/A

• Are adjacent structures including roads/sidewalks properly shored/supported?

  Yes

  No

  N/A

• Is excavation properly sloped, shored or trench box used?

  Yes

  No

  N/A

• Tabulated data for trench box on site?

  Yes

  No

  N/A

• Means of egress within 25 feet?

  Yes

  No

  N/A

• Spoils back min. Of 2 feet?

  Yes

  No

  N/A

• Material i.e... Pipe, not stored at trench edge?

  Yes

  No

  N/A

• Is equipment a safe distance from edge of excavation?

  Yes

  No

  N/A

• Fall protection/barricading adequate?

  Yes

  No

  N/A

• Daily documented inspections or if condition change?

  Yes

  No

  N/A

WELDING AND CUTTING/OTHER HOT WORK

• Screens and shields used where necessary?

  Yes

  No

  N/A

• Goggles, gloves, proper clothing worn?

  Yes

  No

  N/A

• Electrical equipment grounded?

  Yes

  No

  N/A

• Welding leads and gases hoses protected and in good condition?

  Yes

  No

  N/A

• Fire extinguishers or proper type nearby?

  Yes

  No

  N/A

• Inspection of fire hazards?

  Yes

  No

  N/A

• Gas cylinders secured and upright. Fuel cylinders at least 20 ft from oxygen?

  Yes

  No

  N/A

• Are cylinder caps in use?

  Yes

  No

  N/A

• Fire watch used where needed/required?

  Yes

  No

  N/A

STEEL ERECTION

• Letter of commencement provided of steel erector?

  Yes

  No

  N/A

• Erection floor solidly planked or decked or safety net within 25 feet?

  Yes

  No

  N/A

• Safety railing (1/2 wire rope) at perimeter?

  Yes

  No

  N/A

• Cable guardrails has no more than 3inches deflection and flagged every 6ft.

  Yes

  No

  N/A

• Floor and other opening covered and barricaded?

  Yes

  No

  N/A

• Ladders, stairs, or other access provided?

  Yes

  No

  N/A

• Other trades protected from overhead hazards or schedule arrangements made?

  Yes

  No

  N/A

• Tag lines used?

  Yes

  No

  N/A

CONCRETE AND MASONRY CONSTRUCTION

• If red letter of commencement provided to steel erector including mortar in masonry?

  Yes

  No

  N/A

• Vertically protruding rebar capped?

  Yes

  No

  N/A

• Forms properly installed and braced?

  Yes

  No

  N/A

• Adequate shoring, plumbed and cross braced?

  Yes

  No

  N/A

• Route planned for concrete trucks? Plumping equipment properly supported?

  Yes

  No

  N/A

• Controls in place to limit silica exposure - water, vacuum tools, etc...

  Yes

  No

  N/A

• Limited access zone around masonry walls?

  Yes

  No

  N/A

• Masonry walls over 8ft adequately braced?

  Yes

  No

  N/A

• No dry cutting of black/concrete w/o adequate eng controls?

  Yes

  No

  N/A

• Safety hoisting equipment/material?

  Yes

  No

  N/A

• Hand washing station for hexavalent chromium from portland cement?

  Yes

  No

  N/A

CONFINED SPACES

• Have potential confined space been identified?

  Yes

  No

  N/A

• Had safety Dep. been notified of potential confined spaces?

  Yes

  No

  N/A

• Permit required? Completed?

  Yes

  No

  N/A

• Atmosphere tested?

  Yes

  No

  N/A

• Workers properly trained?

  Yes

  No

  N/A

• Ventilation needed?

  Yes

  No

  N/A

• Retrieval devices required?

  Yes

  No

  N/A

COMMENTS & ADDITIONAL ITEMS

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• Signatures

• SAFETY MANGER

  Sign

• SUPERINTENDENT

  Sign