ASI Site Safety Survey

• Completed On

  Date

• Document No.

• Audit Title

• Conducted on

  Date

• Prepared by

• Personnel

Public Safety

• Is vehicular traffic control in place?

  Yes

  No

  N/A

• Is the site blocked off from Pedestrian traffic?

  Yes

  No

  N/A

• Are all lane closure signs in place?<br>Are flaggers trained? PPE?

  Yes

  No

  N/A

General Safety

• Does project have First Aid Kit onsite and readily available?

  Yes

  No

  N/A

• Does project site have fire extinguisher onsite?

  Yes

  No

  N/A

Personnel Safety

• Are all personnel wearing PPE correctly?

  Yes

  No

  N/A

• Are personnel aware of surrounding?

  Yes

  No

  N/A

• Are all operators wearing PPE?

  Yes

  No

  N/A

Equipment Safety

• Equipment issues

  Yes

  No

  N/A

• Resolution?

  Yes

  No

  N/A

Environmental Safety

• Are all storm water drains on the site blocked off?

  Yes

  No

  N/A

• Is Equipment free of Leaks?

  Yes

  No

  N/A