Information
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Audit Title
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Document No.
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Select date
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Take a Photo of the Site Sign
Certifications: (list employee certifications / Tower Rescue, CPR/FA) (list personnel certified)
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If climbing is being conducted are two or more employees on site Tower Rescue Certified?
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Are two or more employees on site CPR/FA certified?
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Is employee using hoist qualified/certified?
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Are employees certified in rigging?
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Are employees certified in confined space entry?
Emergency Contacts
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Cell phone coverage?
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Are 911 systems functional / cell phone?
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Phone number and address for local Police, Fire and ER
Rescue Procedures (explain rescue procedures under selection)
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Outside Services?
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Internal Crew?
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Other? (describe)
Job/Tasks for Scope (describe job tasks under selected category)
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Tower Construction/Survey?
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Electrical?
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Civil/Concrete?
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Drilling?
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Bridge Construction/Survey?
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Foundation Construction/Survey?
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Other? (describe)
Jobsite Exposures Physical Hazards (select and explain abatement on all that apply)
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Confined Space?
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Dropped Tools/Equipment?
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Electrical?
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Elevation/Site Terrain?
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Fall from Elevation/Roof Edge?
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Fire Hazard?
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Navigable Waters?
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Heavy Equipment?
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Overhead Utilities?
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Slips, Trips, Falls?
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Underground Utilities?
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Vehicle Traffic?
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Other? (describe)
Jobsite Exposures Health Hazards (select and explain abatement on all that apply)
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Biological Hazards?
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Chemical Exposures?
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EME/RFR?
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Environmental Hazards?
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HazMat Exposure/Disturbance?
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Heat Stress/Cold Stress?
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High Noise (> 85 dBA)?
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Lifting Hazards?
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Silica Exposure?
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Other? (describe)
Civil Work
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Describe the type and depth of excavation:
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Have private utility locates been completed where required?
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Have utilities been located where core boring/drilling is required?
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Public utility locate work order number along with effective and expiration dates:
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Have all owner identified underground obstructions been located & marked?
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Describe the cave-in control measures to be used if excavation will be greater than 5 feet personnel are entering the trench (sloping, benching, shoring, shield/box, ladder in trench at 4 feet):
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Describe elevation/site terrain/environmental concerns or hazards:
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Describe hazards with site/vehicle access (e.g. boom and cranes/electrical lines) and storage of materials:
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Describe the type of electrical hazards:
Elevated Work
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Type of Elevated Work Location:
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Type of Antenna Boom(s):
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Anchorage Straps Used?
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Controlled Descent Devices?
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Retractable Lifelines?
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Rope Grab?
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Cable Grab?
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Y-Lanyards?
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Full Body Harness?
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Other: (describe)
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Site Supervisor/Foreman:
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Lower Tier Subcontractor Supervisor:
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Visitor(s):
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Date and Time of Visitor(s):