Backcountry Consultant Services

• Audit Title

• Client

• Jobsite Name

• Location
  Address

• Select date

  Date

• Superintendent

• Safety Representative

• Audit Conducted By

Jobsite Office

• Safety Manual & HazCom Program

  Yes

  No

  N/A

• Subcontractors' Safety Manual & HazCom Program

  Yes

  No

  N/A

• Fire Extinguisher

  Yes

  No

  N/A

• First Aid & Bloodborne Pathogens Kit

  Yes

  No

  N/A

• OSHA Posters

  Yes

  No

  N/A

• OSHA 300 Log (Feb-April)

  Yes

  No

  N/A

• Visitor PPE Available

  Yes

  No

  N/A

Program Administration

• Emergency Action Plan

  Yes

  No

  N/A

• Emergency Procedures

  Select EVAC Route Notifications/Communications Rally Points Posted Conspicuously

  • EVAC Route
  • Notifications/Communications
  • Rally Points
  • Posted Conspicuously

• Emergency Numbers & Locations

  Select Occupational Health Clinic Hospital ER Police/Fire/Ambulance

  • Occupational Health Clinic
  • Hospital ER
  • Police/Fire/Ambulance

• Safety Meetings

  Select Tool Box Talks New Hire Orientation Site Safety Meetings

  • Tool Box Talks
  • New Hire Orientation
  • Site Safety Meetings

• Safety Audits Completed

  Yes

  No

  N/A

• Pre-Task Hazard Assessments Conducted

  Yes

  No

  N/A

• LOTO Plan

  Yes

  No

  N/A

• LOTO Log up to date

  Yes

  No

  N/A

Aerial Lifts

• Daily Inspections Completed

  Yes

  No

  N/A

• Operator Certification

  Yes

  No

  N/A

• Proper Fall Protection

  Yes

  No

  N/A

• Chain Latched / Gate Closed

  Yes

  No

  N/A

• Platform Free of Debris

  Yes

  No

  N/A

• Feet Firmly on Platform

  Yes

  No

  N/A

• Company name clearly visible

  Yes

  No

  N/A

• Equipment ID clearly visible

  Yes

  No

  N/A

Forklift operations

• Seatbelt being warn

  Yes

  No

  N/A

• Daily inspections completed

  Yes

  No

  N/A

• Operator certification

  Yes

  No

  N/A

• Sounding horn at blind corners

  Yes

  No

  N/A

• Spotters being used when needed

  Yes

  No

  N/A

• Company name clearly visible

  Yes

  No

  N/A

• Equipment ID # clearly visible

  Yes

  No

  N/A

• Equipment manufacturer information plate readable

  Yes

  No

  N/A

• Traveling in reverse when moving a load that obstructs vision

  Yes

  No

  N/A

• Equipment being used for designed purpose

  Yes

  No

  N/A

Barricades

• Setup, Maintained & Removed (end of work)

  Yes

  No

  N/A

• Signage In Place

  Yes

  No

  N/A

• Roadways, Sidewalks, & Stairs Protected

  Yes

  No

  N/A

• Traffic Controls in Place

  Yes

  No

  N/A

• Floor & Wall Openings

  Yes

  No

  N/A

• Unattended Trenches & Excavations

  Yes

  No

  N/A

• Special Hazards Work Protected

  Yes

  No

  N/A

Concrete and Masonry

• Impalement Hazards Protected

  Yes

  No

  N/A

• Limited Access Zones Established

  Yes

  No

  N/A

• Forms Installed & Braced Properly

  Yes

  No

  N/A

• Adequate Shoring: Plumbed, Braced, & Inspected

  Yes

  No

  N/A

• Form Materials Stored Neatly

  Yes

  No

  N/A

• Protection From Silica Dust

  Yes

  No

  N/A

• Concrete PPE In Use

  Yes

  No

  N/A

• Concrete Wash-Out Area Available & Constructed Properly

  Yes

  No

  N/A

Confined Space

• Training For: Attendant, Entrant, & Supervisor

  Yes

  No

  N/A

• Rescue Procedures In Place

  Yes

  No

  N/A

• Air Sampling Completed & Documented

  Yes

  No

  N/A

• Permit Posted & Properly Completed

  Yes

  No

  N/A

Cranes, Derricks, Hoists, & Rigging

• Annually Inspected

  Yes

  No

  N/A

• Inspection & Maintanence Logs Up To Date

  Yes

  No

  N/A

• Crane Operator - CCO

  Yes

  No

  N/A

• Signalman Designated & Trained

  Yes

  No

  N/A

• Equipment Firmly Supported, Outriggers Fully Extended

  Yes

  No

  N/A

• Swing Radius Barricaded

  Yes

  No

  N/A

• Rigging Equipment Inspected

  Yes

  No

  N/A

• Proper Rigging Techniques Used

  Yes

  No

  N/A

• Rigging Used Within Capacity

  Yes

  No

  N/A

• Tag Lines In Use

  Yes

  No

  N/A

Demolition

• Written Plan In Place

  Yes

  No

  N/A

• Emergency Egress Maintained

  Yes

  No

  N/A

• Dust & Falling Debris Control

  Yes

  No

  N/A

• Adjacent Structures Shored or Guarded

  Yes

  No

  N/A

Electrical & Utilities

• Live Electrical Panels Labeled "HOT"

  Yes

  No

  N/A

• Energized Parts Protected

  Yes

  No

  N/A

• GFCI Protection Utilized at Power Source

  Yes

  No

  N/A

• LO/TO Procedures Utilized

  Yes

  No

  N/A

• Insulation and Prongs Intact

  Yes

  No

  N/A

• Extension Cords Out of Walkways / Suspended by Non-Conductive Material

  Yes

  No

  N/A

• Temporary Lighting Guarded & All Bulbs in Place

  Yes

  No

  N/A

• Temporary Lighting Suspended by Mounting Point on Cage with Non-Conductive Material

  Yes

  No

  N/A

• Adequate Lighting Provided

  Yes

  No

  N/A

• Safely Working Around Power Lines

  Yes

  No

  N/A

• Underground Utilities Marked

  Yes

  No

  N/A

Fall Protection

• Fall Protection Rescue Plan in Place

  Yes

  No

  N/A

• 100% PFAS Utilized

  Yes

  No

  N/A

• PFAS in Good Working Condition

  Yes

  No

  N/A

• Sufficient Anchorage Points

  Yes

  No

  N/A

• Fall Protection Methods in Accordance to OSHA Standards

  Yes

  No

  N/A

• Leading Edges Protected

  Yes

  No

  N/A

• Guardrails Constructed Properly

  Yes

  No

  N/A

• Perimeter Cable Installed in Compliance & Flagged Every 6'

  Yes

  No

  N/A

• Warning Lines Properly Installed

  Yes

  No

  N/A

• Ironworkers with Subpart R Provisions

  Yes

  No

  N/A

• Floor Holes Covered, Marked & Secured

  Yes

  No

  N/A

• Being inspected prior to use

  Yes

  No

  N/A

Fire Prevention/Protection

• Fire Extinguishers Every 3,000 sq.ft, within 50 ft. Horizontally, Locaded in Stairways

  Yes

  No

  N/A

• Fire Extinguisher Readily Available for Hot Work Operations

  Yes

  No

  N/A

• Fire Extinguishers Inspected Annually & Monthly

  Yes

  No

  N/A

• Sprinkler System Live

  Yes

  No

  N/A

Fuel Storage

• Approved Containers and Potable Tanks Used & Labeled Properly

  Yes

  No

  N/A

• Not Closer than 20' to a Building

  Yes

  No

  N/A

• No More than 25 Gallons Stored Inside or Stored in an Approved Cabinet

  Yes

  No

  N/A

• Fire Extinguisher Not Less than 20-B, Locaded within 25-75'

  Yes

  No

  N/A

• Double Containment for Tanks > 50 Gallons

  Yes

  No

  N/A

• Protected by Dikes or Barricades from Vehicular Collision/Damage

  Yes

  No

  N/A

• Proper Labels and Signage in Place

  Yes

  No

  N/A

Gas Cylinders

• Cylinders Upright, Secured & Caps On

  Yes

  No

  N/A

• Oxygen & Flammables Properly Stored

  Yes

  No

  N/A

• Guages Removed & Caps On When Not in Use

  Yes

  No

  N/A

Hand & Power Tools

• Proper Tool for the Job

  Yes

  No

  N/A

• Tools in Good Operating Condition

  Yes

  No

  N/A

• Mechanical Guards in Place

  Yes

  No

  N/A

• Tools Inspected Prior to Use

  Yes

  No

  N/A

• Manufacturer's Recommended PPE In Use

  Yes

  No

  N/A

• Cords in Good Condition

  Yes

  No

  N/A

• Tools Properly Stored

  Yes

  No

  N/A

• Air Compressors hose couplings safety pined

  Yes

  No

  N/A

Health Hazards

• Asbestos

  Yes

  No

  N/A

• Lead

  Yes

  No

  N/A

• Silica

  Yes

  No

  N/A

• Other

  Yes

  No

  N/A

Heavy Equipment

• Operator Properly Trained

  Yes

  No

  N/A

• Regularly Inspected

  Yes

  No

  N/A

• Seat Belts Worn when Rollover Protection is in Place

  Yes

  No

  N/A

• Glass is Free from Distortion

  Yes

  No

  N/A

• Alarms and Lights Functioning Properly

  Yes

  No

  N/A

Housekeeping & Sanitation

• Site Free of Slip, Trip, Fall Fall Hazards

  Yes

  No

  N/A

• Trash in containers overflowing

  Yes

  No

  N/A

• Aisle, Stairs and Passageways Clear

  Yes

  No

  N/A

• Enclosed Chute Used for Drops > 20'

  Yes

  No

  N/A

• 1 Toilet Per 10 Employees. Sanitation Station Available.

  Yes

  No

  N/A

Ladders & Stairways

• Correct Ladder and Properly Used for the Task

  Yes

  No

  N/A

• Ladders in Good Condition

  Yes

  No

  N/A

• Extension Ladders Extend at Least 36' Above the Upper Landing

  Yes

  No

  N/A

• Secured and at a 4:1 Pitch

  Yes

  No

  N/A

• Spreader Bars Fully Open

  Yes

  No

  N/A

• Steps or Ramps at Elevation Breaks >19"

  Yes

  No

  N/A

• Rails at Stairs and Landings with 4 or More Risers or 30" High

  Yes

  No

  N/A

• Risers are Uniform Height

  Yes

  No

  N/A

• Platforms Extend at Least 20" Past Door Swing Radius

  Yes

  No

  N/A

Material Storage

• 10' From Exterior & 6' From Interior Leading Edges

  Yes

  No

  N/A

• Material Stacked to Prevent Sliding, Falling, or Collapse

  Yes

  No

  N/A

• Nails Pulled from Lumber

  Yes

  No

  N/A

• Materials No Closer than 3' of Live Electrical Equipment

  Yes

  No

  N/A

Personal Protective Equipment

• Hard Hats - Overhead Hazard

  Yes

  No

  N/A

• Safety Glasses - Task Specific

  Yes

  No

  N/A

• Faceshield - Task Specific

  Yes

  No

  N/A

• Work Boots Worn

  Yes

  No

  N/A

• Gloves Worn - Different Types Available Per Task

  Yes

  No

  N/A

• Hearing Protection Available/Utilized

  Yes

  No

  N/A

• Reflective High Visibility Clothing

  Yes

  No

  N/A

• Respirators or Dust Masks Utilized

  Yes

  No

  N/A

Scaffolds

• Competent Supervision: Erecting, Altering, & Dismantling

  Yes

  No

  N/A

• Scaffold Tagging Procedure Utilized

  Yes

  No

  N/A

• All Parts is Good Condition

  Yes

  No

  N/A

• Locking Wheels, Base Plates or Mud Sills Provided

  Yes

  No

  N/A

• Plumb & Square with all Bracing

  Yes

  No

  N/A

• Toprails & Midrails in Adequate and Ends Protected

  Yes

  No

  N/A

• Working Deck Complete & Correctly Erected

  Yes

  No

  N/A

• Plank Cracks/ Splits No Longer than the Width

  Yes

  No

  N/A

• Working Areas Free of Debris, Snow & Ice

  Yes

  No

  N/A

• Falling Object Protection Provided

  Yes

  No

  N/A

• Proper Access to Platforms

  Yes

  No

  N/A

• Tied into Structure when Over 4 Times is Width

  Yes

  No

  N/A

Trenching & Excavations

• Inspected by a Competent Person

  Yes

  No

  N/A

• Proper Protection Per Soil Type

  Yes

  No

  N/A

• Equipment Kept at a Safe Distance from Edge

  Yes

  No

  N/A

• Proper Access and Egress

  Yes

  No

  N/A

• Spoil Piles at Least 2' from Edge

  Yes

  No

  N/A

• Adjacent Structures Shored

  Yes

  No

  N/A

• Underground Utilities Located and Marked

  Yes

  No

  N/A

• Equipment Access Ramp Adequate

  Yes

  No

  N/A

Welding, Cuttting & Grinding

• Proper PPE Utilized

  Yes

  No

  N/A

• Fire Extinguisher Readily Available

  Yes

  No

  N/A

• Flashback Arrestors on Torches

  Yes

  No

  N/A

• Boots on Welding Lugs

  Yes

  No

  N/A

• Leads in Good Condition

  Yes

  No

  N/A

• Combustibles 35' Away or Cover with Fire Blankets

  Yes

  No

  N/A

• Inspection Reviewed With

• Audit Completion

  Date