Barnard Crew Safety Audit - duplicate

• Job #

• Title

• Prepared by

• Conducted on

  Date

• Crew Foreman

• Site Name

• Location
  Address

• Activity Being Performed

  Select Backfill Bending Coating Excavation Potholing Tie-in Welding Other

  • Backfill
  • Bending
  • Coating
  • Excavation
  • Potholing
  • Tie-in
  • Welding
  • Other

• What activity is going on

PPE

• Hard Hats

  Yes

  No

  N/A

• Safety Glasses

  Yes

  No

  N/A

• Hand Protection

  Yes

  No

  N/A

• Foot Protection

  Yes

  No

  N/A

• Reflective Vests

  Yes

  No

  N/A

• Respiratory Protection

  Yes

  No

  N/A

• Chaps/Toe Guards/Other

  Yes

  No

  N/A

• Face Shield

  Yes

  No

  N/A

GAS CYLINDERS

• Gas Cylinders Present

  Yes

  No

• Stored Upright

  Yes

  No

  N/A

• Caps in Place<br>

  Yes

  No

  N/A

• Properly Labeled<br>

  Yes

  No

  N/A

• Properly Secured<br>

  Yes

  No

  N/A

• Away From Heat<br>

  Yes

  No

  N/A

• Warning Signs<br>

  Yes

  No

  N/A

• Fire Extinguisher<br>

  Yes

  No

  N/A

• Separation Wall<br>

  Yes

  No

  N/A

SANITATION

• Litter Picked Up

  Yes

  No

  N/A

• Trash Cans Removed from ROW or Emptied Daily

  Yes

  No

  N/A

• Adequate Toilet & Hand Wash Facilities?

  Yes

  No

  N/A

• Adequate TP is Toilets

  Yes

  No

  N/A

HAND TOOLS

• Good Condition<br>

  Yes

  No

  N/A

POWER TOOLS

• Are Power Tools Being Used

  Yes

  No

• Air Hoses in Good Condition<br>

  Yes

  No

  N/A

• Whip Checks / Cotter Pins in place on Air Hoses

  Yes

  No

  N/A

• Tip on Blasting Pot Secure / Threads in Good Condition

  Yes

  No

  N/A

• Handles and Guards being used

  Yes

  No

  N/A

• Extension Cords Tagged with Correct Color. <br>January - White, April - Green, July - Red, October - Orange

  Yes

  No

  N/A

LADDERS

• Are Ladders Present

  Yes

  No

• Inspected<br>

  Yes

  No

  N/A

• Secured<br>

  Yes

  No

  N/A

• 3' Above Landing<br>

  Yes

  No

  N/A

• Spreaders are locked on Step Ladders. No leaning

  Yes

  No

  N/A

• Ladder Stored Properly when Not in Use.

  Yes

  No

  N/A

Scaffold

• Are Scaffolds Present

  Yes

  No

• Competent Person Inspected Daily

  Yes

  No

  N/A

• Name of Competent Person

• Approved Access<br>

  Yes

  No

  N/A

Chemicals

• Are Chemicals Present

  Yes

  No

• Labeled<br>

  Yes

  No

  N/A

• Properly Stored<br>

  Yes

  No

  N/A

• SDS Available<br>

  Yes

  No

  N/A

• Secondary Containment Used where Necessary

  Yes

  No

  N/A

Materials Handling

• Are Materials being Handled

  Yes

  No

• Belts/Slings Inspected<br>

  Yes

  No

  N/A

• Shackles Inspected<br>

  Yes

  No

  N/A

• Hooks Inspected<br>

  Yes

  No

  N/A

• Signal person/Spotter<br>

  Yes

  No

  N/A

• Suspended Loads Secure<br>

  Yes

  No

  N/A

• Proper Lifting Technique<br>

  Yes

  No

  N/A

• Daily Crane Inspection<br>

  Yes

  No

  N/A

Excavations

• Are there Excavations

  Yes

  No

• Competent Person Inspected<br>

  Yes

  No

  N/A

• Name of Competent Person

• Spoil Pile 2' Clearance<br>

  Yes

  No

  N/A

• Shoring / Slopping Per Tab Data<br>

  Yes

  No

  N/A

• Approved Access and Egress<br>

  Yes

  No

  N/A

• Air Monitoring in place<br>

  Yes

  No

  N/A

• Air Monitor Calibrated and Bumped

  Yes

  No

  N/A

Fire Protection

• Fire Extinguisher Current on Inspection Proper Pin Securiment<br>

  Yes

  No

  N/A

• Appropriate Fuel Can<br>

  Yes

  No

  N/A

• Flammable Materials Storage Cabinet Being Used<br>

  Yes

  No

  N/A

Heat Awareness

• Cool Water Available and Not Stored in Direct Sunlight

  Yes

  No

  N/A

• What is the Temerature

  Less than 80 deg

  80 deg - 95 deg

  Greater the 95

• Shade Available Upon Request

  Yes

  No

  N/A

• Is Shade Available

  Yes

  No

  N/A

• Water Logs Being Completed

  Yes

  No

  N/A

• Is Shade Available

  Yes

  No

  N/A

• Water Logs Being Completed

  Yes

  No

  N/A

• Employees taking 10 min break every 2 hours

  Yes

  No

  N/A

• Tailgate meetings held to review with employees the importance of drinking water, the number and schedule of water and rest breaks and the signs and symptoms of heat illness.

  Yes

  No

  N/A

Medical

• First Aid Kit On Site and in Good Condition<br>

  Yes

  No

  N/A

• AED Available and Current on Inspection

  Yes

  No

  N/A

• Designated 1st Aid Person

Behavior

• Crew Aware of Conditions

  Yes

  No

  N/A

• Crew Compliant With Requests

  Yes

  No

  N/A

Site Documentation

• JHA

  Yes

  No

  N/A

• SSSP

  Yes

  No

  N/A

• Hot Work Permits<br>

  Yes

  No

  N/A

• Pre Dig Form

  Yes

  No

  N/A

• USA Tickets

  Yes

  No

  N/A

• Tabulated Data<br><br>

  Yes

  No

  N/A

• Excavation Inspection Report<br>

  Yes

  No

  N/A

• Confined Space Permit<br>

  Yes

  No

  N/A

• Excavation Safety Manual

  Yes

  No

  N/A

• Clearance Procedure<br>

  Yes

  No

  N/A

• Traffic Control Plans<br>

  Yes

  No

  N/A

• Current bump Test Log

  Yes

  No

  N/A