BBC/Safety Assessment-Draft

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Personal Protective Equipment: Are all employees compliant with company policy and procedures in regards to the following;

• 1.1 Head Protection: Hard Hats, Helmets, etc.

  Safe

  At Risk

  N/A

• 1.2 Hearing Protection: Ear muffs, plugs, etc.

  Safe

  At Risk

  N/A

• 1.3 Eye and Face Protection: Goggles, mask, etc.

  Safe

  At Risk

  N/A

• 1.4 Foot Protection: Proper footwear.

  Safe

  At Risk

  N/A

• 1.5 Fall Protection: Cables, harness, etc.

  Safe

  At Risk

  N/A

• 1.6 Respirators: Are respirators in good working condition and being used as required.

  Safe

  At Risk

  N/A

• 1.6.1 Medical evaluation and fit test

  Safe

  At Risk

  N/A

• 1.7 Proper Clothing: Reflective vests, gloves, etc.

  Safe

  At Risk

  N/A

• Comments:

2. Tools and Equipment

• 2.1 Tools: In good condition.

  Safe

  At Risk

  N/A

• 2.2 Equipment: In good condition.

  Safe

  At Risk

  N/A

• 2.3 Tools and equipment which are powered by electric, are connected properly grounded.

  Safe

  At Risk

  N/A

• 2.3.1 GCFI and automatic magnetic cut-off for wood working tools is in working condition.

  Yes

  No

  N/A

• 2.4 Machine guards and pinch points are identified and protected.

  Safe

  At Risk

  N/A

• 2.5 Rigging and lifting equipment has been inspected and in good condition.

  Safe

  At Risk

  N/A

• 2.6 Ladders are in good condition.

  Safe

  At Risk

  N/A

• 2.6.1 Ladders tied back.

  Yes

  No

  N/A

• 2.6.2 Ladders extended 3 ft. beyond landing.

  Yes

  No

  N/A

• Comments:

3. Heavy Equipment

• 3.1 Records of completed daily inspections.

  Safe

  At Risk

  N/A

• 3.2 Fire extinguisher mounted and in good condition.

  Safe

  At Risk

  N/A

• 3.3 Seat belts are being worn during operation.

  Safe

  At Risk

  N/A

• 3.4 Back-up alarm is operable with guide available.

  Safe

  At Risk

  N/A

4. Hazardous Chemicals/Air Contaminants

• 4.1 The Hazard Communication (Right-to-Know) poster / written program on job.

  Safe

  At Risk

  N/A

• 4.1.1 Employees are familiar with the program.

  Safe

  At Risk

  N/A

• 4.2 List of hazardous materials on job.

  Safe

  At Risk

  N/A

• 4.3 Material Safety Data Sheets are being utilized.

  Safe

  At Risk

  N/A

• 4.4 Proper containers are in use with correct labels.

  Safe

  At Risk

  N/A

• Comments:

5. General

• 5.1 Safe access to work area.

  Safe

  At Risk

  N/A

• 5.2 Good housekeeping and material storage.

  Safe

  At Risk

  N/A

• 5.3 Barricades, debris protection, and warning signs are in place.

  Safe

  At Risk

  N/A

• 5.4 Shoring properly installed; engineers stamp on drawings.

  Safe

  At Risk

  N/A

• 5.5 Excavated areas and trenches are properly protected.

  Safe

  At Risk

  N/A

• 5.6 Eye wash is available.

  Safe

  At Risk

  N/A

• 5.7 Fire extinguisher is in good condition with a current inspection tag (within 50').

  Safe

  At Risk

  N/A

• 5.8 First Aid kit available.

  Safe

  At Risk

  N/A

• 5.9 Employee certified in first aid available.

  Yes

  No

  N/A

• 5.10 Trucks: Are in safe/good condition and compliant with DOT regulations.

  Safe

  At Risk

  N/A

• Comments:

6. Miscellaneous Documents Available

• 6.1 OSHA Poster/Log.

  Safe

  At Risk

  N/A

• 6.2 Emergency phone number card.

  Safe

  At Risk

  N/A

• 6.3 Daily Pre-Task card reviewed.

  Safe

  At Risk

  N/A

• 6.4 SWPPP inspection documented.

  Safe

  At Risk

  N/A

• 6.5 I9 logs are up-to-date.

  Safe

  At Risk

  N/A

• Comments:

• Select date

  Date