Title Page

  • Document No.

  • Job Name

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Crew Leader

All of the following questions will be answered in one of three ways: "YES" (green) 2 points - met or exceeded expectations for this specific audit question. "Improve" (yellow) 1 point - Generally met expectations but some improvements are needed. "NO" (red) -2 points - Failed to meet expectations or a serious violation was identified. If an audit question does not apply to the job sites activities, NA "not applicable" will be selected - no points.

Descriptive photo

  • Overall safety rating

  • Add media

1.0. First Impression

  • 1.1. Company vehicles parked in safe location?<br>

  • 1.2. Company vehicles reasonably clean and organized?

  • 1.3. Are materials on ground reasonably organized?

  • Add media

2.0. Ladder

  • 2.1. Do ladders appear to be in good condition?

  • 2.2. Is the ladder set up and positioned correctly?

  • 2.3. Is the area near the ladder free from slip/trip hazards?

  • 2.4. Are employees maintaining 3 points of contact while using ladder?

  • 2.5. Is the ladder secured to prevent movement?

  • 2.6. Is a step, ramp or ladder in place at break in elevation of 19", or more?

  • Add media

3.0. Fall Protection

  • 3.1. Does it appear fall protection was planned for?

  • 3.2. Is adequate fall protection equipment on site?

  • 3.3. Are employees protected from falling 6', or more?

  • 3.4. Are warning lines being maintained at the correct height and distance from edge?

  • 3.5. If applicable; Does the safety monitor appear trained and aware of their responsibilities?

  • 3.6. Is the area within 6' of the roof edge free of slip/trip hazards?

  • 3.7. Does it appear a Competent Person is on site?

  • Add media

4.0. Housekeeping

  • 4.1. Is the work area reasonably clean and organized?

  • 4.2. Is the surrounding area free of debris that has been thrown, or blown, off the roof?

  • 4.3. Are pedestrians and building occupants protected from construction activity?

  • Add media

5.0. Electrical

  • 5.1. Electrical cords in good condition?

  • 5.2. Is GFI protection being used with all electrical cords?

  • 5.3. Are employees protected from energized parts?

  • Add media

6.0. Chemicals / Fuels

  • 6.1. Are containers labeled?

  • 6.2. Flammables stored in safety can with self-closing lid?

  • 6.3. Is compressed gas upright and secure?

  • 6.4. Are safety data sheets (SDS) on site or readily available?

  • Add media

7.0. Fire Prevention/Protection

  • 7.1. Are fire extinguishers fully charged and immediately available?

  • 7.2. Is an up to date annual inspection tag affixed to the extinguisher?

  • 7.3. Are torches in good condition and being operated safely?

  • Add media

8.0. Equipment

  • 8.1. Forklift operators certified?

  • 8.2. Does equipment appear to be reasonably maintained?

  • 8.3. Did operator conduct an inspection of the forklift and surrounding work area?

  • 8.4. Was the equipment being operated in a safe manner?

  • Add media

9.0. Personal Protective Equipment (PPE)

  • 9.1. Are hard hats being worn when required?

  • 9.2. Is adequate eye protection being worn?

  • 9.3. Are nitrile gloves being worn when working with solvents?

  • 9.4. Are leather work boots being worn?

  • 9.5. Is hearing protection readily available?

  • 9.6. Are employees dressed in appropriate work clothes?

  • Add media

10.0. Emergency Response

  • 10.1. Is an adequately stocked first-aid kit readily available?

  • 10.2. Is the foremen aware of where the nearest medical facility is?

11.0. OTHER hazards/concerns

  • 11.1. Other hazards or concerns

  • Add media

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.