BMC SOCAL

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Scaffold Safety

• Are power lines at least the minimum distance away from scaffolding? (3' for LV, 10' for HV)

  Safe

  At Risk

  N/A

• Is the scaffold suitable for the loads and materials that will be placed this day as well as for the weather conditions and the employees using it?

  Safe

  At Risk

  N/A

• Is the scaffold secured to a building or structure as required? (every 26' vertically, 30' horizontally).

  Safe

  At Risk

  N/A

• Is the scaffold plumb, square and level?

  Safe

  At Risk

  N/A

• Are footings sound, rigid and capable of supporting load?

  Safe

  At Risk

  N/A

• Are the legs, posts, frames and uprights on base plates and mud sills?

  Safe

  At Risk

  N/A

• Is the load of the scaffold within its maximum load capacity? (25#'s per SF).

  Safe

  At Risk

  N/A

• Are workers aware of the maximum load capacity of scaffold?

  Yes

  No

  N/A

• Are any bends, cracks, holes, rust, broken welds, or non-compatible parts visible on metal components?

  Safe

  At Risk

  N/A

• Is safe access available? (ladder frames, attachable ladders).

  Safe

  At Risk

  N/A

• Is the lumber (planks) used for scaffold -"Scaffold Grade"?

  Yes

  No

  N/A

• Are wooden planks free from cracks, splits larger than 1/4" and long end splits that exceed 12" long?

  Safe

  At Risk

  N/A

• Are planks that are 10' or shorter at least 6-12" over the center line of the support and no more than 18" over the end?

  Safe

  At Risk

  N/A

• Are all working platforms fully planked with a minimum of 3 planks?

  Yes

  No

  N/A

• Is the working platform 14" (or more) away from the wall or 18" or less if workers are plastering?

  Safe

  At Risk

  N/A

• Are guardrails and mid rails in place?

  Safe

  At Risk

  N/A

• Are toe boards installed on platforms in travel areas?

  Safe

  At Risk

  N/A

• Are braces, tie-ins and guying in use at each end and at appropriate intervals both vertically and horizontally to prevent tipping?

  Safe

  At Risk

  N/A

• Are tie backs loose or single wires?

  Yes

  No

  N/A

• Are A-frames and planks set up properly?

  Safe

  At Risk

  N/A

Tools & Equipment

• Are proper tools being used for the job?

  Yes

  No

  N/A

• Are tools being maintained in safe, good working condition?

  Yes

  No

  N/A

• Are mechanical guards in place on mixers, pumps, compressors, etc?

  Safe

  At Risk

  N/A

• Are electrical cords the proper size, grounded and in good working condition?

  Safe

  At Risk

  N/A

• Are ladders the correct type, size and in good working condition?

  Safe

  At Risk

  N/A

• Are ladders being used correctly?

  Safe

  At Risk

  N/A

Personal Protective Equipment

• Is ANSI Z87 approved safety glasses being worn by all workers?

  Safe

  At Risk

  N/A

• Is respiratory protection being used and in good working condition? (mixer operator or any affected EE)?

  Safe

  At Risk

  N/A

• Is hearing protection available and being used as needed?

  Safe

  At Risk

  N/A

• Are hard hats in good condition and being worn by all workers?

  Safe

  At Risk

  N/A

Housekeeping and Site Conditions

• Is immediate work area clear from debris and obstructions?

  Safe

  At Risk

  N/A

• Are trash containers available and being used?

  Yes

  No

  N/A

• Are trenches/excavations protected and at a minimum safe distance from work area and or scaffolding?

  Safe

  At Risk

  N/A

• Is rebar exposed without proper protection?

  Safe

  At Risk

  N/A

Heat Illness/General Items

• Temperature at time of audit?

  Safe

  At Risk

  N/A

• Are EE's trained and aware of heat illness and procedures?

  Safe

  At Risk

  N/A

• Is there an adequate supply of cool potable water provided and replenished as needed?

  Safe

  At Risk

  N/A

• Are disposable cups and water jugs on site and being used?

  Safe

  At Risk

  N/A

• Is shade provided on site?

  Safe

  At Risk

  N/A

• Is there a certified 1st aid/CPR trained person on site?

  Yes

  No

  N/A

• Are all required documents and safety items onsite?<br>(IIPP, HIPP, COSP, 1st aid kit, fire extinguisher)?

  Safe

  At Risk

  N/A

• Foreman

  Sign

• Person conducting audit

  Sign