Brent Scarbrough & Co

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

• Select date

  Date
• Add location
  Address

• Add media

  Media

Posted Emergency Numbers

• The nearest emergency facility has been located?

  Yes

  No

  N/A

• Posted emergency numbers / job site address has been located?<br>

  Yes

  No

  N/A

• First aid kit in truck and / or job site trailer?

  Yes

  No

  N/A

• Toilet facilities available?

  Yes

  No

  N/A

Fire Protection

• 10lbs fire extinguisher located on each machine?

  Yes

  No

  N/A

• Fire extinguisher has been serviced and is chared?

  Yes

  No

  N/A

Fuel Storage

• Job site fuel tanks are placed in steel contaminant dikes or inside of containment banks

  Yes

  No

  N/A

• Fuel storage area is properly placard and is readable at 100ft?

  Yes

  No

  N/A

• A 25 lbs fire ext. is located between 25'- 75' of each fuel tank

  Yes

  No

  N/A

• All fuel dispensing equipment is kept in good condition?

  Yes

  No

  N/A

PPE ( personal protective equipment)

• Each employee wearing hard hat while on the job? (This excludes operators in the machines)

  Yes

  No

  N/A

• Safety toe footwear being utilized?

  Yes

  No

  N/A

• Eye protection is being worn where hazards exists?

  Yes

  No

  N/A

• Hearing protection is being worn where hazards exist?

  Yes

  No

  N/A

• Respiratory protection is being worn where hazards exist?

  Yes

  No

  N/A

Confined Space Entry

• Check atmosphere (air quality) for acceptable entry conditions?

  Yes

  No

  N/A

• Log gas detector readings in lifeline, connect gas detector to harness and have attendant present before employee enters a confined space?

  Yes

  No

  N/A

• Put on harness, connect to lifeline, connect gas detector to harness and have attendant resent before employee enters a confined spaces?

  Yes

  No

  N/A

• If a hazardous atmosphere exists, ventilate area until atmospheric readings are acceptable for entry?

  Yes

  No

  N/A

• Follow item 3 in CSE, but now connect harness to a tripod and winch for entry?

  Yes

  No

  N/A

Trenching and Excavation

• Daily trenching log is filled out prior to work beginning?

  Yes

  No

  N/A

• There is at least one "competent person" on site who has the authority to stop work if an unsafe condition or act presents itself?

  Yes

  No

  N/A

• Spoil pile is kept back 24" from the edge of the trench when employees are working in the trench?

  Yes

  No

  N/A

• A safe exit is always provided every 25' - if a ladder is used, it must extend from the bottom of the trench to at least 3' above the top of the trench slope or trench box. Are ladders being correctly utilized

  Yes

  No

  N/A

• Unattended trenches are barricaded with caution tape or constructed of a spoil pile berm?

  Yes

  No

  N/A

Trench cave-in protection

• Proper slope being used? i.e. (1 1/2 : 1 type C soil, 1:1 type B soil 3/4 : 1 type A soil)

  Yes

  No

  N/A

• Trench box is being used in accordance with the manufacturers recommended tabulated data?

  Yes

  No

  N/A

• When a trench box and slope combination is used, is the slope starting 18" below the top of the trench box?

  Yes

  No

  N/A

• Trench boxes and components are in good shape?

  Yes

  No

  N/A

General concerns / housekeeping

• Job site entrances are clean and in good order?

  Yes

  No

  N/A

• Flagmen wearing an ANSI level II vest and have been trained when directing traffic?

  Yes

  No

  N/A

• All company vehicles maintain a camera, proof of insurance and blank accident form?

  Yes

  No

  N/A