Burgess Company - JHA

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

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  Address

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  Date

Daily Checklist

• All employees have been oriented?

  Yes

  No

  N/A

• Proper PPE being worn, including high visibility clothing?

  Yes

  No

  N/A

• Employees have reviewed daily JHA before beginning work?

  Yes

  No

  N/A

• Employees who operate tools/equipment have been trained, qualified and/or certified?

  Yes

  No

  N/A

• Back up alarm on all construction equipment audible of surrounding noise?<br>

  Yes

  No

  N/A

• MSDS training been provided?

  Yes

  No

  N/A

• Drinking water, cup dispenser, and trash receptacles provided?

  Yes

  No

  N/A

• Electrical cords and equipment been inspected and color coded?

  Yes

  No

  N/A

• Extension cords routed to prevent cuts, pinch points, etc?

  Yes

  No

  N/A

• Electrical tools and equipment are GFCI protected?

  Yes

  No

  N/A

• Protruded hazards protected?

  Yes

  No

  N/A

• Housekeeping on a continuous basis?

  Yes

  No

  N/A

• Fire extinguishers (ABC) located on all equipment?

  Yes

  No

  N/A

• Do all ladders meet OSHA/Cal-OSHA requirements?

  Yes

  No

  N/A

• All required inspections complete? (Scaffolding, harnesses, lifts, etc)

  Yes

  No

  N/A

• Weekly safety meeting completed? (Enter topic below)

  Yes

  No

  N/A

• Weekly GFCI inspection being conducted? (Temporary power, generator's, etc)

  Yes

  No

  N/A

• Only UL approved metal fuel cans being used?

  Yes

  No

  N/A

List all other safety concerns

Photos of safety hazards

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