C. J HUGHES CONSTRUCTION CO. INC.

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

WORK ZONE

• IS WORK ZONE SET UP PROPERLY?

  Safe

  At Risk

  N/A

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  Media

• IS SIGNS AT PROPER DISTANCES?

  Safe

  At Risk

  N/A

• IS THERE A SUFFICIENT AMOUNT OF CONES AROUND VEHICLES AND EQUIPMENT?

  Safe

  At Risk

  N/A

• IS THE SIGNS AND STANDS IN GOOD CONDITION AND SUITABLE FOR THE TYPE OF WORK ZONE?

  Safe

  At Risk

  N/A

• DO THEY HAVE THE PROPER FLAGGING EQUIPMENT, STOP AND SLOW PADDLES, TWO WAY RADIOS?

  Safe

  At Risk

  N/A

• IS THE FLAGMEN THE PROPER DISTANCE APART FOR SAFE CONTROL OF TRAFFIC?

  Safe

  At Risk

  N/A

• ARE THEY PROPERLY TRAINED, OR CERTIFIED TO FLAG?

  Safe

  At Risk

  N/A

• CAN THEY SHOW PROOF OF TRAINING, AND IS IT UP TO DATE?

  Safe

  At Risk

  N/A

• IS THE PUBLIC PROTECTED FROM OPEN HOLES OR MOVING EQUIPMENT?

  Safe

  At Risk

  N/A

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  Media

EXCAVATION SAFETY

• IS THERE A COMPETENT PERSON ON SIGHT?

  Yes

  No

  N/A

• CAN THE COMPETENT PERSON SHOW PROOF BY CARD OR CERTIFICATE?

  Yes

  No

  N/A

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• HAS A ONE CALL BEEN MADE AND UTILITIES BEEN MARKED?

  Yes

  No

  N/A

• IS THERE A TICKET # AVAILABLE ON SITE?

  Yes

  No

  N/A

• IS THE SPOIL PILE KEPT BACK 2 FEET FROM THE EXCAVATION?

  Safe

  At Risk

  N/A

• IS THE HOLE MORE THAN 4 FEET IN DEPTH?

  Yes

  No

  N/A

• IF YES, IS THERE PROPER MEANS OF EXIT AND ENTRY?

  Yes

  No

  N/A

• IF A LADDER IS BEING USED, DOES IT EXTEND 3 FEET ABOVE THE TRENCH AND IS IT TIED OFF?

  Safe

  At Risk

  N/A

• IF RAMPS ARE DUG IN, ARE THEY SUITABLE FOR ENTRY AND EXIT?

  Safe

  At Risk

  N/A

• HAS THE TRENCH BEEN SLOPED, BENCHED OR SHORED IF OVER 5 FEET IN DEPTH?

  Yes

  No

  N/A

• IS IT DONE ACCORDING TO OSHA REGULATIONS?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• HARD HATS BEING WORN?

  Safe

  At Risk

  N/A

• ARE THEY IN GOOD CONDITION AND NOT EXPIRED?

  Safe

  At Risk

  N/A

• SAFETY GLASSES BEING WORN?

  Safe

  At Risk

  N/A

• SIDE SHIELDS BEING USED?

  Safe

  At Risk

  N/A

• FACE SHIELDS BEING USED WHEN REQUIRED?

  Safe

  At Risk

  N/A

• EAR PLUGS BEING USED WHEN REQUIRED?

  Safe

  At Risk

  N/A

• PROPER GLOVES BEING USED FOR THE TASK BEING PERFORMED?

  Safe

  At Risk

  N/A

• PROPER VEST BEING WORN? AND IN GOOD CONDITION?

  Safe

  At Risk

  N/A

• STEEL TOE OR SAFETY TOE WORK BOOTS BEING WORN?

  Safe

  At Risk

  N/A

• ARE ALL OXYGEN MONITORS BEING WORN IN THE PROPER LOCATIONS WITHIN BREATHING ZONE?

  Safe

  At Risk

  N/A

• ARE THE MONITORS WORKING PROPERLY

  Safe

  At Risk

  N/A

• IS FR CLOTHING BEING WORN WHEN REQUIRED?

  Safe

  At Risk

  N/A

TRUCKS AND EQUIPMENT

• TRUCKS, TRAILERS, AND AIR COMPRESSOR'S WHEELS DOUBLE CHOCKED?

  Safe

  At Risk

  N/A

• BUCKETS ON EQUIPMENT GROUNDED, NOT RAISED OFF OF GROUND?

  Safe

  At Risk

  N/A

• KEYS REMOVED FROM ALL TRUCKS AND EQUIPMENT WHEN NOT OCCUPIED?

  Safe

  At Risk

  N/A

• ALL LIGHTS WORKING PROPERLY?

  Safe

  At Risk

  N/A

• ANY LEAKS, OIL, ANTIFREEZE, HYDRAULIC ?<br>

  Safe

  At Risk

  N/A

• BACKUP ALARMS WORKING?

  Yes

  No

  N/A

• OPERATORS OF EQUIPMENT AND TRUCKS WEARING SEAT BELTS WHEN OPERATING?

  Safe

  At Risk

  N/A

• EQUIPMENT CHECKS BEING PERFORMED DAILY?

  Safe

  At Risk

  N/A

• HOUSE KEEPING IN TOOL TRAILER OR TOOL HOUSE BEING KEPT?

  Yes

  No

  N/A

TOOLS

• HAND AND SMALL TOOLS IN GOOD CONDITION?

  Safe

  At Risk

  N/A

• TOOL CHECKS BEING PERFORMED DAILY/

  Safe

  At Risk

  N/A

• HAVE THE RIGHT TOOLS TO DO JOB CORRECTLY?

  Safe

  At Risk

  N/A

• ARE SLINGS AND CHAINS IN GOOD CONDITION?

  Safe

  At Risk

  N/A

• ARE THEY APPROPRIATE FOR WHAT IS BEING LIFTED, PULLED OR TIED DOWN?

  Yes

  No

  N/A

• DOES THE LIFTING HOOKS HAVE SAFETY LATCHES?

  Safe

  At Risk

  N/A

EMPLOYEE TRAINING AND QUALIFICATIONS

• ARE THE ONES PERFORMING TASKS TRAINED AND QUALIFIED TO DO SO?

  Safe

  At Risk

  N/A

• ARE THEY CARRYING A VALID O.Q, OR QUALIFICATION CARD TO PROVE SO?

  Safe

  At Risk

  N/A

• IF NOT, IS THERE SOMEONE THERE WHO IS QUALIFIED TO WATCH AND VERIFY TASK IS BEING DONE CORRECTLY?

  Safe

  At Risk

  N/A

• IS THERE ENOUGH QUALIFIED PEOPLE ON THE JOB?

  Safe

  At Risk

  N/A

EQUIPMENT WITH REQUIRED CALIBRATION OR INPSECTION

• HAVE ALL FIRE EXTINGUISHERS BEEN INSPECTED WITHIN THE LAST 30 DAYS AND INITIALED ON BACK OF TAG?

  Safe

  At Risk

  N/A

• IS THE TAG AVAILABLE AND IDENTIFIED PER EXTINGUISHER /

  Safe

  At Risk

  N/A

• HAS ALL GAS SNIFFERS AND TRACKERS BEEN CALIBRATED WITHIN THE CUSTOMERS REQUIRED TIME LINE (3 MONTHS) ?

  Safe

  At Risk

  N/A

• ALL OTHER CALIBRATION REQUIRED EQUIPMENT?

  Safe

  At Risk

  N/A

EMERGENCY RESPONSE AND FIRST AID

• IS THERE A ENOUGH PEOPLE QUALIFIED IN FIRST AID ON SITE?

  Safe

  At Risk

  N/A

• ARE THE FIRST AID KITS PROPERLY STOCKED AND UP TO DATE, WITH INSPECTION LABEL PRESENT?

  Yes

  No

  N/A

• ARE THERE EYE WASH STATIONS STOCKED AND UP TO DATE ON SITE?

  Safe

  At Risk

  N/A

HAZARD COMMUNICATION

• IS COPIES OF MSDS, OR SDS SHEETS AVAILABLE WHETHER ELECTRONIC OR PAPER FORM?

  Safe

  At Risk

  N/A

• ARE ALL EMPLOYEES AWARE THIS INFORMATION'S LOCATION ON SITE?

  Safe

  At Risk

  N/A

HAZARDOUS,FLAMMABLE MATERIAL STORAGE AND CONTAINMENT

• ARE ALL GAS CANS AND FUEL STORAGE TANKS PROPERLY LABELED?

  Safe

  At Risk

  N/A

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• ARE ALL LEAK-SEEK BOTTLES PROPERLY LABELED?

  Safe

  At Risk

  N/A

REQUIRED DAILY AND WEEKLY PAPERWORK

• HAS JSA BEEN FILLED OUT?

  Safe

  At Risk

  N/A

• WAS JSA COMMUNICATED TO THE CREW?

  Yes

  No

  N/A

• DOES THE JSA COVER APPROPRIATE HAZARDS FOR TASK BEING PERFORMED?

  Safe

  At Risk

  N/A

HYGIENE & EMPLOYEE HEALTH

• IS RESTROOMS AVAILABLE?

  Safe

  At Risk

  N/A

• IS THERE WATER AVAILABLE FOR EMPLOYEE'S

  Safe

  At Risk

  N/A

• ARE THEY DRINKING ENOUGH WATER TO PREVENT HEAT STRESS ILLNESS?

  Safe

  At Risk

  N/A

• Audit done by

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