C P Ward Inc.

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Housekeeping

• Project work areas are clean, free of excess trash/debris

  Yes

  No

  N/A

• Project materials have been stored / stacked safely

  Yes

  No

  N/A

• Project materials stored with clear aisles for travel

  Yes

  No

  N/A

• Trash receptacles are provided for work areas

  Yes

  No

  N/A

• Portable water containers on site with adequate amount for crews

  Yes

  No

  N/A

• Portable water containers clean / sealed with cups properly contained

  Yes

  No

  N/A

• Are jobsite port-a-lets clean and properly placed

  Yes

  No

  N/A

Personal Protective Equipment

• Hard hats worn / maintained as required by PPE pgm/mgf recommendations

  Yes

  No

  N/A

• Safety glasses in use

  Yes

  No

  N/A

• Hearing protection is worn where required

  Yes

  No

  N/A

• Face shield or googles worn as required

  Yes

  No

  N/A

• High visibility garments worn where required

  Yes

  No

  N/A

• Safety toe footwear being worn

  Yes

  No

  N/A

• Correct gloves being utilized for task being conducted

  Yes

  No

  N/A

• Respirators utilized as required

  Yes

  No

  N/A

Fall Protection

• Body harness worn properly

  Yes

  No

  N/A

• Lanyards are adequately secured to suitable anchorage

  Yes

  No

  N/A

• Perimeter guarding in place

  Yes

  No

  N/A

• Man-Lift tie off points are in good condition

  Yes

  No

  N/A

Excavations

• Sloped, shielded or shored properly based on soil classification

  Yes

  No

  N/A

• Spoil set back 2' from excavation

  Yes

  No

  N/A

• Access and Egress is provided every 25 feet

  Yes

  No

  N/A

• Daily / periodic documented inspections conducted by competent person and posted at excavation

  Yes

  No

  N/A

• Propane bottles removed prior to start of welding

  Yes

  No

  N/A

• Ladders secured at top and extend 3' above

  Yes

  No

  N/A

• Ladder users facing ladders ascending and descending and not carrying a load

  Yes

  No

  N/A

• No work performed on slope above workers in the bottom of excavation

  Yes

  No

  N/A

• No workers in excavation during overhead lifts

  Yes

  No

  N/A

• Trench box certification paperwork on site

  Yes

  No

  N/A

• Water pumps utilized as necessary to reduce water accumulation and competent person monitoring pump

  Yes

  No

  N/A

• Ventilation adequate for any hazards that may exist

  Yes

  No

  N/A

• Barricades / Barriers installed for traffic control ( within 25' of roadway) pedestrian warning as needed

  Yes

  No

  N/A

Scaffolds and Ladders

• Scaffold built per specification

  Yes

  No

  N/A

• Scaffolding is inspected/tagged daily per requirements by competent person

  Yes

  No

  N/A

• Proper access and egress ladders provided, secured, and extends beyond the landing by 3'

  Yes

  No

  N/A

Hoisting and Lifting Equipment

• Proper rigging equipment utilized and in good condition

  Yes

  No

  N/A

• Proper rigging techniques used

  Yes

  No

  N/A

• Proper signaling used during lifts

  Yes

  No

  N/A

• Tag lines utilized during lifts

  Yes

  No

  N/A

• Stickers on fuel tank

  Yes

  No

  N/A

Tools and equipment

• Proper tools used for the job being performed

  Yes

  No

  N/A

• Guards on all hand grinders/circular saws (w/o modifications made)

  Yes

  No

  N/A

• Tools being carried correctly

  Yes

  No

  N/A

• Electrical cords free of visible damage

  Yes

  No

  N/A

• Tools are maintained in a safe condition

  Yes

  No

  N/A

• Tools are stored properly

  Yes

  No

  N/A

• Pneumatic / hydraulic hose connections properly secured (crows feet pins, whip checks)

  Yes

  No

  N/A

• Rebar caps installed on exposed rebar

  Yes

  No

  N/A

Fire Protection

• Flammables stored properly (bulk, portable in vehicles, proper distance, etc)

  Yes

  No

  N/A

• Oxygen and combustible cylinders separated

  Yes

  No

  N/A

• Containers labeled as to content

  Yes

  No

  N/A

• Fire extinguishers properly located and has current inspection tag

  Yes

  No

  N/A

• Compressed gas cylinders properly maintained

  Yes

  No

  N/A

• Containment of hot work and welding screens as required

  Yes

  No

  N/A

• Regulator gauges properly attached and maintained. Flash arrestors installed

  Yes

  No

  N/A

• Bulk fuel tanks grounded and electrical classification maintained

  Yes

  No

  N/A

• Portable equipment allowed to cool prior to refueling

  Yes

  No

  N/A

• Spout / funnel used during portable container refueling

  Yes

  No

  N/A

JSA

• Daily JSA available for review

  Yes

  No

  N/A

• Safety tailgate meeting content confirmed by worker interview(s)

  Yes

  No

  N/A

• JSA job steps described task being performed

  Yes

  No

  N/A

• JSA addresses specific hazards at the task location

  Yes

  No

  N/A

• JSA indicates utilization of Foreman/Employee handbooks for job discussions

  Yes

  No

  N/A

Responsibilities

• MSDS's are readily available

  Yes

  No

  N/A

• Supervisor observed making safe behavior interventions

  Yes

  No

  N/A

• Employees observed making safe behavior interventions

  Yes

  No

  N/A

• Stop work authority observed being used by supervisor or employee(s)

  Yes

  No

  N/A

Power Line Crossings

• Overhead power lines have been identified

  Yes

  No

  N/A

• Proper signage posted, legible, visible to approaching equipment

  Yes

  No

  N/A

• Goal posts and flagging are in place

  Yes

  No

  N/A

Seat belts used by all occupants

• Observed damage has been reported

  Yes

  No

  N/A

• Yes

  No

  N/A

• Power line spotter is present during work near / under power lines and when passing equipment under lines

  Yes

  No

  N/A

• Spotter has proper PPE and horn while performing spotter duties

  Yes

  No

  N/A

Confined Space Entry

• CSE properly identified as permit / non-permit required

  Yes

  No

  N/A

• CSE properly cleared, cleaned and isolated

  Yes

  No

  N/A

• CSE respiratory protection adequate for the task (ventilation / air supply)

  Yes

  No

  N/A

• CSE checklist and procedures on site with the attendant

  Yes

  No

  N/A

• Permitted CSE rescue equipment on site with trained personnel on hand

  Yes

  No

  N/A

• CSE lighting is 32v or less and all electrical shock concerns eliminated / mitigated

  Yes

  No

  N/A

• CSE external / introduced air contaminate concerns have been eliminated

  Yes

  No

  N/A

• Environmental hazardous monitoring is adequate for the task performed

  Yes

  No

  N/A

Welding / Cutting

• Hard hats/Safety glasses worn outside the immediate welding zone

  Yes

  No

  N/A

• Welding leads are positioned to prevent tripping hazards

  Yes

  No

  N/A

• Spent rods are properly disposed of in a bucket

  Yes

  No

  N/A

• Fully operational/inspected fire extinguishers are present at "hot work" location

  Yes

  No

  N/A

• Flash arrestors in place on gauges

  Yes

  No

  N/A

• Proper cribbing support supplied for bottom welding to prevent subsidence

  Yes

  No

  N/A

• Proper excavation floor to prevent laying in mud/water to weld

  Yes

  No

  N/A

• No loose clothing worn during grinding / buffing operations

  Yes

  No

  N/A

• Thermal burn protection being worn

  Yes

  No

  N/A

• Double eye protection used during buffing / grinding

  Yes

  No

  N/A

Abrasive Blasting and Coating

• Hoods with proper air supply being used

  Yes

  No

  N/A

• CO monitors installed (inside hood/inline or both when applicable)

  Yes

  No

  N/A

• Unnecessary personnel are cleared crosswind / upwind of the abrasive blast

  Yes

  No

  N/A

• Proper respiratory protection being worn during coating (wet & dry powder)

  Yes

  No

  N/A

• Remote switches are protected from inadvertent operations

  Yes

  No

  N/A

• Abrasive media pot work area clear of trip hazards, empty bags, pallets, etc.

  Yes

  No

  N/A

• Environmental requirements are being met where applicable

  Yes

  No

  N/A

• Hoses, hose connections are in proper working order, cotter pins in place, whip checks on all connections

  Yes

  No

  N/A

• Personnel fit tested when applicable and medical questionnaires completed

  Yes

  No

  N/A

Environmental

• Silt fences and/or environmental logs installed and maintained

  Yes

  No

  N/A

• Wetland signage properly installed and maintained

  Yes

  No

  N/A

• Equipment is supplied with spill kits

  Yes

  No

  N/A

• No re-fueling within 100' of a wetland area

  Yes

  No

  N/A

• ROW boundary markers properly installed and being maintained

  Yes

  No

  N/A

• SPCC plan on site and requirements being met

  Yes

  No

  N/A

• Secondary containment in place for equipment / portable fuel storage etc.

  Yes

  No

  N/A

• Oil and fuel storage areas bermed and maintained dry

  Yes

  No

  N/A

• Proper ROW berming erosion control and flow water correctly directed to drainage area

  Yes

  No

  N/A

• Waste petroleum containers properly labeled and in secondary containment

  Yes

  No

  N/A

Flagging

• DOT (Federal, local) temporary traffic control plan, specific to the site, exists

  Yes

  No

  N/A

• Traffic control signage properly stored when flaggers not in attendance

  Yes

  No

  N/A

• Flaggers wearing proper PPE

  Yes

  No

  N/A

• Flaggers properly trained

  Yes

  No

  N/A

• Flaggers properly using hand and sign communications with traffic

  Yes

  No

  N/A

Body Position

• Workers not observed in pinch point / caught between line of fire

  Yes

  No

  N/A

• Workers not observed in falling object line of fire

  Yes

  No

  N/A

• Workers not observed in a struck by line of fire

  Yes

  No

  N/A

• Workers observed using control to prevent strike against / strain line of fire

  Yes

  No

  N/A

• Workers observed using proper lifting techniques or helping each other

  Yes

  No

  N/A

• Workers observed ascending / descending in a safe manner

  Yes

  No

  N/A

• Workers observed properly using push / pull for the task to be done

  Yes

  No

  N/A

• Workers observed properly maintaining focus (eyes) on the task being done

  Yes

  No

  N/A

• Workers observed using proper center of balance / walking technique to prevent falls

  Yes

  No

  N/A

• Workers are not under suspended loads

  Yes

  No

  N/A

DOT

• All documents in cab of trucks secured in a binder

  Yes

  No

  N/A

• Crew truck checklist available / completed correctly

  Yes

  No

  N/A

• All lights, all lighting, windshield washer and wipers operational

  Yes

  No

  N/A

• Fire extinguisher secured and charged

  Yes

  No

  N/A

• Driver documentation in order (DL, CDL, medical card current)

  Yes

  No

  N/A

• Windshields free of cracks

  Yes

  No

  N/A

• Electrical cords inspected (Color coded)

  Yes

  No

  N/A

• Ladders inspected (color coded)

  Yes

  No

  N/A

• Rigging tackle inspected / documented

  Yes

  No

  N/A

• Fall protection maintained and has current inspection documented

  Yes

  No

  N/A

• Forklift operator has certification

  Yes

  No

  N/A

• Personnel lifts inspected and documented

  Yes

  No

  N/A

• Daily equipment checklists available for review / completed for the day's operations

  Yes

  No

  N/A

Lock - Out / Tag-Out Review

• Is a review conducted at least once a year

  Yes

  No

  N/A

• Procedures properly followed during LOTO operations

  Yes

  No

  N/A

• Employees involved understand procedure

  Yes

  No

  N/A

• Proper documentation present

  Yes

  No

  N/A

Other Site Specific

• Other

  Yes

  No

  N/A

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