Information

  • Document No.

  • Audit Title

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

  • Select date

  • Observers

  • # of people observed

  • Location of Observation Site Name Address City State

  • Observation Items

  • Work Zone Safety

  • 1. Adequate warning signs

  • Yes

  • Needs Improvement

  • No

  • 2. Flaggers/Police Details being utilized properly

  • Safe

  • Needs Improvement

  • Unsafe

  • 4. Actively Managing Work Area - Good Housekeeping

  • Poor

  • Needs Improvement

  • Good

  • Communication & Risk Assessment

  • 1. A complete, well-written, Job brief has been performed identifying the hazards and risks associated with the job and the steps put in place to reduce those risks. (Ie: proximity of energized lines, grounding, shoring, low hanging pipes, etc.)

  • Poor

  • Needs Improvement

  • Good

  • 2. Crew Members are focused on the task at hand and demonstrate a clear understanding of job hazards and conditions.

  • Poor

  • Needs Improvement

  • Good

  • Methods and Procedures

  • 1. Follows proper grounding procedures

  • Yes

  • Needs Improvement

  • No

  • 2. Were required notifications and proper permits obtained (Confined Space, hot work, area work permit, etc.)

  • Safe

  • Needs Improvement

  • Unsafe

  • 3. Were Three points of contact utilized

  • Yes

  • Needs Improvement

  • No

  • 6. Is housekeeping of the trucks adequate?

  • Yes

  • Needs Improvement

  • No

  • 7. Is Proper PPE being utilized?

  • Good

  • Needs improvement

  • Poor

  • 8. Understands the consequences of not wearing proper PPE that protects from the hazards of the job

  • Good

  • Needs improvement

  • Poor

  • 9.Using the correct equipment and tools for the job

  • Good

  • Needs Improvement

  • Poor

  • 10. Maintains the equipment and tools in good working condition

  • Good

  • Needs Improvement

  • Poor

  • 11. Uses equipment or tools in a way that protects them and others in the immediate area.

  • Good

  • Needs Improvement

  • Poor

  • Work Practices

  • 1.Maintains awareness of other activities in the work area ie.( moving equipment near excavations, confined areas, traffic, etc.)

  • Good

  • Needs Improvement

  • Poor

  • 2.Takes precautions and maintains a safe position when working in unique conditions

  • Good

  • Needs Improvement

  • Poor

  • 3.Uses a safe route for the movement of materials

  • Good

  • Needs Improvement

  • Poor

  • 4.Uses their bodies and hands in safe manner

  • Good

  • Needs Improvement

  • Poor

  • Workplace environment

  • 1.Proper site preparation has been performed

  • Good

  • Needs Improvement

  • Poor

  • 2.Exits/escape routes are clearly defined and visible

  • Good

  • Needs improvement

  • Poor

  • 3. Fire extinguishers, spill cleanup, first aid and burn kits visible, accessible, inspected, and fully stocked.

  • Safe

  • Needs improvement

  • Unsafe

  • 4. Uses wheel chocks properly

  • Good

  • Needs improvement

  • Poor

  • 5. Equipment properly grounded

  • Good

  • Needs improvement

  • Poor

  • 6. Vehicles properly positioned at work site.

  • Yes

  • Needs improvement

  • No

  • 7.housekeeping of vehicles or equipment is acceptable

  • Good

  • Needs improvement

  • Poor

  • 8. Cargo and loads are contained, tied down, and secured in a manner that prevents it from becoming unsafe.

  • Yes

  • Needs Improvement

  • No

  • 9. Pintle latch is closed and pin is inserted.

  • Yes

  • Needs Improvement

  • No

  • 10. Trailer electrical cord is securely connected.

  • Yes

  • Needs improvement

  • No

  • Excavation

  • 1. Has a dig safe number assigned to the work site

  • Yes

  • Needs improvement

  • No

  • 2. All underground facilities have been identified (ie gas, electric, telephone, water)

  • Good

  • Needs improvement

  • Poor

  • 3. Method used for identifying the underground facilities is an accepted practice.

  • Safe

  • Needs improvement

  • Unsafe

  • 4. Soil classification and protective systems have been identified and are in place.

  • Safe

  • Needs Improvement

  • Unsafe

  • 5. Has proper soil setback been maintained? (24 inches)

  • Yes

  • Needs improvement

  • No

  • 6. Are workers clear from equipment and out of swing radius when digging, moving, or handling loads is in progress?

  • Good

  • Needs Improvement

  • Poor

  • 7. has proper access/egress been established? (Ladder at 4' in depth, no more than 25' travel and extending 3' above the excavation

  • Yes

  • Needs Improvement

  • No

  • 8. Has adequate protection been provided for the excavation if it left open unattended?

  • Safe

  • Needs Improvement

  • Unsafe

The templates available in our Public Library have been created by our customers and employees to help get you started using SafetyCulture's solutions. The templates are intended to be used as hypothetical examples only and should not be used as a substitute for professional advice. You should seek your own professional advice to determine if the use of a template is permissible in your workplace or jurisdiction. You should independently determine whether the template is suitable for your circumstances.