Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
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Select date
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Observers
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# of people observed
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Location of Observation Site Name Address City State
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Observation Items
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Work Zone Safety
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1. Adequate warning signs
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Yes
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Needs Improvement
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No
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2. Flaggers/Police Details being utilized properly
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Safe
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Needs Improvement
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Unsafe
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4. Actively Managing Work Area - Good Housekeeping
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Poor
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Needs Improvement
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Good
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Communication & Risk Assessment
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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.)
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Poor
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Needs Improvement
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Good
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2. Crew Members are focused on the task at hand and demonstrate a clear understanding of job hazards and conditions.
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Poor
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Needs Improvement
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Good
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Methods and Procedures
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1. Follows proper grounding procedures
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Yes
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Needs Improvement
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No
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2. Were required notifications and proper permits obtained (Confined Space, hot work, area work permit, etc.)
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Safe
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Needs Improvement
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Unsafe
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3. Were Three points of contact utilized
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Yes
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Needs Improvement
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No
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6. Is housekeeping of the trucks adequate?
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Yes
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Needs Improvement
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No
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7. Is Proper PPE being utilized?
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Good
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Needs improvement
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Poor
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8. Understands the consequences of not wearing proper PPE that protects from the hazards of the job
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Good
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Needs improvement
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Poor
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9.Using the correct equipment and tools for the job
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Good
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Needs Improvement
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Poor
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10. Maintains the equipment and tools in good working condition
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Good
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Needs Improvement
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Poor
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11. Uses equipment or tools in a way that protects them and others in the immediate area.
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Good
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Needs Improvement
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Poor
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Work Practices
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1.Maintains awareness of other activities in the work area ie.( moving equipment near excavations, confined areas, traffic, etc.)
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Good
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Needs Improvement
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Poor
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2.Takes precautions and maintains a safe position when working in unique conditions
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Good
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Needs Improvement
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Poor
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3.Uses a safe route for the movement of materials
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Good
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Needs Improvement
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Poor
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4.Uses their bodies and hands in safe manner
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Good
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Needs Improvement
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Poor
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Workplace environment
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1.Proper site preparation has been performed
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Good
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Needs Improvement
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Poor
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2.Exits/escape routes are clearly defined and visible
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Good
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Needs improvement
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Poor
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3. Fire extinguishers, spill cleanup, first aid and burn kits visible, accessible, inspected, and fully stocked.
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Safe
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Needs improvement
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Unsafe
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4. Uses wheel chocks properly
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Good
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Needs improvement
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Poor
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5. Equipment properly grounded
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Good
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Needs improvement
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Poor
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6. Vehicles properly positioned at work site.
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Yes
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Needs improvement
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No
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7.housekeeping of vehicles or equipment is acceptable
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Good
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Needs improvement
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Poor
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8. Cargo and loads are contained, tied down, and secured in a manner that prevents it from becoming unsafe.
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Yes
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Needs Improvement
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No
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9. Pintle latch is closed and pin is inserted.
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Yes
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Needs Improvement
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No
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10. Trailer electrical cord is securely connected.
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Yes
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Needs improvement
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No
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Excavation
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1. Has a dig safe number assigned to the work site
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Yes
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Needs improvement
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No
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2. All underground facilities have been identified (ie gas, electric, telephone, water)
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Good
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Needs improvement
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Poor
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3. Method used for identifying the underground facilities is an accepted practice.
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Safe
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Needs improvement
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Unsafe
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4. Soil classification and protective systems have been identified and are in place.
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Safe
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Needs Improvement
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Unsafe
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5. Has proper soil setback been maintained? (24 inches)
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Yes
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Needs improvement
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No
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6. Are workers clear from equipment and out of swing radius when digging, moving, or handling loads is in progress?
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Good
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Needs Improvement
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Poor
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7. has proper access/egress been established? (Ladder at 4' in depth, no more than 25' travel and extending 3' above the excavation
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Yes
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Needs Improvement
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No
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8. Has adequate protection been provided for the excavation if it left open unattended?
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Safe
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Needs Improvement
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Unsafe