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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Location/Work Description/Personnel
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Work Zone Safety
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1. Actively Managing Work Area ?
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Poor
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Needs Improvement
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Good
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2. Signs Flaggers and Police Details being used properly?
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Yes
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Needs improvement
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No
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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?
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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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4. 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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5. 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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Work Practices
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1. Takes precautions and maintains a safe position when working.
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Good
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Needs Improvement
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Poor
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2. uses equipment and tools in a way that protects them and others from danger?
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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. 2-5-25 rule in place?
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Yes
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Needs improvement
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No
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3. Equipment properly grounded
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Good
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Needs improvement
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Poor
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4. Safety equipment accessible, inspected, fully stocked and utilized?
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Good
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Needs improvement
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Poor
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5. Grounding procedures adhered to?
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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 been 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. 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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4. Proper grounding procedures adhered to?
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Yes
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Needs improvement
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No
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5. All activity in workplace being performed in a safe manner?
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Yes
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Needs improvement
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No