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
OFFICE / TRAILER
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Project Specific Safety Plan
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CCI Safety Policy
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Is the JHA filled out and presented to the employees?
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Is the haz-mat poster posted?
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Equipment Release Form
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Fire Extinguishers (inspection tagged within the past 12 months)<br>
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TAGS Documented
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First aid kits
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Job site right – to - know posters
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Emergency plan and number
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GENERAL SAFETY
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PPE's properly stored
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Record of PPE inspections
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Safety glasses and hardhats
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Work area free of clutter and debris
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Tools and equipment stored properly
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Cords in good condition
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Mechanical safeguards in place - required guards on all tools
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Hot work permit used where needed
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GFCI's in use
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Ladders inspected and used properly
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Ladders 3 feet above landing and secured
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Guard rails and barricades erected and in good condition. If cable guardrails ensure tension is adequate.
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SCAFFOLD
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Scaffold erected properly
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Scaffold built on solid level ground
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Work surfaces free of debris
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Material neatly stored and stacked as required
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Materials protected from weather
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Proper material handling equipment being used
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EXCAVATION
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Excavations properly barricaded
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Adjacent ground and structures shored or laid-back to proper slope
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Ladders in use if needed and properly spaced at no more than 25 feet apart. If trench or opening is larger than 4 feet in depth a ladder is required.
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Excess materials stored at least 2 feet back from the edge of the excavation. All other materials are to be stored at not less than 6 feet away from top edge.
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All utilities clearly marked
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FLAMMABLES
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Containers clearly identified
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Fire extinguishers readily available
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Cylinders in Carts
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Cylinders chained and secured
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Gauges removed and caps in place on stored cylinders
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Equipment inspected daily and in good working order
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Proper PPE in use
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FORMS/FORM WORK
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Are forms properly erected pins, clamps, dogs ect...
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Forms properly braced
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Gloves, safety glasses, and hardhats
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All lumber free of nails
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Fall protection system in place
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Fall protection equipment inspected daily
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PPE's
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High visibility vest or shirts as required
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Respirators and masks as needed
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Rubber gloves when using acids and alkalis
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Confined space equipment tested and in good working condition.
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Eye protection and face shield when needed
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Hard hats and safety glasses at all times
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Hearing protection when needed
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CRANES / AERIAL LIFTS
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Certified operator
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Swing radius guarded
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Annual inspection on site
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Qualified signal person
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Qualified rigging person
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Daily inspections completed
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All guards, gates, and chains in place
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Fall protection as required
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CONCRETE
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Is at the top of wall scaffold ( for pouring ) erected properly, proper amount of walk planks and guard rails?
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Are rebar caps in place or candy cane bars being used?
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Are safety glasses, gloves, and hard hats being worn?
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Is there sufficient anchorage points for fall protection?
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Is fall protection being used as needed?
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Is the fall protection equipment being inspected daily?
UNSAFE ACTS AND /OR PRACTICES OBSERVED
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GENERAL NOTES OR COMMENTS
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CORRECTIVE ACTION TAKEN
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Select date
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SIGNATURES
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Superintendent / foreman
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Safety Inspector
