Information

  • Audit Title/Site

  • Conducted on

  • Location
  • Prepared by

  • Foreman

  • Foreman

  • Weather

  • CDI Division on Site

  • Carpenters

  • Laborers

  • Tapers

  • Painters

  • Work Performed

Personal Protective Equipment

  • Hard hats

  • Hard hats

  • Hard hats

  • Hard hats

  • Hard hats

  • Hard hats

  • Hard hats

  • Class 2 vest

  • Class 2 vest

  • Class 2 vest

  • Class 2 vest

  • Hearing protection

  • Hearing protection

  • Hearing protection

  • Hearing protection

  • Hearing protection

  • Eye protection

  • Eye protection

  • Eye protection

  • Eye protection

  • Eye protection

  • Eye protection

  • Proper foot protection

  • Face shield or goggles

  • Face shield or goggles

  • Gloves

  • Gloves

  • Gloves

  • Gloves

  • Gloves

  • Gloves

  • Gloves

  • Respirators/chemical resistant garments

  • Respirators/chemical resistant garments

  • Respirators/chemical resistant garments

  • Respirators/chemical resistant garments

Fall Protection

  • Use of anchor points.

  • Use of anchor points.

  • Use of anchor points.

  • PFAS worn in a proper manner?

  • PFAS worn in a proper manner?

  • PFAS worn in a proper manner?

  • Fall protection equipment maintained and inspected?

  • Fall protection equipment maintained and inspected?

  • Fall protection equipment maintained and inspected?

  • PFAS utilized at loading zones with guardrails in place.

  • PFAS utilized at loading zones with guardrails in place.

  • Fall protection equipment shall not be used for rigging.

  • Fall protection equipment shall not be used for rigging.

  • Guardrails/PFAS utilized when near perimeters, elevator shafts, windows, and stairways. > 6 ft. Fall hazard.

  • Guardrails/PFAS utilized when near perimeters, elevator shafts, windows, and stairways. > 6 ft. Fall hazard.

  • Wall openings are properly covered.

  • Wall openings are properly covered.

  • Guardrails shall be able to withstand at least 200 lbs. of force.

  • Guardrails shall be able to withstand at least 200 lbs. of force.

  • Workers protected near floor openings.

  • Workers protected near floor openings.

  • Workers protected around roof openings.

  • Workers protected around roof openings.

  • Guardrail height 42 inches +\- 3 inches

  • Guardrail height 42 inches +\- 3 inches

Scaffolds

  • 18 inches of walking/working surface

  • 18 inches of walking/working surface

  • Scaffold guardrail height (when 6 ft. or higher) 42 inches +\- 3 inches

  • Scaffold guardrail height (when 6 ft. or higher) 42 inches +\- 3 inches

  • Inspected and used properly.

  • Inspected and used properly.

  • Scaffold tag present when applicable.

  • Scaffold tag present when applicable.

  • Guardrails in place when required.

  • Guardrails in place when required.

  • Guardrails in place when required.

  • Guardrails in place when required.

  • Proper access and egress required.

  • Proper access and egress required.

  • Proper access and egress required.

  • Components are free from defect.

  • Components are free from defect.

  • Components are free from defect.

  • Aerial and scissor lifts are properly inspected.

  • Aerial and scissor lifts are properly inspected.

  • Fall protection utilized on aerial lifts.

  • Fall protection utilized on aerial lifts.

  • Fall protection utilized on aerial lifts.

  • Fall protection utilized on aerial lifts.

Ladders

  • Proper angle using 4:1 ratio.

  • Proper angle using 4:1 ratio.

  • Exceeds landing by 3 feet.

  • Exceeds landing by 3 feet.

  • Ladder properly secured to prevent movement.

  • Ladder properly secured to prevent movement.

  • Worker is not using top 2 steps of stepladder.

  • Worker is not using top 2 steps of stepladder.

  • Worker is not using top 2 steps of stepladder.

  • Stepladder used only in the open position and fully locked.

  • Stepladder used only in the open position and fully locked.

  • Stepladder used only in the open position and fully locked.

  • Inspected and free from defect.

  • Inspected and free from defect.

Housekeeping/General Safety

  • Project work areas are clean and free of excess trash and debris.

  • Project work areas are clean and free of excess trash and debris.

  • Walkways and passageways are clear.

  • Walkways and passageways are clear.

  • Material or equipment is properly stored.

  • Material or equipment is properly stored.

  • Electrical cords, hoses, etc. installed to prevent trip hazards.

  • Electrical cords, hoses, etc. installed to prevent trip hazards.

  • Scrap metal/material free from protruding nails or other puncture hazards.

  • Scrap metal/material free from protruding nails or other puncture hazards.

  • Trash receptacles are provided for work areas.

  • Trash receptacles are provided for work areas.

  • Barricades and/or rebar caps are installed and maintained

  • Barricades and/or rebar caps are installed and maintained

  • Wall openings/floor holes

  • Wall openings/floor holes

  • Electrical

  • Electrical

  • Slip/trip hazards

  • Slip/trip hazards

Tools and Equipment

  • Electrical cords- condition.

  • Electrical cords- condition.

  • Exposed wires?

  • Exposed wires?

  • Missing ground pin?

  • Missing ground pin?

  • Tools are maintained in a safe condition

  • Tools are maintained in a safe condition

  • Tools are maintained in a safe condition

  • Pneumatic/hydraulic hose connections properly secured.

  • Pneumatic/hydraulic hose connections properly secured.

  • Tools are carried and stored.

  • Tools are carried and stored.

  • Proper tools used for the job performed.

  • Proper tools used for the job performed.

  • Guards and shields in place.

  • Guards and shields in place.

  • Guards and shields in place.

  • Hilti clips are free from live rounds.

  • Hilti clips are free from live rounds.

  • Job lights have cages on them to prevent the glass from breaking.

  • Job lights have cages on them to prevent the glass from breaking.

  • Job lights have cages on them to prevent the glass from breaking.

  • Job lights have cages on them to prevent the glass from breaking.

  • Job lights have cages on them to prevent the glass from breaking.

Fire Protection

  • Flammables are stored properly.

  • Flammables are stored properly.

  • Fire extinguishers are inspected.

  • Fire extinguishers are inspected.

  • Fire extinguisher is located near chop saw or other Hot Work procedures.

  • Fire extinguisher is located near chop saw or other Hot Work procedures.

  • Combustibles removed in area of hot work.

  • Combustibles removed in area of hot work.

Permits/signage/documentation

  • Hot Work permit.

  • Hot Work permit.

  • JHA

  • JHA

  • Toolbox talk.

  • Toolbox talk.

  • MSDS's

  • MSDS's

  • Laser in use signage.

  • Laser in use signage.

  • Laser in use signage.

Comments

  • General Comments

  • Add media

  • Add media

  • Add drawing

  • Was anyone injured on site?

  • CDI Incident Report completed?

  • Add signature

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.