Title Page
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Clients Name
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Project Name
- Wabash Valley Power
- First Person
- Toyota Tsusho
- PLC 4&5
- Lakefront at Keystone
- 65 Commerce
- Allegion TI
- Park 350
- College Crossing
- Other
- Whiteland Exchange Building 1&2
- Lakefront at Keystone Roadwork
- Lakefront at Keystone Amenities
- Yamaha Marine Precision Propeller's
- Metro Air 8 & 9
- PLC 4 Lot 2
- Mount Comfort Logistics Center
- Plainfield Logistics Park Building1
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Conducted on
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Conducted audit with? (Contractor and Employees name.)
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Prepared by
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Location
General Safety
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Are personnel active on the project?
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All personnel are wearing hard hats
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All personnel are wearing safety glasses
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All personnel are wearing high visibility clothing
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All personnel onsite have successfully completed orientation
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All personnel are conducting daily planning activities (Task Hazard Analysis)
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Workarea is clean and materials organized
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Lighting in all work areas is adequate
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Fire extinguishers are available, inspected, and in good working order
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Emergency Action Plan and escape routes are complete and readily available
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Ventilation in work area is effective
Mobile Equipment
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Is mobile equipment (i.e. earth moving equipment, lulls, fork trucks) being utilized on the project?
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Mobile equipment has been inspected
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Operator is functioning in a competent manner
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Spotter are being utilized to assist in backing up and protecting operator's blind spots
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Backup alarm and horn are operational
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Operator is wearing safety belt
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Pedestrians are aware and are staying clear of mobile equipment operation
Cranes, Rigging, Hoisting, Suspended Loads
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Are cranes being utilized?
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Operator has training certification on person and available
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Operator appears to be competent in running crane
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Crane has annual and daily inspection
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Barriers around crane are established to protect for swing radius
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Outriggers and cribbing is effectively utilized
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If necessary, a critical lift plan is completed and approved
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Are suspended loads present?
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Personnel rigging and signaling are trained
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Rigging equipment has been inspected and is in good working condition
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Loads are balanced and rigged correctly
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Suspended loads are away from personnel
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Tag lines are used on all suspended loads
Ladders
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Are ladders being used?
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Ladders are free of damage and defects
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Ladders are set up and secured
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Personnel using ladder is maintaining three points of contact
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Ladders are made of fiberglass
Lifts
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Are scissors lifts being used?
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Scissors lift has been inspected
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Scissors lift is being operated on a level surface
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Personnel have feet on deck of scissors lift
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Chain on scissors lift is attached
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Are aerial lifts being used?
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Aerial lift has been inspected
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Ground is suitable for safe operation
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Personnel in basket are utilizing fall protection (i.e. harness and lanyard) and are tied off to the basket
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Personnel in basket are only working off of basket platform (i.e. not standing on rails)
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Operator of aerial lift is doing so in a safe manner
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Personnel are clear below working area of elevated aerial lift
Public Protection
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Does the work potentially interact with public and/or staff?
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The perimeter of the work area identified and protected
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Signage is present identifying work areas as "Construction Zone"
Fall Protection
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Are personnel working with their feet at/or above 6 feet?
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Are guardrails present
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Top rail, mid-rail, and toe board present in all areas
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Toprail, mid-rail, and toe board sturdy (200 pounds of force) and in good condition
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Is a harness, lanyard, and anchor point being used?
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Anchor point is secure and can withstand 5,000 pounds
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Lanyard is securely affixed to anchor point and harness
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Lanyard is in good condition and the correct type of lanyard is utilized for working environment
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Harness fits well and is in good condition
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Are covers being utilized to protect floor penetrations greater than 2 inches in diameter?
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Covers are secured and labeled as "HOLE
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Material used for floor penetration protection has sufficient load capacity for activity in work area
Electrical
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Is electrical power for tools, equipment, lighting, etc. being used?
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Electrical panels and/or cabinets are identified and secured
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Electrical cords, pugs, and/or outlets are in good working condition
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Ground Fault Circuit Interrupter (GFCI) are used with all electrical tools and equipment
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Electrical cords are out of walkways
Fire Protection
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Are flammable and/or combustable materials being stored on the project?
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All flammable and combustable materials are stored in a safe location
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Location of stored flammable and combustable materials are identified with signage and secure
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Compressed gas cylinders are secured, upright, and are capped
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Are grinding, cutting, welding or any other spark producing activities being conducted?
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If required, are Hot Work Permits completed, reviewed, and approved?
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A fire extinguisher available for the activity being conducted
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All flames, sparks and/or slag is contained from spreading (i.e. floor penetrations, stairways, etc.)
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Gauges, hoses, cables, and welding leads in good working condition
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Flash arrest protection is present with torches
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When welding, flash protection is used
Trench and Excavation
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Daily inspection has been completed
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Access/egress is with 25’ of travel
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Are there trenches or excavations on site
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Contractors name
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Are 811 locates completed
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Has an excavation permit been filled out and reviewed
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Sloping, benching or shoring is in accordance with trench forms
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Has all private utilities been identified
Scaffolding
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Is there scaffolding erected on site
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Guardrails or fall protection is in place for deck over 10'
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Access to platform is sufficiently provided
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Bracing is installed and sufficient
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Mudsills, plates, or wheels are in place
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Scaffold has tie in or outriggers at 20'
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Scaffold is not overloaded
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Daily inspections by competent person has been completed
