CPW Safety

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

HOUSEKEEPING

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  Media

• Work area clean and free of debris

  Yes

  No

  N/A

• Water on jobsite

  Yes

  No

  N/A

• Porta-jon / bathroom facilitys available

  Yes

  No

  N/A

JSA / Hazard Risk / Tool box talks

• Daily JSA completed before start of work

  Yes

  No

  N/A

• JSA addresses specific hazards for work performed

  Yes

  No

  N/A

• Competent person(s) listed on form

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT

• Hard Hats

• Safety Glasses

• Hearing Protection

• Face shield / Goggles when cutting grinding

• Proper Foot wear

• High Vis Apparel

Confined Space Entry

• 4 Gas meter being used

  Yes

  No

  N/A

• Have hazards been eliminated to make it non-permit

  Yes

  No

  N/A

• Davit arm / Tripod set up

  Yes

  No

  N/A

Responsabilities

• Is everyone aware of precautions needed for task

  Yes

  No

  N/A

• Supervisor observed following and enforcing safety guidelines

  Yes

  No

  N/A

• Employees observed making safe behavior decissions

  Yes

  No

  N/A

• SDS sheets for products available ( Electronic or Paper )

• Everyone aware of ability to stop work in unsafe situations

Respiratory Protection

• Employee fit tested and medically qualified

  Yes

  No

  N/A

• Proper cartridges / dust / organic vapor

  Yes

  No

  N/A

• Training complete

  Yes

  No

  N/A

Fall Protection

• Annual inspection on harness, lanyard, tie-off equipment

  Yes

  No

  N/A

• Site specific training completed

  Yes

  No

  N/A

• Equipment inspected each time it is put on

  Yes

  No

  N/A

• Guard rails to proper height (42" +/- 3")

SCAFFOLDS

• Assembly / Dis-assembly by competent person

• Scaffolding is inspected and documented daily

  Yes

  No

  N/A

• Proper access/egress ladders, 3'above landing, tied off

  Yes

  No

  N/A

EXCAVATIONS

• Sloped, shielded, or shored properly<br>Type "c" soil for most jobs

  Yes

  No

  N/A

• Spoil set minimum 2' back from edge of excavation

  Yes

  No

  N/A

• Daily / periodic documented inspection of excavation by competent person

  Yes

  No

  N/A

• Access / Egress is provided every 25'

  Yes

  No

  N/A

• Ladder extends 3' over top of excavation and secured

  Yes

  No

  N/A

• Trench box certification on file

• Excavation barricaded or covered at end of day

Tools and Equipment

• Proper tools for the job at hand

  Yes

  No

  N/A

• Guards in place on grinders / Demo saws /circular saws

  Yes

  No

  N/A

• Extension cords in good shape (ground prong, no cuts or knots)

  Yes

  No

  N/A

Vehicles

• Proper stickers on porta-tank (no smoking-flammable-Diesel Fuel)

  Yes

  No

  N/A

• 20 lb. Rated fire extinguisher on board

  Yes

  No

  N/A

• Driver vehicle inspection report for prior day completed

  Yes

  No

  N/A

• Is truck / trailer over 10,001lb. GVWR

  Yes

  No

  N/A

• If Yes, Medical Certificate on File

Job site Photos

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  Media