Creative Multicare

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Type Crew

• Resurfacing Technicians

• Carpet Technicians

• Plumbing Technicians

Vehicle Safety

• Drivers License

  Safe

  At Risk

  N/A

• Vehicle Registration

  Safe

  At Risk

  N/A

• Insurance Card

  Safe

  At Risk

  N/A

• Fire Extinguisher

  Safe

  At Risk

  N/A

• First Aid Kit

  Safe

  At Risk

  N/A

• Accident Information Packet

  Safe

  At Risk

  N/A

• MSDS Sheets

  Safe

  At Risk

  N/A

• Fire Hazard Cleanliness

  Safe

  At Risk

  N/A

Resurfacing Technician Safety

• Wearing proper respirator for conditions

  Safe

  At Risk

  N/A

• Proper working knowledge of respirator

  Safe

  At Risk

  N/A

• Is respirater being stored properly when not in use

  Safe

  At Risk

  N/A

• Employees wearing gloves when exposed to cut/chemical hazards?wearing proper PPE<br>Gloves, spray suit, etc

  Safe

  At Risk

  N/A

• Proper ventilation. Windows and doors open, or fume exhaust ventalation

  Safe

  At Risk

  N/A

• All pilot lights out

  Safe

  At Risk

  N/A

• Are all chemical being used properly

  Safe

  At Risk

  N/A

• Are chemicals being proper disposed of, (Dump Tank)

  Safe

  At Risk

  N/A

• Is there a fire extinguisher in the unit

  Safe

  At Risk

  N/A

• Are all chemicals properly stored in the vehicle

  Safe

  At Risk

  N/A

• Does technician have all equipment needed and is everything working properly

  Safe

  At Risk

  N/A

Carpet Cleaning Technicians

• Inside of van clean and organized

  Safe

  At Risk

  N/A

• Heater/ truck-mount free of trash or hazards

  Safe

  At Risk

  N/A

• Has proper tools for dumping waste water

  Safe

  At Risk

  N/A

• Has proper knowledge of how to dump waste water

  Safe

  At Risk

  N/A

Plumbing Technician

• Have utilities been located and protected?

  Safe

  At Risk

  N/A

• Depth of Excavation 5 ' or greater

  < 5'

  > 5'

• If >5' , Shoring or Trench box used

  Yes

  No

  N/A

• Means of egress, ladder in place when needed, egress every 25 feet? If applicable

  Safe

  At Risk

  N/A

• Spoil pile and equipment back at least 2 feet from edge?

  Safe

  At Risk

  N/A

• Water being pumped out if present?

  Safe

  At Risk

  N/A

• Soil sample taken

  Yes

  No

  N/A

People

• Unsafe acts

  None Observed

  Observed

• Unsafe work procedures

  None Observed

  Observed

• Improper tool usage

  None Observed

  Observed

• Improper equipment usage

  None Observed

  Observed

Ergonomics Body Posture

• Lifting/Bending

  Safe

  At Risk

  N/A

• Reaching/Twisting

  Safe

  At Risk

  N/A

• Pushing/Pulling

  Safe

  At Risk

  N/A

• Posture

  Safe

  At Risk

  N/A

• Awkward posture sustained

  Yes

  No

  N/A

Review

• Safety Director

  Sign

• Safety Director signature

  Sign