Information

  • Audit Title

  • Document No.

  • Client / Site

  • Conducted on

  • Prepared by

  • Location
  • Personnel

Type Crew

  • Resurfacing Technicians

  • Carpet Technicians

  • Plumbing Technicians

Vehicle Safety

  • Drivers License

  • Vehicle Registration

  • Insurance Card

  • Fire Extinguisher

  • First Aid Kit

  • Accident Information Packet

  • MSDS Sheets

  • Fire Hazard Cleanliness

Resurfacing Technician Safety

  • Wearing proper respirator for conditions

  • Proper working knowledge of respirator

  • Is respirater being stored properly when not in use

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

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

  • All pilot lights out

  • Are all chemical being used properly

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

  • Is there a fire extinguisher in the unit

  • Are all chemicals properly stored in the vehicle

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

Carpet Cleaning Technicians

  • Inside of van clean and organized

  • Heater/ truck-mount free of trash or hazards

  • Has proper knowledge of how to dump waste water

Plumbing Technician

  • Have utilities been located and protected?

  • Depth of Excavation 5 ' or greater

  • If >5' , Shoring or Trench box used

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

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

  • Soil sample taken?

People

  • Improper tool usage

  • Improper equipment usage

Ergonomics Body Posture

  • Lifting/Bending

  • Reaching/Twisting

  • Pushing/Pulling

  • Posture

  • Awkward posture sustained

Review

  • Safety Director

  • Safety Director 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.