Title Page
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Conducted on
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Document No.
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Audit Title
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Client / Site
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Prepared by
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Personnel
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Location
Job Description Being Performed
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JOB PLANNING
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Job Briefing?
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Documented?
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Discussion on site?
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Comments:
PERSONAL PROTECTIVE EQUIPMENT
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Is eye protection being worn?
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Are hard hats used according to Safety Manual requirements?
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Is hand protection being used?
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Is foot ware appropriate to job?
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Is hearing protection used when needed?
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Is clothing policy followed?
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Comments:
VEHICLES
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Are wheel chocks used?
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Daily pre-trip inspection performed?
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Did they "fly" the booms?
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Diggers/buckets properly set up?
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Vehicles grounded?
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Comments:
OVERHEAD AND URD CONSTRUCTION
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All equipment inspected prior to use?
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All equipment used correctly?
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Working between grounds?
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Are grounds in good condition and tested?
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Are hand lines used?
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Is there good housekeeping?
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Are excavations safe?
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Comments:
ENERGIZED WORK
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Are sleeves and gloves correct rating and date?
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Are gloves air tested and inspected prior to use?
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Is adequate cover-up used?
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Are approach distances maintained?
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Is ground-ground, lock-lock policy followed?
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Are employees performing hot work observed?
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Comments:
GENERAL
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Are poles tested prior to climbing?
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Is proper fall protection in used?
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Is climbing equipment inspected before use?
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Are gaff guards used?
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Are slings in good shape?
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Is work area clean when job is finished?
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Comments:
TRAFFIC CONTROL
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Are beacon/strobe lights used?
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Are four way flashers used?
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Are reflective vests used?
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Were cones used?
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Were signs used?
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Was law enforcement used?
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Was a flagger used?
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Comments:
REVIEWED
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Department Head:
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Photos
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Take photos of the job site or use from gallery.