Title Page
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Project
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Department
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Contractor
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Time and Date of Audit
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Prepared by
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Location
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INSTRUCTIONS
1. Please answer "Yes", "No" or "N/A" on the questions below.
2. Add Photos and Notes by clicking on the Paperclip icon
3. To add a Corrective Action click on the paperclip icon then "Add Action", provide a description, assign to a member, set priority, and due date
4. Complete audit by providing digital signature on one of the applicable roles listed (TMMA/TMMI Safety, Project Leader, Contractor Representative)
5. Share your report by exporting as PDF, Word, Excel or Web Link
Ratings:
100% - 95% = Excellent
94% - 86% = Needs Improvement
Below 85% = Unacceptable
Section C - Major Violations
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JSA/JHA Reviewed and Signed by Workers?
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Follows Work: applicable<br><br>
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Updated: being followed<br>
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Hot Work Requirements Met: Issued
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100% Tie off in use?
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Leading Edges Identified, Protected?
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Floor openings: Permit issued, followed?
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Excavation over 5ft.; Sloped, Benched, and shored
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Energy Sources: Identified, Isolated, Locked Out
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Crane Operator Certified: Card Checked
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Confined Space Permit, and Air Quality Tested
Section C1 JSA
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Posted, easy access<br>
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Required Documents on control board<br>
Section D - Environment / Site Conditions
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First Aid Kit: stocked, eye wash, accessible
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Sanitation: toilets clean, stocked (portables)
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Noise: below 85dba, protection used
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Lighting: general, task
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Ventilation: heat, odors
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Dust Control
Section E - Personal Protective Equipment
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Stand: hard hat, glasses, high vis clothing, boots<br>
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Other: correct for area, task, department<br>
Section F - Fire Protection
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Extinguishers: present, sized for task<br>
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Flammable liquids: controlled, stored properly<br>
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Fuel: stored correctly (Propane, Oxygen )<br>
Section G - Signs, Barricades
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Proper Barricades: placement <br>
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Signs: correct, posted, phone #, red/yellow tape<br>
Section H - Materials / Handling / Storage / 5S
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Mat, Tools, Equip: stored prop, neatly stacked
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Trip Hazards: cords neatly run, areas clean
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Liquids on floor: spill kit available
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Rigging for mat handling correct, stored properly
Section I - Tools: Hand and Power
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Condition: handles on, cord not cut<br>
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Guarding: used, adjusted correctly<br>
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Proper Usage: correct tool for the job<br>
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Identification on gang boxes, tools, equipment<br>
Section J - Welding, Cutting, and Grinding
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Hot Work Requirements Met: issued<br>
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Proper PPE: non flammable clothing<br>
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Shields, Barriers: equipment, area protected <br>
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Gas Equip: proper storage, flash arrestors used<br>
Section K - Electrical
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GFCI Protection: tested
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Ext Cords: condition, protected, inspected
Section L - Scaffolds
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No missing planking, bracing, guardrails<br>
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Inspected: tagged, hazards noted<br>
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Falling Object Protection: toe boards<br>
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Rolling Scaffolds: wheels locked<br>
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Workers tied off in Aerial Lifts, Prop fall pro<br>
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Basket: floor cleaned, materials loaded properly<br>
Section M - Fall Protection
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PFAS: inspected, good condition, worn properly<br>
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Proper Anchorage: clamps, straps, lines<br>
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Workers tied off in scissor lifts<br>
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100% tie off in use (double Lanyards)<br>
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Leading Edges: identified, protected<br>
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Warning Lines: used, proper distance<br>
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Floor openings: permit issued, followed<br>
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Roof work: permitted, weather conditions<br>
Section O - Motor vehicles / Mechanized Equipment
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Daily Inspections, equipment identified<br>
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Safety Devices: seat belts, lights, alarm<br>
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Operators: certified, authorized, licensed<br>
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Forklift operated correctly<br>
Section P - Excavations
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Over 5 ft: sloped, benched, shored<br>
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Over 4 ft: ladder access, every 25 ft.<br>
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Spoils: back 3ft<br>
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Water Intrusion: rain, seepage<br>
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Excavation Protected: equipment, workers<br>
Section Q - Concrete and Masonry Construction
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Rebar / rods capped, protected<br>
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Masonry walls supported, Limited access zone<br>
Section R - Steel Erection, Equipment Placement
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Area protected from overhead lifts<br>
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Site specific erection plan in place<br>
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Area Will Support Equipment and Load<br>
Section T - Demolition
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Engineer survey by Competent Person made<br>
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All serv: shut off, capped, disc, removed<br>
Section V - Power Transmission / Distribution / LO
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Energy Sources: identified, isolated, locked out<br>
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Sign In/Out Sheet: used and correct<br>
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Group LO: key box used / key inside<br>
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Locks: labeled, contain required info.<br>
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Arc Flash: proper PPE, workers trained<br>
Section X - Ladders
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Secured: used properly, right type for work<br>
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Non-Conductive: no metal side rails<br>
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Good Condition: rungs, rails, bracing<br>
Section Z - Toxic / Hazardous Substances
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Chemicals: identified, labeled<br>
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Stored Properly: correct containment<br>
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SDS Sheets: available, correct<br>
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Proper PPE Being Used<br>
Section CC - Cranes and Derricks
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Crane Operator Certified: card checked<br>
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Crane Inspection: certifications current<br>
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Rigging: condition, inspected, rating tag<br>
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Rigger Qualified: checked<br>
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Signal Person: Qualified, checked<br>
Section A1 - Confined Space
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Air Quality Tested<br>
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Permit / Checklist Posted<br>
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Workers Trained / rescue notified<br>
Other
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Safety Rep. on site and available <br>
Completion
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Project Leadership Comments (Required for below 85%)
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Project Mgr./Leader : (Name and Signature)
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Contractor Representative : (Name and Siganture)
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TMNA/TMMI Safety Representative: (Name and Signature)
