Danella Safety Audit

• Safety Inspection

• Conducted on

  Date

• Prepared by

• Location
  Address

• Competent Person

• Permit number

• Weather

1.0 Workplace

• 1.1-Code 753 (Mark Outs)

  Yes

  No

  N/A

• 1.2-Inspector

  Yes

  No

  N/A

• 1.3-Competent Person

  Yes

  No

  N/A

2.0 Administrative

• 2.1-Documentation of Job Briefing

  Yes

  No

  N/A

• 2.2-Certifications, Certificates of Fitness, & Training Cards

  Yes

  No

  N/A

• 2.3-Air monitor in use & calibrated

  Yes

  No

  N/A

• 2.4-Air Monitor log on-site

  Yes

  No

  N/A

• 2.5-Current HASP on-site

  Yes

  No

  N/A

• 2.6-Current permits posted & visible

  Yes

  No

  N/A

• 2.7-Complete Job Package on-site

  Yes

  No

  N/A

• 2.8-Noise Mitigation Plan on-site

  Yes

  No

  N/A

• 2.9-Con Edison's rule book for MUTCD on-site

  Yes

  No

  N/A

• 2.10-First Aid Kit/Blood Bourne Pathogen Kit on-site & current

  Yes

  No

  N/A

• 2.11-Spill Kit on-site

  Yes

  No

  N/A

• 2.12-Fire extinguisher visible, current, & immediately available

  Yes

  No

  N/A

• 2.13-Complete contact list in HASP

  Yes

  No

  N/A

• 2.14-Local hospital information in HASP

  Yes

  No

  N/A

• 2.15-Safety Data Sheets in HASP (SDS's)

  Yes

  No

  N/A

• 2.16- CEHSP 13.00 Excavation Procedures

  Yes

  No

  N/A

• 2.17- Current RWLB matrix posted

  Yes

  No

  N/A

• 2.19- Silica program in place

  Yes

  No

  N/A

3.00 Work Area Protection

• 3.1- Flagger present with advanced warning signs

  Yes

  No

  N/A

• 3.2- Barricades/Cones/Stanchions complete & in compliance

  Yes

  No

  N/A

• 3.3- MUTCD signs in use where required

  Yes

  No

  N/A

• 3.4 Arrow board operating & in use when applicable

  Yes

  No

  N/A

• 3.5- Pedestrians provided with safe & clear path of travel

  Yes

  No

  N/A

• 3.6- Plates Pinned, ramped, flush, skid resistant, & in complete compliance

  Yes

  No

  N/A

• 3.7- Manhole guardrail in use when work is in progress in such areas

  Yes

  No

  N/A

• 3.8- Slings & chains in good condition

  Yes

  No

  N/A

• 3.9- KV Gloves dated & within expiration

  Yes

  No

  N/A

• 3.10- Proper PPE in use when required

  Yes

  No

  N/A

• 3.11- Vehicle’s engine turned off (Idling regulations)

  Yes

  No

  N/A

• 3.12- Seat belts intact & in good condition

  Yes

  No

  N/A

• 3.13- Wheels Chocked when truck on standby

  Yes

  No

  N/A

• 3.14- Hydrants & bus stops clear

  Yes

  No

  N/A

• 3.15- All tools in good shape

  Yes

  No

  N/A

• 3.16- Adequate set-up

  Yes

  No

  N/A

• 3.17- Housekeeping

  Yes

  No

  N/A

4.00 Excavation

• 4.1- Spoils & equipment 2’ away from excavation

  Yes

  No

  N/A

• 4.2- Gas monitoring where required

  Yes

  No

  N/A

• 4.3- Ladders used at 4’ depth or greater and extending 3’ above landing

  Yes

  No

  N/A

• 4.4- Ladders in place every 25’ of lateral travel

  Yes

  No

  N/A

• 4.5- Shoring/sheeting when required

  Yes

  No

  N/A

• 4.6- Daily excavation Inspection conducted

  Yes

  No

  N/A

Sign off

• On- site Representative

• Auditor’s signature