DCS Job Site Audit

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

PPE

• Has Hard Hat?

  Safe

  At Risk

  N/A

• Has Safety Glasses?

  Safe

  At Risk

  N/A

• Has Hearing Protection?

  Safe

  At Risk

  N/A

• Has Hi Visibility Vest?

  Safe

  At Risk

  N/A

Specialty PPE

• Has Dust Mask? (Dry Cutting)

  Safe

  At Risk

  N/A

• Dielectric Rubber Gloves?

  Safe

  At Risk

  N/A

• Rubber Boots?

  Safe

  At Risk

  N/A

Specific Job Site Risks

• Have the operators explored the possibility of unseen conduits in the concrete or on the other side of the concrete?

  Yes

  No

  N/A

• Fall protection required and used properly?

  Safe

  At Risk

  N/A

• Is equipment guarding required and being used properly?

  Safe

  At Risk

  N/A

• Scaffolding required and used properly?

  Safe

  At Risk

  N/A

• Ladder required and used properly?

  Safe

  At Risk

  N/A

• Anchors required and set properly?

  Safe

  At Risk

  N/A

• Barricades required and set properly?

  Safe

  At Risk

  N/A

• Cores dropping and area below protected properly?

  Safe

  At Risk

  N/A

• Housekeeping - Is the work area need and orderly? Tools and lines organized?

  Safe

  At Risk

  N/A

• Rigging - Is material or equipment being lifted? Are anchors, cables, straps, and associated equipment being used properly?

  Safe

  At Risk

  N/A

• Lines - Do electric and hydraulic lines appear to be in good condition?

  Safe

  At Risk

  N/A

• Is a GFI being used for 110V power connections?

  Safe

  At Risk

  N/A

• Is work in an excavation and is it sloped properly?

  Safe

  At Risk

  N/A

• MIOSHA Excavation Angles in Excess of 5' Depth

• Is work on a roadway and is barricading/traffic control set properly and working?

  Safe

  At Risk

  N/A

• Is work in a confined space and is there proper ventilation?

  Safe

  At Risk

  N/A

• Is work in a permitted confined space and is permit posted, proper ventilation, harness and extraction plan in use?

  Safe

  At Risk

  N/A

• Is lockout/tag out required and in use properly?

  Safe

  At Risk

  N/A

• Are wheeled or tracked equipment being used? Is the operator qualified to operate and are backup alarms working properly?

  Safe

  At Risk

  N/A

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