DOA Safety & Health Inspection Checklist

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Contractor name:

• Select date

  Date

Electrical Safety

• Are all extension cords and too cords free from visible damage?<br>

  Yes

  No

  N/A

• Do all cords have a properly grounded plug (all three prongs are present on plug)?

  Yes

  No

  N/A

• Are GFCI (ground fault) receptacles in use on all power source cords and tools?

  Yes

  No

  N/A

PPE (Personal Protective Equipment)

• Are all employees and subcontractors employees wearing safety glasses?

  Yes

  No

  N/A

• Are employees doing demolition or working where there are overhead hazards wearing hard hats?

  Yes

  No

  N/A

• Are all workers working in active traffic areas either on lifts or on foot wearing a hi-visibility vest, jacket or other hi-viz clothing?

  Yes

  No

  N/A

• Yes

  No

  N/A

General Site Conditions

• Are all electrical cords taped or secured so they are not a trip hazard?

  Yes

  No

  N/A

• Is general housekeeping on the site maintained (including areas in front and behind barricades)?

  Yes

  No

  N/A

• Are all construction entrances to barricaded areas marked with "Authorized Personnel Only" signage?

  Yes

  No

  N/A

• Are all work areas, tool storage, equipment, and lay-down areas properly marked and barricaded or protected?

  Yes

  No

  N/A

• Do all fenced areas have "no trespassing" signs posted on perimeter fencing?

  Yes

  No

  N/A

• General site photos

  Media

Powered Lifts

• Articulating boom and mobile platforms attached to lifts: are harnesses being used, properly worn and properly tethered?

  Yes

  No

  N/A

• Are operators of lifts outside the building wearing DOT / Hi-Viz vest?

  Yes

  No

  N/A

General Health and Safety - Observations

• Are there any confined spaces?

  Safe

  At Risk

  N/A

• Do all emergency exit routes and doors have free and easy access and a clear path of travel both to the door and from the door away from the building?

  Yes

  No

  N/A

• Are all ladders in use being used safely? Set up correctly / No standing on top 2 steps / etc...?

  Yes

  No

  N/A

• Is machinery properly guarded?

  Yes

  No

  N/A

• Are workers within 6 feet of leading edge wearing harness and tether to approved attachment point (5400 lbs cap.)?

  Yes

  No

  N/A

• Are all fire extinguishers, electrical panels, fire risers/shutoffs, and other emergency equipment free from obstruction and clearly accessible?

  Yes

  No

  N/A

• Are there any other trip/fall hazards observed inside or out as you walk the site (flooring transitions, temporary flooring changes, sidewalks, parking lots, etc...)?

  Yes

  No

  N/A

Industrial Hygiene Survey

• Are workers being exposed to chemical hazards?

  Safe

  At Risk

  N/A

• Do all containers containing chemicals properly labeled?

  Yes

  No

  N/A

• Are Safety Data Sheets available?

  Yes

  No

  N/A

• Are all workers operating internal combustion equipment inside the building or other enclosed space(s) using a Carbon Monoxide monitor?

  Yes

  No

  N/A

• Are workers involved in spraying operations wearing approved respirators?

  Yes

  No

  N/A

• Are workers being exposed to silica dust?

  Safe

  At Risk

  N/A

• Have building materials been sampled for asbestos?

  Yes

  No

  N/A

• Are noise hazards present?

  Yes

  No

  N/A

Screening

• Chemical

  Below PEL

  Above PEL

  N/A

• H2S

  Below PEL

  Above PEL

  N/A

• Noise

  Below PEL

  Above PEL

  N/A

Inspector

• Select date

  Date

• Inspector Signature

  Sign