Douglas N. Higgins

• Audit Number

• Project Name

• Project Number

• Conducted on

  Date

• Prepared by

• Location
  Address

SUPERINTENDENTS NAME

PERSONAL PROTECTIVE EQUIPMENT

• Hard Hats (with bills forward)

  Yes

  No

  N/A

• Safety Glasses Appropriate for Conditions (tinted or clear)

  Yes

  No

  N/A

• Reflective Vests (when required) and/or High Visibility Shirts

  Yes

  No

  N/A

• Hard Toed Work Boots

  Yes

  No

  N/A

• Gloves (if required)

  Yes

  No

  N/A

• Hearing Protection (if required)

  Yes

  No

  N/A

• Face Shields (if required)

  Yes

  No

  N/A

HOUSEKEEPING

• General Site Storage and Housekeeping

  Yes

  No

  N/A

• Trash Cans in Work Area

  Yes

  No

  N/A

• Storage / Conex

  Yes

  No

  N/A

• Safe Walkways or Passages

  Yes

  No

  N/A

TEMPORARY BARRICADES

• Proper tape used (red for danger and yellow for caution if required)

  Yes

  No

  N/A

• All sides of work area barricaded and labeled (if required)

  Yes

  No

  N/A

LADDERS AND ELEVATED WORK

• Extension ladders tied off

  Yes

  No

  N/A

• Extension ladders extended 3' above leading edge

  Yes

  No

  N/A

• Damaged ladders tagged Out-of-Service

  Yes

  No

  N/A

• Step ladders fully open and locked

  Yes

  No

  N/A

• Employees 100% tied off when working over 6'

  Yes

  No

  N/A

• Fall protection in place at the leading edge greater than 6' (i.e. handrails and warning lines)

  Yes

  No

  N/A

FALL PROTECTION

• Harness and lanyards used correctly

  Yes

  No

  N/A

• Harness and lanyards inspected prior to use

  Yes

  No

  N/A

• Employees anchored off correctly

  Yes

  No

  N/A

MOBILE EQUIPMENT

• Operating at a safe speed (both travel and swing)

  Yes

  No

  N/A

• Operating at a safe distance from ground personnel

  Yes

  No

  N/A

• Inspected and documented prior to each shift

  Yes

  No

  N/A

• Seatbelts used

  Yes

  No

  N/A

• Operators trained

  Yes

  No

  N/A

• Backup alarms working

  Yes

  No

  N/A

• Spotters used when needed

  Yes

  No

  N/A

• Equipment maintained without leaks

  Yes

  No

  N/A

• Safety guards and covers in place

  Yes

  No

  N/A

HOISTING AND RIGGING EQUIPMENT

• Annual crane inspection placard in place

  Yes

  No

  N/A

• Daily crane inspection performed and documented

  Yes

  No

  N/A

• Operators manual in cab

  Yes

  No

  N/A

• Swing radius protection in place

  Yes

  No

  N/A

• Workers staying clear of suspended loads

  Yes

  No

  N/A

• Rigging inspected prior to each use

  Yes

  No

  N/A

• Proper rigging and techniques used

  Yes

  No

  N/A

• Rigging properly stored

  Yes

  No

  N/A

• Qualified rigger/signal person being used

  Yes

  No

  N/A

• Knowledge of crane signals

  Yes

  No

  N/A

• Proper use of tag lines

  Yes

  No

  N/A

EXCAVATION

• Daily excavations inspected and documented by a competent person

  Yes

  No

  N/A

• Means of entering/exiting for excavations deeper than 4' when is use

  Yes

  No

  N/A

• Excavations deeper than 4' posted as Confined Space

  Yes

  No

  N/A

• Daily air quality checked for excavations deeper than 4’ when is use

  Yes

  No

  N/A

• Cave-In protection for excavations deeper that 5' when is use

  Yes

  No

  N/A

• Excavation protected from unauthorized personnel (handrails/barricades)

  Yes

  No

  N/A

• Equipment staged at a safe distance from the edge

  Yes

  No

  N/A

• Spoils and materials at least 2' from leading edge

  Yes

  No

  N/A

COMPRESSES GAS CYLINDERS

• Stored upright and succored

  Yes

  No

  N/A

• Oxygen and acetylene stored at least 20 feet apart when not in use

  Yes

  No

  N/A

• Hard caps in place when not in use and/or during transport

  Yes

  No

  N/A

CONCRETE OPERATIONS

• Concrete pump and hoses in good condition and used properly

  Yes

  No

  N/A

• Slick lines and hoses properly clamped with safety wire and whip checks

  Yes

  No

  N/A

• Concrete washed from skin in a timely manner

  Yes

  No

  N/A

• Employees involved where concrete dust is present, have been trained in Silica Awareness

  Yes

  No

  N/A

CONFINED SPACE

• Are confined spaces identified and posted

  Yes

  No

  N/A

• Permit required spaces controlled by permit and attendant (when in use)

  Yes

  No

  N/A

• All confined spaces inspected and documented

  Yes

  No

  N/A

• All confined spaces air quality checked and documented (when in use)

  Yes

  No

  N/A

• Are open spaces, such as manholes protected from pedestrians and vehicular traffic

  Yes

  No

  N/A

PREWORK

• Weekly Toolbox Talks are performed and documented

  Yes

  No

  N/A

• Daily JHA's communicated to all employees and documented

  Yes

  No

  N/A

• SDS for all chemicals on the project are available upon request

  Yes

  No

  N/A

• Supervisors are aware of local first-aid and hospital facilities

  Yes

  No

  N/A

• All required jobsite work permits (i.e. hot work permits, excavation permits) obtained

  Yes

  No

  N/A

• Underground locates are in place and current

  Yes

  No

  N/A

• Employee training records are available for work being performed

  Yes

  No

  N/A

REPRIMANDS OR WARNINGS

• We're any safety violations issued?

  Yes

  No

• We're any verbals warnings or directives given?

  Yes

  No

• Was any Stop Work order issued?

  Yes

  No

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