Edko LLC Crew Safety Audit

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Vehicle

• Vehicle appearance inside and out

  Yes

  No

  N/A

• Vehicle lighting

  Yes

  No

  N/A

• Condition of Windshield/Glass/Mirrors

  Yes

  No

  N/A

• Tires

  Yes

  No

  N/A

• Cones/Placement

  Yes

  No

  N/A

• Horn/Wipers/Guages

  Yes

  No

  N/A

• Truck sticker in place and in good condition

  Yes

  No

  N/A

• Strobes and Flashers

  Yes

  No

  N/A

• Truck Mileage

• Oil change mileage

Personal Protective Equipment (PPE)

• Mixing and Spray Gloves

  Yes

  No

  N/A

• Safety Goggles

  Yes

  No

  N/A

• Hard Hat

  Yes

  No

  N/A

• Long sleeve shirt

  Yes

  No

  N/A

• Hearing Protection

  Yes

  No

  N/A

• Respirator

  Yes

  No

  N/A

• Safety Vest

  Yes

  No

  N/A

Documentation

• Vehicle Paperwork

  Yes

  No

  N/A

• MSDS available and current

  Yes

  No

  N/A

• DOT CDL Paperwork

  Yes

  No

  N/A

• DOT Vehicle Paperwork

  Yes

  No

  N/A

• JSA

  Yes

  No

  N/A

Other Safety Items

• Fire Extinguisher inspected and working

  Yes

  No

  N/A

• Spill Kit

  Yes

  No

  N/A

• First Aid Kit available and fully stocked

  Yes

  No

  N/A

• Eye wash bottle

  Yes

  No

  N/A

• Drinking Water

  Yes

  No

  N/A

Equipment

• Backpack/Probe condition

  Yes

  No

  N/A

• Fuel Cans/Tanks

  Yes

  No

  N/A

• Hoses/Clamps

  Yes

  No

  N/A

• Chemicals labeled

  Yes

  No

  N/A

• Nurse Tank Condition

  Yes

  No

  N/A

• Skid Unit/Load Securement

  Yes

  No

  N/A

• Straps/Chains

  Yes

  No

  N/A

Employee

• Employee Appearance

  Yes

  No

  N/A

• Employee I.D.

  Yes

  No

  N/A

• Task Knowledge

  Yes

  No

  N/A

Aquatic

• Boat condition

  Yes

  No

  N/A

• Life vests in good condition and in use

  Yes

  No

  N/A

• Rope

  Yes

  No

  N/A

Other Items

• List additional issues

Equipment Dispersed

• List here

Employee Signatures

• Employee Signature

  Sign

• Employee Signature

  Sign

• Employee Signature

  Sign