Efficient Safety

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Paper Work and Qualifications

• 1 JSA Completed/Meaning Full Conversation

  Yes

  No

  N/A

• 2 Proper Permit Completed

  Yes

  No

  N/A

• 3 Meet & Greet Procedures/EAP

  Yes

  No

  N/A

• 5 Pre-Job Safety Meeting/Pre Trip Documentation

  Yes

  No

  N/A

• 6 Designated Smoking Area

  Yes

  No

  N/A

• 7 Training Documentation

  Yes

  No

  N/A

• 8 Operators Trained & Certified

  Yes

  No

  N/A

• 9 Drivers License

  Yes

  No

  N/A

• 10 First Aid/CPR certified

  Yes

  No

  N/A

Standard Job Safety

• 11 Minimum PPE Worn

  Yes

  No

  N/A

• 12 H2S Monitor/Gas Monitor

  Yes

  No

  N/A

• 13 First Aid Kits & Inspection

  Yes

  No

  N/A

• 14 Fire Extinguisher & Inspection

  Yes

  No

  N/A

• 15 Heat Illness Prevention

  Yes

  No

  N/A

• 16 Fall Protection

  Yes

  No

  N/A

• 17 Hearing Protection @ 85 dec.

  Yes

  No

  N/A

• 18 House Keeping

  Yes

  No

  N/A

• 19 Ladder Use and Condition

  Yes

  No

  N/A

• 20 Proper Tools for the Job

  Yes

  No

  N/A

• 21 Tools In Good Condition

  Yes

  No

  N/A

Specific Job Task Safety

• 22 Energy Isolation/ LOTO

  Yes

  No

  N/A

• 23 Traffic Control

  Yes

  No

  N/A

• 24 Proper Lifting Techniques (mechanical means/buddy system, flex the knees

  Yes

  No

  N/A

Equipment Clean & In Order

• 25 Guards on Equipment

  Yes

  No

  N/A

• 26 Static/Ground

  Yes

  No

  N/A

• 27 Tires/Rims/Lugs

  Yes

  No

  N/A

• 28 hoses/ Connection/Fittings

  Yes

  No

  N/A

• 29 Windows/Mirrors

  Yes

  No

  N/A

• 30 In Cab Inspection (seat belts,triangles,gauges, etc.)

  Yes

  No

  N/A

• Auditor Signature

  Sign