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

• 4 Pre-Job Safety Meeting

  Yes

  No

  N/A

• 5 Designated Smoking Area

  Yes

  No

  N/A

• 6 Training Documentation

  Yes

  No

  N/A

• 7 Operators Trained & Certified

  Yes

  No

  N/A

• 8 Drivers License

  Yes

  No

  N/A

• 9 First Aid/CPR certified

  Yes

  No

  N/A

Standard Job Safety

• 10 Minimum PPE Worn

  Yes

  No

  N/A

• 11 H2S Monitor/Gas Monitor

  Yes

  No

  N/A

• 12 First Aid Kits & Inspection

  Yes

  No

  N/A

• 13 Fire Extinguisher & Inspection

  Yes

  No

  N/A

• 14 Heat Illness Prevention

  Yes

  No

  N/A

• 15 Fall Protection

  Yes

  No

  N/A

• 16 Hearing Protection @ 85 dec.

  Yes

  No

  N/A

• 17 House Keeping

  Yes

  No

  N/A

• 18 Proper Tools for the Job

  Yes

  No

  N/A

• 19 Tools In Good Condition

  Yes

  No

  N/A

Specific Job Task Safety

• 20 Energy Isolation/ LOTO

  Yes

  No

  N/A

• 21 Traffic Control

  Yes

  No

  N/A

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

  Yes

  No

  N/A

• 23 Power LIne Avoidance

  Yes

  No

  N/A

Equipment Clean and in Order

• 24 Guards on Equipment

  Yes

  No

  N/A

• 25 In Cab Inspection

  Yes

  No

  N/A

• 26 Truck Bed/Tool Box

  Yes

  No

  N/A

• Auditor Signature

  Sign