ELITE SAFETY AUDIT 2017

• THIS SITE HAS BEEN RATED:

  Select A B C D

  • A
  • B
  • C
  • D

• Job Name

• Job Number

• Conducted on

  Date

• Safety Person Conducting Audit

• Location
  Address

• Personnel Participating

ADMINISTRATIVE

• INCIDENT AND INJURY FREE (IIF)

• Does the Job have an IIF or "Why I'm Safe" board?

  Yes

  No

  N/A

• How many co-workers on site including Subs?

• What percentage of project coworkers have attended the 4hr IIF Orientation?

  90-100%

  70-89%

  50-69%

  30-49%

  N/A

• Have this project reported any incident this Week?

  No

  Yes

  N/A

• Have the First Aid Logs / First Report of Injury been sent to Safety department?

  Yes

  No

  N/A

• Date and time the First Aid Log / First Report of Injury will be send to Safety Department

  Date

SUPERVISION INVOLVEMENT

• Conduct a Job site safety survey?

  Yes

  No

  N/A

• Attend or conduct a tool box talk safety meeting?

  Yes

  No

  N/A

• Lead or participate in morning stretch and flex?

  Yes

  No

STRETCH & FLEX

• Are Stretch and Flex posters located in stretching areas? (Available from Safety)?

  Yes

  No

  N/A

• Are Coworkers following the Baker Stretch & Flex program (at a minimum)?

  Yes

  No

  N/A

• Is enough time devoted to each stretch?

  Yes

  No

  N/A

• Do the PE / PM / Super / Gen. Super participate?

  Yes

  No

  N/A

MTA's

• Are MTA's conducted and documented for each crew?

  Yes

  No

  N/A

• Does it contain an adequate description of the work being performed?

  Yes

  No

  N/A

• Is there a history of completed MTA's for each crew? (check last 7 days)

  Yes

  No

  N/A

• Does the project team properly store & track MTA documents?

  Yes

  No

  N/A

• Are Safety hazards thoroughly addressed along with controls the hazards on the form?

  Yes

  No

  N/A

TOOLBOX TALKS

• Are toolbox meetings being conducted and documented?

  Yes

  No

  N/A

• Is a toolbox talk completed every week?

  Yes

  No

  N/A

• Is the topic applicable to our work?

  Yes

  No

  N/A

FIRST AID / INJURY CARE / HEALTH

• Are CPR & First Aid certified coworkers on the project?

  Yes

  No

  N/A

• Is a well stocked First Aid kit available?

  Yes

  No

  N/A

• Is the Incident Reporting Procedure posted in the office or elsewhere?

  Yes

  No

  N/A

• Are required posters (OSHA job safety and health protection poster displayed in a prominent location?)

  Yes

  No

  N/A

• Are emergency telephone numbers posted?

  Yes

  No

  N/A

• Is there adequate eye wash immediately available at working areas

  Yes

  No

  N/A

• Is Neutrality available to neutralize wet concrete that may have contacted a coworker skin?

  Yes

  No

  N/A

• Is drinking water readily available?

  Yes

  No

  N/A

• Are water kegs cleaned regularly and labeled?

  Yes

  No

  N/A

• Are drinking cups provided and properly disposed of?

  Yes

  No

  N/A

• Are toilets clean & properly stocked with paper?

  Yes

  No

  N/A

• Are any Carbon monoxide hazard in our work areas?

  No

  Yes

  N/A

EXCAVATIONS

• Excavations and protective systems inspected by a competent person daily, before start of work?

  Yes

  No

  N/A

• Competent person has the authority to remove coworkers from excavation immediately?

  Yes

  No

  N/A

• Surface encumbrances supported or removed?

  Yes

  No

  N/A

• Coworkers protected from loose rock or soil?

  Yes

  No

  N/A

• Hard hats worn by all coworkers?

  Yes

  No

  N/A

• Spoils, materials, and equipment set back a minimum of 2' from edge of excavation?

  Yes

  No

  N/A

• Barriers provided at all remote excavations, wells, pits, shafts, etc?

  Yes

  No

  N/A

• Walkways and bridges over excavations 6' or more in depth equipped with guardrails?

  Yes

  No

  N/A

• Warning vests, or other highly visible PPE provided and worn by all coworkers exposed to vehicular traffic?

  Yes

  No

  N/A

• Coworkers prohibited from working on faces of sloped or benched excavations above other coworkers?

  Yes

  No

  N/A

• Warning system established and used when mobile equipment is operating near edge of excavation?

  Yes

  No

  N/A

• UTILITIES

• Utility companies contacted and/or utilities located?

  Yes

  No

  N/A

• Exact location of utilities marked when near excavation?

  Yes

  No

  N/A

• Underground installations protected, supported, or removed when excavation is open?

  Yes

  No

  N/A

• WET CONDITIONS

• Precautions taken to protect coworkers from accumulation of water?

  Yes

  No

  N/A

• Water removal equipment monitored by competent person?

  Yes

  No

  N/A

• Surface water controlled or diverted?

  Yes

  No

  N/A

• Inspection made after each rainstorm?

  Yes

  No

  N/A

• HAZARDOUS ATMOSPHERE

• Atmosphere tested when there is possibility of oxygen deficiency or build up of hazardous gases?

  Yes

  No

  N/A

• Oxygen content is between 19.5% and 21%?

  Yes

  No

  N/A

• Ventilation provided to prevent flammable gas build up 20% of lower explosive limit of the gas?

  Yes

  No

  N/A

• Testing conducting to ensure that atmosphere remains safe?

  Yes

  No

  N/A

• Emergency response equipment readily available where a hazardous atmosphere could or does exist?

  Yes

  No

  N/A

• Coworkers trained in the use of PPE and emergency response equipment?

  Yes

  No

  N/A

• Safety harness and life line individually attended when coworkers enter deep confined excavation?

  Yes

  No

  N/A

PERSONAL PROTECTIVE EQUIPMENT (PPE) & WORK WEAR

• Are all coworkers wearing hardhats, and eye protection?

  Yes

  No

  N/A

• Are co-workers wearing face-shield or special eye protection (burning goggles) where required?

  Yes

  No

  N/A

• Are co-workers wearing high visibility work wear and / or vest where they are required?

  Yes

  No

  N/A

• Are coworkers wearing proper work clothing and work boots?

  Yes

  No

  N/A

• Are coworkers wearing hearing protection where they are required?

  Yes

  No

  N/A

• Are co-workers wearing appropriate gloves for the task?

  Yes

  No

  N/A

• Are co-workers wearing respirators when grinding or working on a dusty environment?

  Yes

  No

  N/A

• Did coworkers inspect their PPE prior to the start of their shift?

  Yes

  No

  N/A

PERSONAL FALL ARREST SYSTEM (FALL PROTECTION)

• Have the coworkers exposed to an immediate fall hazard?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Date and Time of Abatement

  Date

• Picture of Abatement

  Media

• Are there any open edge left unprotected?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Date and Time of Abatement

  Date

• Picture of Abatement

  Media

• Are all holes (2" & larger) securely covered & marked?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Date and Time of Abatement

  Date

• Picture of Abatement

  Media

• Are warning signs posted at leading edge barriers? (Available from Safety)

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Date and Time of Abatement

  Date

• Picture of Abatement

  Media

• Is the Miller edge being used correctly?

  Yes

  No

  N/A

• Are coworkers at the leading edge adequately protected?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• STOP THE ACTIVITY AND CORRECT IT INMEDIATELLY!!

• Are Horizontal lifelines being installed, inspected & used correctly?

  Yes

  No

  N/A

• Are proper tie-off points used?

  Yes

  No

  N/A

• How you corrected?

• Correction Pictures

  Media

• Are coworkers exposed to swing fall hazard?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• How you corrected?

• Correction Pictures

  Media

• Are all components of Personal Fall Arrest System (harness, SRLs, anchorage) in good condition?

  Yes

  No

  N/A

• Do you replaced the damaged equipment?

  Yes

  No

  N/A

• When it will be replaced?

  Date

• Picture of replaced equipment

  Media

• Are dual SRL (twin turbo, Diablo) properly connected to harnesses (if used)?

  Yes

  No

  N/A

• Picture of Corrected issue

  Media

• Are coworkers trained for the fall protection system in use?

  Yes

  No

  N/A

• STOP!! CALL CYNDIE AND SET UP A TRAINING DATE

• Date of training

  Date

• Are damage / defective fall protection components tagged and removed from service?

  Yes

  No

  N/A

• TAG AND REMOVE IT FROM SERVICE INMEDIATELY

• Picture of the damage equipment tagged

  Media

• Are the guardrails properly built to Baker Engineering standards (top-rail, mid-rail and toe-board)

  Yes

  No

  N/A

• Date and Time of Abatement

  Date

• Picture of Abatement

  Media

• Are wooden 2x4 stanchions no greater than 8ft apart?

  Yes

  No

  N/A

• Corrective Pictures

  Media

• Are cable handrails flagged every 6ft with high visibility material?

  Yes

  No

  N/A

• Corrective Pictures

  Media

HAND & POWER TOOLS

• Are all hand and power tools maintained in a safe condition & inspected before each use?

  Yes

  No

  N/A

• Are the unsafe tools tagged and removed from service

  Yes

  No

  N/A

• Why not? Explain

• Picture of the unsafe tool

  Media

• Are all electric power tools grounded or double insulated?

  Yes

  No

  N/A

• It was tagged and removed from service?

  Yes

  No

  N/A

• Are power cords in good condition with ground pin (when required)?

  Yes

  No

  N/A

• TAG IT AND REMOVE IT FROM SERVICE OR HAVE IT FIXED

• Picture of the TAGGED or fixed cord

  Media

• Are pneumatic power tools secured to the hose by clip, wire or whip check?

  Yes

  No

  N/A

• STOP AND HAVE IT FIXED

• Picture of the fixed tool

  Media

• Are all tools properly equipped with the guards or safety features they were designed to have?

  Yes

  No

  N/A

• Is the guard re-placed or otherwise tagged and removed from service?

  Yes

  No

  N/A

• Why not? Explain

• Picture of the tool with guard

  Media

• Are the right tools used for the right task?

  Yes

  No

  N/A

• If used, are coworkers trained to operate powder Actuated tools?

  Yes

  No

  N/A

ELECTRICAL (OTHER THAN TOOLS)

• Are GFCI's provided for all temporary power sources?

  Yes

  No

  N/A

• Are GFCI's regularly inspected & in good repair?

  Yes

  No

  N/A

• Have damaged / defective unsafe hand or power tool been tagged and removed from service?

  Yes

  No

  N/A

• TAG THE TOOL AND REMOVE IT FROM SERVICE

• Picture of the gaged tool

  Media

• Are electrical panels properly labeled & fully enclosed?

  Yes

  No

  N/A

• Are generators properly grounded?

  Yes

  No

  N/A

CHEMICAL & FIRE HAZARD

• Has this job performed a GHS / chemical safety refresher training?

  Yes

  No

  N/A

• Date and Time of Planned Training

  Date

• Are Safety Data Sheets (SDS) available for ALL chemicals on site?

  Yes

  No

  N/A

• CONTACT SAFETY DEPARTMENT TO GET YOURS

• Are ALL chemicals containers (fuel cans, spray cans, spray bottles, buckets, etc.)) labeled?

  Yes

  No

  N/A

• CONTACT SAFETY DEPARTMENT TO GET YOURS

• Is fuel stored only in approved safety cans?

  Yes

  No

  N/A

• Are bulk fuel tanks protected from vehicular traffic?

  Yes

  No

  N/A

• Is a fire extinguisher located 25 to 75ft. from bulk storage tanks?

  Yes

  No

  N/A

• Are "NO SMOKING" signs posted in fuel storage areas?

  Yes

  No

  N/A

• Is there a fire extinguisher provided for each 3,000 square feet of building area?

  Yes

  No

  N/A

• Is there a fire extinguisher within 100ft of all work areas?

  Yes

  No

  N/A

• Is a spill kit available to address chemical spills?

  Yes

  No

  N/A

• Are fire extinguishers provided at or near fuel powered equipment?

  Yes

  No

  N/A

• Do fuel cans have flame arrest screens & self-closing lids?

  Yes

  No

  N/A

• Are compressed gases properly stored?

  Yes

  No

  N/A

RIGGING & SIGNALING - Supplement C

• Are only Baker coworkers or NCCO Trained coworker allowed to rig loads & signal cranes?

  Yes

  No

  N/A

• Are Subcontractors personnel properly trained?

  Yes

  No

  N/A

• Are riggers / Signal persons properly identified (hard hat stripes and / or vest?

  Yes

  No

  N/A

• Are whistles used to alert others when hoisting / landing loads ?

  Yes

  No

  N/A

• Are tag lines properly attached & used to control loads?

  Yes

  No

  N/A

• Are coworkers keeping their hands free of rigging & loads while hoisting?

  Yes

  No

  N/A

• Is rigging inspected before use?

  Yes

  No

  N/A

• Is there a current documented annual inspection for each chain sling on site?

  Yes

  No

  N/A

• Are chain slings tagged & in proper condition?

  Yes

  No

  N/A

• Are nylon slings tagged & in proper condition?

  Yes

  No

  N/A

• Are wire rope slings tagged & in proper condition?

  Yes

  No

  N/A

• Are damaged / defective rigging components removed from service?

  Yes

  No

  N/A

• Are proper rigging procedures in use for all observed lifts?

  Yes

  No

  N/A

• Are formwork rigging accessories (clamps, shake-out pins, shackles, hooks) used propperly?

  Yes

  No

  N/A

• Is the shackles moussed or bolt type used in permanent connections?

  Yes

  No

  N/A

CRANE OPERATIONS

• Is the annual inspection current?

  Yes

  No

  N/A

• Are daily inspections documented?

  Yes

  No

  N/A

• Is the operator certified (NCCO). Are the operator's qualifications readily available?

  Yes

  No

  N/A

• Is the operator's manual and load chart in the crane?

  Yes

  No

  N/A

• Is regular maintenance of the crane being performed?

  Yes

  No

  N/A

• Are approved voice commands & hand signals being used?

  Yes

  No

  N/A

• Are two way radios used to communicate with the operator?

  Yes

  No

  N/A

• Does each crane have a dedicated radio channel?

  Yes

  No

  N/A

• Are cranes located a safe distance from power lines?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Are weather conditions adequate for hoisting?

  Yes

  No

  N/A

• Is safe access provided for the tower crane operator?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Mobile: Has the GC ensured that the ground (on which the crane will operate) is sufficiently firm and level?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Mobile: Has the GC provided the location of hazards beneath the crane set-up area?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Mobile: If outriggers are used, are they fully extended and on a level surface

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Mobile: is proper cribbing or matting used?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Mobile: Is the swing radius of the crane barricaded?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

WALLS

• Are the wall rack tie off points with retractable on it or fully guardrailed?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Date and Time of Abatement

  Date

• Picture of Abatement

  Media

• Is there clear access to the wall racks?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Abatement Date and Time

  Date

• Abatement Pictures

  Media

• Are the walls placed on a firm surface?

  Yes

  No

  N/A

• Are walls placed evenly on the racks?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Are Ladders being provided and secured on top and bottom?

  Yes

  No

  N/A

• PROVIDE A LADDER

• Pictures of the provided Ladder

  Media

• Are wall forms secured to the storage racks to prevent tipping?

  Yes

  No

  N/A

• HAVE THE WALL FORMS SECURED

• Pictures of the secured Wall Form

  Media

RESPIRATORY HAZARD

• Are coworkers adequately protected when performing activities known to generate silica dust (chipping, grinding, cutting concrete?

  Yes

  No

  N/A

• Are there procedures to control silica dust during sweeping activities?

  Yes

  No

  N/A

COWORKERS WEARING RESPIRATORS

• Does each coworker have a current medical clearance (within 2 calendar years)?

  Yes

  No

  N/A

• Is there documentation of respirator training?

  Yes

  No

  N/A

• Is the fit test current (within 1 calendar year)?

  Yes

  No

  N/A

• Are respirator kept in a sanitary condition?

  Yes

  No

  N/A

• Are coworkers following facial hair guidelines?

  Yes

  No

  N/A

SHORING / SCAFFOLDS

• Have coworkers received documented shoring / scaffold training

  Yes

  No

  N/A

• Have Shoring / Scaffolds been inspected & tagged by a competent Person?

  Yes

  No

  N/A

• Are shoring / scaffolds set on firm, secure footings with base plates and mud sills?

  Yes

  No

  N/A

• Are casters (on rolling scaffolds) locked when scaffold is occupied?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Are shoring / scaffold components inspected & in good condition?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Have damaged / defective components been removed from service?

  Yes

  No

  N/A

• Is the shoring / scaffold properly assembled?

  Yes

  No

  N/A

• Are working platforms fully planked?

  Yes

  No

  N/A

• Are wallkboards properly overlapped or secured with cleats?

  Yes

  No

  N/A

• Are platforms free of excessive tools, material and debris?

  Yes

  No

  N/A

• Are shoring / scaffolds adequately supported (when height -to-base width ratio > 4:1)?

  Yes

  No

  N/A

• Is proper access provided to the working platform?

  Yes

  No

  N/A

LADDERS & STAIRWAYS

• Are ladders in good condition?

  Yes

  No

  N/A

• REMOVE IT FROM SERVICE

• Pictures of the removed Ladder

  Media

• Are manufacturer's labels affixed & legible?

  Yes

  No

  N/A

• Are job build ladders properly constructed?

  Yes

  No

  N/A

• REMOVE IT FORM SERVICE AND ORDER ONE FROM THE YARD

• Pictures of the new Ladder from the Yard

  Media

• Are coworkers climbing ladders properly?

  Yes

  No

  N/A

• Do side rails of ladders extend 36" above landings?

  Yes

  No

  N/A

• Is the ladder placed at a proper angle (4:1 ratio)?

  Yes

  No

  N/A

• Are ladders properly secured top and bottom?

  Yes

  No

  N/A

• Are ropes provided to move material without carrying up/down ladder?

  Yes

  No

  N/A

• Is clear access provided at top & bottom of access ladder?

  Yes

  No

  N/A

• Are two ladders provided when 25+ coworkers are on elevated decks?

  Yes

  No

  N/A

• Have damaged / defective ladders or components been removed from service?

  Yes

  No

  N/A

• REMOVE IT FROM SERVICE OR HAVE IT FIXED

• Pictures of the removed or fixed Ladder

  Media

STAIRWAYS

• Are sides & edges of stairways protected by a guardrails system?

  Yes

  No

  N/A

• Are rails in place on any stairways with more than 4 risers?

  Yes

  No

  N/A

• Are slab openings at stairways protected by toe boards?

  Yes

  No

  N/A

• Are stairs clean & unobstructed?

  Yes

  No

  N/A

• If temporarily closed, are stairs adequately barricaded with signage?

  Yes

  No

  N/A

FRAMING / FORMING

• Are formwork drawing available on site?

  Yes

  No

  N/A

• Are elevated decks inspected by a qualified person?

  Yes

  No

  N/A

• Are coworkers trained to work with these form system?

  Yes

  No

  N/A

• Are nonessential coworkers / other trades prevented from walking beneath the leading edge of decks under construction?

  Yes

  No

  N/A

• Are coworkers aware of pinch points & hand hazards associated with these systems?

  Yes

  No

  N/A

• Are overhead materials (plywood, panels) left unsupported?

  No

  Yes

  N/A

• Are props and / or frames plumb & set on a firm surface capable of supporting the intended load?

  Yes

  No

  N/A

• Are braces properly installed?

  Yes

  No

  N/A

• Have damaged / defective forms been removed from service?

  Yes

  No

  N/A

• Are coworkers manually moving materials following framing / forming procedures?

  Yes

  No

  N/A

STRIPPING FORMWORK / RESHORING

• Has concrete reached sufficient strength for stripping?

  Yes

  No

  N/A

• Is the stripping area barricaded and with signage?

  Yes

  No

  N/A

• Is stripped material lowered safely or allowed to "free fall?

  Yes

  No

  N/A

• Is stripped material kept clear of walkways & egress routes?

  Yes

  No

  N/A

• Are protruding nails pulled or bend over?

  Yes

  No

  N/A

HOUSEKEEPING (PREVENTING SLIP, TRIP & FALLS)

• Is there adequate lightning in all walkways & work areas?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Is task lighting adequate?

  Yes

  No

  N/A

• Are all aisle -ways and emergency routes clear of materials and debris?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Are material storage areas orderly & navigable?

  Yes

  No

  N/A

• Are there receptacles for lunch trash?

  Yes

  No

  N/A

• Is Caution & Danger tape barricades removed when they are no longer needed?

  Yes

  No

  N/A

• Is all exposed rebar caped to protected coworkers from injury?

  Yes

  No

  N/A

SKIP PANS, TRASH BOXES, OUTRIGGERS

• Are skip pans / trash boxes equipped with proper rigging that is tagged (or stamped with rated capacity) and in good condition)?

  Yes

  No

  N/A

• REMOVE IT FROM SERVICE INMEDIATELLY

• Is there a visible load rating on each skip pan / trash box?

  Yes

  No

  N/A

• Are skip pans / trash boxes free of damage (no broken welds)?

  Yes

  No

  N/A

• REMOVE IT FROM SERVICE INMEDIATELLY

• Is material not stacked beyond the sides of skip pans / trash boxes?<br>

  No

  Yes

  N/A

• Are outriggers installed per Baker Engineering requirements?

  Yes

  No

  N/A

• Are removable handrails installed at the slab edge to prevent coworker fall exposure when outrigger doors are open?

  Yes

  No

  N/A

• Are self-retracting lifelines installed to allow coworkers to “tie off” when working on outriggers?

  Yes

  No

  N/A

• Are Outrigger Warning Signs installed to remind coworkers of fall hazards & outrigger capacity?

  Yes

  No

  N/A

• Is pre-tied rebar area kept organized and clean (no excess of tie-wire on the floor)

  Yes

  No

  N/A

HEAVY EQUIPMENT & TRUCKING

• Are seat belts being used by operators?

  Yes

  No

  N/A

• Are other coworkers prohibited from ridding on equipment?

  Yes

  No

  N/A

• Does equipment have a functional back up alarm?

  Yes

  No

  N/A

• Are the operators driving equipment at a safe speed?

  Yes

  No

  N/A

• Is the operator qualified / certified?

  Yes

  No

  N/A

• Has a documented daily inspection of the equipment been performed?

  Yes

  No

  N/A

• Is the parking brake set and all forks / buckets lowered to ground when equipment is not in use?

  Yes

  No

  N/A

• Does the equipment have fire extinguishers and required manufacturer labels?

  Yes

  No

  N/A

• Are coworkers using safe means to access flat bed trailers?

  Yes

  No

  N/A

• Are spotters used to assist backing concrete trucks?

  Yes

  No

  N/A

• Are trained flagman used to control traffic during deliveries?

  Yes

  No

  N/A

• Are the mud flaps present and in good conditions?

  Yes

  No

  N/A

• FL DOT Insurance, Inspection Decal, and Certificate present?

  Yes

  No

  N/A

• Is the load secure?

  Yes

  No

  N/A

• Are the straps in good working condition?

  Yes

  No

  N/A

• Height / wide load clearance meet DOT requirements?

  SAFE

  Low Severity $5K-7K

  Medium Severity $7K-70K

  High Severity $ 70K-120K

  Non Applicable

• Are the lights, horn, flashers and brakes working?

  Yes

  No

  N/A

• Is the insurance card current?

  Yes

  No

  N/A

• Accident kit (accident form, camera) present in the truck?

  Yes

  No

  N/A

• Is a fire extinguisher available and charged?

  Yes

  No

  N/A

MISCELLANIOUS PICTURES

• Miscellaneous pictures

  Media

OFFICE TRAILER

• Are office trailers clean and organized?

  Yes

  No

  N/A

• Are all trash bins being emptied?

  Yes

  No

  N/A

• Are electrical panels secured and safe?

  Yes

  No

  N/A

• If generator is in use, is it a safe distance and has a fire extinguisher within 25'?

  Yes

  No

  N/A

• SCORING
  A = Compliant or 95 - -100%
  B = Positive effort or 85 - 94 %
  C = Average effort or 75 - 84%
  D = Serious or 0 - 74%

• This audit reflects the condition of the job-site at the time of inspection and limited by the portion of the site that was inspected.

• Superintendent's Name

  Sign

• Personnel Present

  Sign

• Safety Officer

  Sign

• "COMMITTED TO CREATING A HEALTHY LIFE, FREE OF INJURY, FOR ALL CO- WORKERS"

• "TOMORROW IS YOUR REWARD FOR WORKING SAFELY TODAY"