Empower Energies

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Contractor Information

• Contractor Company<br><br>Contractor Site Manager<br><br>Contact Information <br><br> Phone Number<br> Cell Phone

  Yes

  No

  N/A

• Subcontractors<br><br>Sub 1 Company Name<br>Sub 1 Site Manager<br>Sub 2 Company Name<br>Sub 2 Site Manager

  Yes

  No

  N/A

Section 1 Administrative

• 1.1 Safety Manual, SDS's, OSHA Poster on site and available for review?

  Yes

  No

  N/A

• 1.2 Is the Sub-contractor Site Safety Manual, MSDS's Available?

  Yes

  No

  N/A

• 1.3 Have Competent Persons been Designated by the Contractor and Sub-Contractor, are these persons on site and available?

  Yes

  No

  N/A

• 1.4 Have "Tool Box Talks" or "Tailgate" Safety Meetings been conducted on site?

  Yes

  No

  N/A

• Enter date and Time of last meeting

  Date

• 1.5 Have all Applicable Permits been pulled and are they available?<br>(Note This information may be in the Project File Located on the Share File)

  Yes

  No

  N/A

• 1.5.1 One Call or Dig Safe?

  Yes

  No

  N/A

• 1.5.1.1 Utility Markouts completed and locations identified?

  Yes

  No

  N/A

• 1.5.2 Storm Water Pollution Prevention Plan (SWPPP)

  Yes

  No

  N/A

• 1.5.3 Other

  Yes

  No

  N/A

• 1.6 Has a Pre-Construction Site Hazard Assessment been completed?

  Yes

  No

  N/A

• 1.6.1 Has the Contractor Reviewed (XXXX) of the EPC Contract? <br>(Check the Contract Folder located in the Project Folder on the Share File to verify signature pages)

  Yes

  No

  N/A

• enter date from contract signature page

  Date

Section 2 Site Security & Public Protection

• 2.1 Is there adequate lighting as needed to prevent injury or property damage to the general public?

  Yes

  No

  N/A

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• 2.2 Have perimeter fencing and barricades been erected where the general public or unauthorized persons can potentially access the work area?

  Yes

  No

  N/A

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• 2.3 Is a Contractor representative on site during normal business hours and is a contact available for off hour emergencies?

  Yes

  No

  N/A

• 2.5 Are areas below the work zone protected from falling objects that may impact workers, pedestrians, sidewalks, driveways cars or other personal property?

  Safe

  At Risk

  N/A

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  Media

• 2.6 Has the contractor installed signage warning the general public and workers of the potential hazards associated with the work site? (i.e. warning construction zone, hard hats required, no trespassing etc?)

  Safe

  At Risk

  N/A

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  Media

• 2..7 Is there a traffic control plan to warn approaching motorists, delivery drivers and pedestrians of work being performed in the area, and to protect workers from potentially being struck by vehicles?

  Yes

  No

  N/A

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  Media

Section 3 Personal Protective Equipment

• 3.1 Are hard hats worn by all personnel in the work zone, worn properly with the brim facing forward?

  Yes

  No

  N/A

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• 3.2 Are workers in areas with excessive noise, wearing appropriate hearing protection, (>85db single, >100db double)?<br>(note rule of thumb, if necessary to raise voice above normal speaking voice, hearing protection is likely required)

  Yes

  No

  N/A

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  Media

• 3.3 Are all personnel (workers and visitors) wearing eye protection that meets the ANSI Z87.1 Standard?

  Yes

  No

  N/A

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• 3.4 Are workers who may potentially be subjected to injury from flying particles wearing an approved face shield? (Note tasks such as grinding, chipping, torch cutting, or demo saw equipped with an abrasive wheel would require a full face shield)

  Yes

  No

  N/A

• Add media

  Media

• 3.5 Are all personnel (workers and visitors) on site wearing appropriate foot wear? (no sneakers, open toed shoes, sandals) Work boots with safety toe required for workers.

  Yes

  No

  N/A

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• 3.6 Are all workers wearing clothing appropriate for a construction site? (long pants, shirts with sleeves)

  Yes

  No

  N/A

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• 3.7 Are workers wearing high visibility traffic vests with reflective striping?

  Yes

  No

  N/A

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• 3.8 Are workers wearing hand protection appropriate for the task being performed?

  Yes

  No

  N/A

• 3.8.1 are level II cut resistant gloves being used for handling sheet metal and PV panels, using utility knives or tools that can cause cuts or to the hands?

  Yes

  No

  N/A

• 3.8.2 Are workers wearing leather general purpose gloves when handling ballast block or other material that can abrade the hands?

  Yes

  No

  N/A

• 3.8.3 Are workers wearing chemical resistant gloves when handling solvents, cleaners degreasers, or adhesives?

  Yes

  No

  N/A

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• 3.9 Are respirators being used where applicable?

  Yes

  No

  N/A

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• 3.10 Are visitors provided with PPE as necessary?

  Yes

  No

  N/A

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Section 4 Fall Protection

• 4.1 Are Barricades, Guardrails, or warning lines provided to protect workers from falls from heights of 6' or greater on projects with parapets <42" in height, around skylights or open hatches?

  Yes

  No

  N/A

• 4.1.1 Are warning lines set back a minimum of 15' for low sloped roofs from the edge of the roof and is a monitor in place to alert workers who may potentially cross over the warning line?

  Yes

  No

  N/A

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• 4.1.2 Are skylights covered or protected with guardrails to prevent workers from falling through to lower levels?

  Yes

  No

  N/A

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• 4.1.3 When loading a roof with tele-handler forklifts, are workers directing the load protected from falls by the use of a guard rail system or counterweight with full body harness and lanyard?

  Yes

  No

  N/A

• Add media

  Media

• 4.2 Where temporary counterweight anchors are used, are they used as limiting devices only to prevent workers from approaching an unprotected edge to a maximum of 1.5' (0.46m) from the edge of the roof?

  Yes

  No

  N/A

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• 4.3 Are workers qualified through training and application of the proper way to wear a Personal Fall Arrest System?

  Yes

  No

  N/A

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• 4.3.1 Are workers wearing PFAS's properly? (minimal slack in the harness, D ring in middle of the back etc)?

  Yes

  No

  N/A

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• 4.3.2 Are PFAS inspections current and up to date?

  Yes

  No

  N/A

• 4.4 When utilized, 6is 100% fall protection used when there is a potential to fall from a height of 6' or greater?

  Yes

  No

  N/A

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• 4.5 When working from an articulating boom manlift are workers 100% tied off?

  Yes

  No

  N/A

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• 4.6 When working from a scissors lift are workers instructed to NOT work outside of or above the guardrail?

  Yes

  No

  N/A

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• If conditions warrant workers to work above or outside of the guardrail are they wearing a harness with a lanyard, and are they tied off to suitable anchor points?

  Yes

  No

  N/A

• Provide documentation from the Contractor authorizing the worker to perform work outside or above the guardrail.

• 4.7 Are rebar caps used to protect workers against the potential of becoming impaled on exposed rebar, ground rods, lightning rods, re-enforcing stakes or other objects?

  Yes

  No

  N/A

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  Media

Section 5 Excavations

• 5.1 Is access and egress provided every 25' (7.6m) of linear travel in trenches 4' (1.2m) or greater in depth?

  Yes

  No

  N/A

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• 5.2 Are ladders used for egress and ingress extending a minimum of 3' (0.92m) above the top of the trench?

  Yes

  No

  N/A

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• 5.3 Are spoils piles at least 2' (0.62m) from the edge of the excavation and walkway along excavation is free of trip hazards?

  Yes

  No

  N/A

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• 5.4 Has the area to be excavated been marked out, utilities identified and is the area clear of known utilities?

  Yes

  No

  N/A

• Date and Expiration date of Dig Safe Permit

  Date

• Add media

  Media

• 5.4.1 Are soft dig techniques being used when the excavation is within 5' (2.1m) of a utility markout?

  Yes

  No

  N/A

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• 5.5 Is a designated competent person (competent in excavations) on site?

  Yes

  No

  N/A

• 5.5.1 Is there a documented daily inspection completed by the competent person available for review?

  Yes

  No

  N/A

• Date and time of last inspection

  Date

• 5.6 Are excavations free from seeping or standing water, spaulding and cracking around the walls and edges of the excavation?

  Yes

  No

  N/A

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• 5.7 Are trenches and excavations 5'or greater (1.2m) in depth sloped or shored as necessary to prevent the potential for cave in?

  Yes

  No

  N/A

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  Media

• 5.8 Are workers protected from equipment that may potentially cause a cave in? (sloping, shoring, trench boxes)

  Yes

  No

  N/A

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• 5.9 Are trenches and excavations perimeters protected by barricades, fencing or back fill to protect workers from falling into them and to prevent pedestrians and unauthorized persons or vehicles from falling or diving into them?

  Yes

  No

  N/A

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• 5.10 Are workers clear of equipment swing radius, (swing radius from pivot pin to end of fully extended arm & bucket +5') and blind spots?

  Safe

  At Risk

  N/A

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• 5.11 Are workers protected from falling into trenches or excavation 6' (1.8m) or greater in depth by guardrails or gangways equipped with standard guardrails systems?

  Safe

  At Risk

  N/A

• Add media

  Media

Section 6 Cranes and Lifting Equipment

• 6.1 Does the Crane Operator hold a valid Operators Certificate from the NCCCO or other Crane Certifying organization?

  Yes

  No

  N/A

• Enter expiration date on Operators License (NOT DRIVERS LICENSE)

  Date

• 6.2 Are load charts posted in the cab of the crane?

  Yes

  No

  N/A

• 6.3 Is a copy of the most recent inspections available for review?

  Yes

  No

  N/A

• 6.3.1 Daily Pre-start inspection

  Yes

  No

  N/A

• Enter date of inspection

  Date

• Previous Months Inspection

  Yes

  No

  N/A

• Enter date of most recent inspection

  Date

• 6.4 If applicable; has a road closure permit been obtained, and is a copy on site?

  Yes

  No

  N/A

• Enter Expiration Date

  Date

• 6.5 Has the lift area (swing radius of the crane including boom) been secured?

  Yes

  No

  N/A

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• 6.5.1 Are unauthorized persons, workers pedestrians kept away from from the lift area?

  Yes

  No

  N/A

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• 6.6 Is there a qualified Rigger on site ensuring loads are properly rigged and secured for each pick?

  Yes

  No

  N/A

• Enter date of certification and expiration date

  Date

• Enter Name of the Rigger and Company

• 6.7 Have all lifting equipment, straps chains hooks etc, been inspected prior to the start of the days activity and is the inspection on site for review?

  Yes

  No

  N/A

• Enter date of equipment inspection

  Date

• 6.8 Is the signalman qualified?

  Yes

  No

  N/A

• 6.8.1 Is the documentation of Signalers qualification on site per 29 CFR 1926.1428(a)(3)

  Yes

  No

  N/A

• Enter date on qualification signature page (must be from crane company currently employed by)

  Date

• 6.9 Is the signalman protected from falls by a parapet at least 42' (1.07m) high, a standard guardrail, or a PFAS?

  Yes

  No

  N/A

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  Media

• 6.10 Has a Pick Plan been developed for loading the roof and is it available for review?

  Yes

  No

  N/A

• Enter Date plan was developed

  Date

Section 7 Powered Industrial Trucks (forklifts, including telehandler and rough terrain models).

• 7.1 Does the operator(s) hold a current valid license to operate the equipment?

  Yes

  No

  N/A

• Date of training

  Date

• 7.2 Has the operator performed the daily or pre-shift inspection of the forklift, is it available on site for review?

  Yes

  No

  N/A

• Enter Date and Time of most recent Inspection

  Date

• 7.3 Is a Qualified Rigger preparing lifts, is a sky hook or jib boom being used? (under fork lifting is prohibited)

  Yes

  No

  N/A

• 7.4 Are Load Charts posted on the equipment

  Yes

  No

  N/A

• 7.5 Is the Lift Area properly barricaded, and are unauthorized workers, pedestrians and vehicle traffic kept out of the area?

  Yes

  No

  N/A

• 7.6 Have lifting straps, slings, chains and hooks been inspected by a Qualified Person prior to the lift and is the inspection documented and on site for review?

  Yes

  No

  N/A

• Enter Date and Time of most recent inspection

  Date

• 7.7 Is the signalman protected from falling from heights 6' (1.8m) by a parapet no lower than 42" (1.07m), a guardrail or PFAS?

  Yes

  No

  N/A

• 7.8 Do all lights, brakes, horns backup alarms, and strobe lights working properly?

  Yes

  No

  N/A

• 7.9 If equipped, is the Operator wearing the seat belt?

  Yes

  No

  N/A

Section 8 Tools and Equipment

• 8.1 Electrical Tools are maintained in a safe working condition, casing intact, cords in good condition factory molded plugs attached?

  Yes

  No

  N/A

• 8.2 Hand tools are in good condition, handles not taped or cracked, heads are tight, etc?

  Yes

  No

  N/A

• 8.3 Proper tools being used for the task?

  Yes

  No

  N/A

• 8.4 Pneumatic tools being used?

  Yes

  No

  N/A

• 8.4.1 Hoses are in good condition, no splices, no worm clamps being used?

  Yes

  No

  N/A

• 8.4.2 Whip Checks used?

  Yes

  No

  N/A

• 8.4.3 Air pressure set for the working PSI of the tool?

  Yes

  No

  N/A

• 8.5 Are guards in place and operational?

  Yes

  No

  N/A

• 8.6 Are operators qualified to operate power tools?

  Yes

  No

  N/A

• 8.7 Are warning labels intact and legible on power tools?

  Yes

  No

  N/A

Section 9 Fire Protection

• 9.1 Are Flammable Liquids, Stored and Labeled Properly?

  Yes

  No

  N/A

• 9.2 Are Fire Extinguishers rated 2A readily available, accessible, and inspected?

  Yes

  No

  N/A

• 9.3 Are Emergency vehicles provided with access (fire lanes are clear and unobstructed)?

  Yes

  No

  N/A

• 9.4 Flammable liquids storage areas have adequate signage, (Warning Flammable Liquids, No Smoking etc)?

  Yes

  No

  N/A

• 9.5 For work requiring the use of torches, welders or grinding is a permit in place to ensure adequate measures are in place to prevent or minimize the potential for fires? (NO HOT WORK PERFORMED ON CLIENT ROOFS)

  Yes

  No

  N/A

Section 10 Electrical

• 10.1 Electrical Cords are in safe condition, no splices, or taped used, Ground Prong is in place, Cords are equipped with Factory molded ends?

  Yes

  No

  N/A

• 10.2 Cords are protected from traffic by covers rubber bumpers or other means?

  Yes

  No

  N/A

• 10.3 Cords are routed to prevent workers from tripping or from getting caught?

  Yes

  No

  N/A

• 10.4 Ground Fault Circuit Interrupters (GFCI's) are being used (includes Portable Generators in excess of 5KW)? NOTE on boar CB's on portable generators do not count as GFCI)

  Yes

  No

  N/A

• 10.5 Extension cords are rated for Hard or Extra Hard use? (look for marking on cord, type S, SO, ST, or STO, SJ,SJO, SJTO)

  Yes

  No

  N/A

• 10.6 Temporary power boxes and energized parts protected?

  Yes

  No

  N/A

• 10.7 Are Lock Out Tag ut procedures used and followed, are permits completed and available?

  Yes

  No

  N/A

• 10.8 Are electrical rooms protected from unauthorized entry?

  Yes

  No

  N/A

• 10.9 Are workers wearing PPE appropriate to the electrical hazards, (gloves, tools, matts, FR clothing etc)?

  Yes

  No

  N/A

• 10.10 Are warning signs posted warning workers of potential of electrical hazards, (High Voltage etc)?

  Yes

  No

  N/A

Section 11 Medical Emergencies

• 11.1 Is an Emergency Action Plan on site and have workers reviewed and understand it?

  Yes

  No

  N/A

• 11.2 Does the EAP contain phone numbers workers can call to summon emergency medical help, fire or police depts.?

  Yes

  No

  N/A

• 11.3 Does the EAP have an evacuation map, showing routes workers should take and where to assemble?

  Yes

  No

  N/A

• 11.4 is there a last 1 worker trained in First Aid and CPR on site?

  Yes

  No

  N/A

• 11.5 Does the EAP have a map or direction workers can follow to drive to a medical facility?

  Yes

  No

  N/A

Section 12 Housekeeping

• 12.1 Are scrap materials, discarded or removed from the job site daily?

  Yes

  No

  N/A

• 12.2 Are protruding nails, staples or other fasteners removed from scrap lumber, skid boards or boxes that can cause injury to workers?

  Yes

  No

  N/A

• 12.3 Are work areas clean and kept free of excess trash materials or debris that workers can trip on or over?

  Yes

  No

  N/A

• 12.4 Are walking working surfaces free of obstructions?

  Yes

  No

  N/A

Section 13. Ladders/Stairs/Stair Towers

• 13.1 Are ladders being used properly?

  Yes

  No

  N/A

• 13.2 Are ladders inspected daily before use?

  Yes

  No

  N/A

• 13.2.1 Are defective or damaged ladders removed from service and tagged DO NOT USE?

  Yes

  No

  N/A

• 13.3 Are areas around the top and bottom of ladders free of debris, trash or other material that can cause a worker to fall trip or otherwise become injured?

  Yes

  No

  N/A

• 13.4 Are straight ladders (extension ladders) set at a 4:1 Pitch and does the ladders extend at least 3' (0.92m) above the edge of the landing?

  Yes

  No

  N/A

• 13.5 Is a landing or stairs used to access landings whenever there is a break in elevation of 19" (0.48m) or greater? (Include expansion joints, parapets etc)

  Yes

  No

  N/A

• 13.6 Where Stair Towers are used are they secured to the building every 20' (6.15,)?

  Yes

  No

  N/A

• 13.7 Are Stair towers inspected daily by a designated competent person?

  Yes

  No

  N/A

• Enter date and time of last Inspection.

  Date

• Are stairs free of debris trash or materials that can cause a worker to tip or fall?

  Yes

  No

  N/A

• Are stairs with 4 or more risers equipped with hand rails along any unprotected side?

  Yes

  No

  N/A

Section 14. Scissors Lifts/Articulating Boom Lifts

• 14.1 Is the gate or chain secured whenever workers are riding or working from a Lift?

  Yes

  No

  N/A

• 14.1.1 Are workers provide with and are they wearing a harness and lanyard when WORKING from a scissors lift?

  Yes

  No

  N/A

• 14.1.2 Workers are not using ladders, stools buckets or other means to increase height while working from a scissors lift?

  Yes

  No

  N/A

• 14.2 Scissors lifts and articulating boom lifts are being operated on a flat level surface free of holes, and away from trenches?

  Yes

  No

  N/A

• 14.3 Lifts are operated with the manufacturers specifications for loading (See load chart)?

  Yes

  No

  N/A

• 14.4 Lifts are operated a safe distance (Min 10' (3.07m) from power lines or other electrical hazard?

  Yes

  No

  N/A

• 14.5 Lifts are operated away from grates, shaft covers or other openings that may collapse under the weight of the lift?

  Yes

  No

  N/A

Section 15 Power operated equipment

• 15.1 Are moving parts guarded, (flywheels, rotating shafts etc?)

  Yes

  No

  N/A

• 15.2 Are fuel and oil systems free of leaks?

  Yes

  No

  N/A

• 15.3 Are hydraulic oil lines n good condition, free of leaks and not spliced or "patched"?

  Yes

  No

  N/A

• 15.4 Is cutting oil captured and discarded appropriately?

  Yes

  No

  N/A

• 15.4.1 Are spills and drips cleaned up appropriately? (may cause workers to slip and damaged roof liner)

  Yes

  No

  N/A

Comments:

Signatures

• Inspector Signature

  Sign

• Select date

  Date

• Contractor Representative Signature

  Sign

• Select date

  Date

• Empower Energies Project Manager Signature

  Sign

• Select date

  Date