ESC Site Safety Audit

• Supervisor

• Location
  Address

• Conducted on

  Date

• Prepared by:

  Select Trevor Duininck Chris Duininck Judd Duininck Lee Duininck Jason Duininck Rick Maursetter Tim Amundson Jeff Rettig Tyler Myrom Dave Brouwer

  • Trevor Duininck
  • Chris Duininck
  • Judd Duininck
  • Lee Duininck
  • Jason Duininck
  • Rick Maursetter
  • Tim Amundson
  • Jeff Rettig
  • Tyler Myrom
  • Dave Brouwer

First Aid/Emergency Services

• Does the supervisor know where the nearest hospital is located?

  Yes

  No

  N/A

• Does 911 work?

  Yes

  No

  N/A

• Do emergency responders know where the jobsite is located?

  Yes

  No

  N/A

Daily Safety Plan

• Does the daily safety plan outline hazards at the job site?

  Yes

  No

  N/A

• Does the daily safety plan meet passing criteria?

  Yes

  No

  N/A

Attitude

• Is the attitude at the job site positive?

  Yes

  No

  N/A

Additions

• Additional Comments

• Additional Photos

  Media

• Are there slip/trip hazards (i.e. loose cords) present at the jobsite?

  Yes

  No

  N/A

• Is there a build up of excess material in walkways?

  Yes

  No

  N/A

• Is the site clean and orderly? (include garbage in trailers/equipment, toilets, etc.)

  Yes

  No

  N/A

• Additional Comments

• Are employees wearing hardhats?

  Yes

  No

  N/A

• Are employees wearing safety glasses?

  Yes

  No

  N/A

• If employee is grinding, sawing, cutting, etc., is secondary eye protection being worn?

  Yes

  No

  N/A

• Are employees wearing high-vis vests when required?

  Yes

  No

  N/A

• Are employees wearing hearing protection when required?

  Yes

  No

  N/A

• Where required (mechanics, fabricators, yardman), are safety toed footwear being worn?

  Yes

  No

  N/A

Additions

• Additional Comments

• Additional Photos

  Media

Respirators

• Does the user know how to conduct a user seal check with their respirator?

  Yes

  No

  N/A

• Has the user had a fit test from the safety department this year?

  Yes

  No

  N/A

Fall Protection

• Are employees working above 6 feet with fall protection?

  Yes

  No

  N/A

• Have fall harnesses been inspected?

  Yes

  No

  N/A

• Have fall lanyards been inspected?

  Yes

  No

  N/A

Ladders

• Are ladders properly secured?

  Yes

  No

  N/A

• Are ladders free in good condition?

  Yes

  No

  N/A

Fire Extinguishers

• Is there a fire extinguisher present?

  Yes

  No

  N/A

• Is the extinguisher blocked by garbage, material, debris, etc.?

  Yes

  No

  N/A

• Has the extinguisher been inspected on a monthly basis?

  Yes

  No

  N/A

• Is the fire extinguisher up to date with annual inspection?

  Yes

  No

  N/A

Confined Space

• Is retrieval equipment present?

  Yes

  No

  N/A

• Are 4 Gas meters being used prior to confined space entry?

  Yes

  No

  N/A

• If hazardous conditions are observed, are appropriate control measures (ventilation, fans, blowers, etc.) available or present?

  Yes

  No

  N/A

• Are 4 Gas meters being worn into confined spaces by authorized entrant?

  Yes

  No

  N/A

Additional Information

• Additional Comments

• Additional Photos

  Media

• Are operators/drivers wearing seat belts?

  Yes

  No

  N/A

• Do lights (head lights, tail lights, turn signals) function properly on equipment/truck?

  Yes

  No

  N/A

• Do reverse signals function properly?

  Yes

  No

  N/A

• Does the horn function properly?

  Yes

  No

  N/A

• Are loads properly secured and covered?

  Yes

  No

  N/A

• Has the operator completed their Operator Care standards for their equipment?

  Yes

  No

  N/A

Additional Information

• Additional Comments

• Additional Photos

  Media

LOTO

• Do employees know proper LOTO procedures?

  Yes

  No

  N/A

• Do employees have enough equipment to perform the LOTO procedures correctly?

  Yes

  No

  N/A

Power Cords

• Are there any exposed conductors (inner wires) or other damage to the power cords?

  Yes

  No

  N/A

• Are ground plugs present on extension cords?

  Yes

  No

  N/A

Electrical Panels

• Are fuses, breakers, plugs labeled properly with the machinery that they control?

  Yes

  No

  N/A

Additional Information

• Additional Comments

• Additional Photos

  Media

• Are overhead power lines present?

  Yes

  No

  N/A

• Are spotters and/or visual cues in place?

  Yes

  No

  N/A

• Are underground utilities properly and clearly marked?

  Yes

  No

  N/A

• Are locate tickets up to date?

  Yes

  No

  N/A

• What soil type is present for the trench?

  A

  B

  C

• Are trench boxes being used?

  Yes

  No

  N/A

• Are trenches properly sloped (type A=3/4:1 ratio of rise and run (in feet), type B=1:1, type C=1.5:1)

  Yes

  No

  N/A

• Are ladders properly positioned (either within the trenchbox or a maximum of 25 feet from employee)

  Yes

  No

  N/A

Additional Information

• Additional Comments

• Additional Photos

  Media

• Is the traffic control plan outlined?

  Yes

  No

  N/A

• Is there proper amounts of signage, cones, etc.?

  Yes

  No

  N/A

• Are traffic control plans being followed?

  Yes

  No

  N/A

Additional Information

• Additional Comments

• Additional Photos

  Media

• Signature of Auditee

  Sign

• Signature of Auditor

  Sign

• Date Completed

  Date