Field Safety Audit - Southern Home Services

• Center / Location
  Address

• Conducted on

  Date

• Prepared by

  Sign

JSA

• JSA Complete

  Safe

  At Risk

  N/A

• JSA Adequate

  Safe

  At Risk

  N/A

• Employee knowledgeable of Southern Safety Policies

  Safe

  At Risk

  N/A

Personal Protective Equipment (PPE)

• High visibility vest

  Safe

  At Risk

  N/A

• Hard hat

  Safe

  At Risk

  N/A

• Proper gloves for task

  Safe

  At Risk

  N/A

• Safety footwear

  Safe

  At Risk

  N/A

• Hearing Protection

  Safe

  At Risk

  N/A

• Eye Protection

  Safe

  At Risk

  N/A

• PPE Condition

  Safe

  At Risk

  N/A

• PPE Properly Worn

  Safe

  At Risk

  N/A

Fall Protection / Ladders

• Measures in place to eliminate fall hazards

  Safe

  At Risk

  N/A

• Safety Harness condition

  Safe

  At Risk

  N/A

• Safety harness properly worn

  Safe

  At Risk

  N/A

• Ladders - Correct ladder for task

  Safe

  At Risk

  N/A

• Ladders - Inspected prior to use

  Safe

  At Risk

  N/A

• Ladders - Proper use of the ladder

  Safe

  At Risk

  N/A

Working Environment

• Work area free of excessive dust

  Safe

  At Risk

  N/A

• Adequate lighting

  Safe

  At Risk

  N/A

• Walkways and exits clear of obstructions

  Safe

  At Risk

  N/A

Electricity

• Proper electrical PPE worn

  Safe

  At Risk

  N/A

• Power tools are inspected prior to use

  Safe

  At Risk

  N/A

• Electrical circuits have been isolated and tested to confirm dead?

  Safe

  At Risk

  N/A

• Isolated circuits LO/TO applied

  Safe

  At Risk

  N/A

Hot Work

• Gas Cylinders Secured

  Safe

  At Risk

  N/A

• Fire Extinguishers Present

  Safe

  At Risk

  N/A

• Gauges In Good Condition

  Safe

  At Risk

  N/A

• Hoses In Good Condition

  Safe

  At Risk

  N/A

• Flash Back Arrestors In Good Condition

  Safe

  At Risk

  N/A

• Fire Blankets In Place

  Safe

  At Risk

  N/A

Storage / Housekeeping

• Work area cleaned continuously

  Safe

  At Risk

  N/A

Vehicle

• Is the operatives vehicle in a road worthy condition?

  Safe

  At Risk

  N/A

• Tire condition

  Safe

  At Risk

  N/A

• Loading

  Safe

  At Risk

  N/A

• Fire extinguisher

  Safe

  At Risk

  N/A

• First aid kit

  Safe

  At Risk

  N/A

Other items identified

• undefined

• undefined

• Signed:

  Sign