Frank M. Booth

• Conducted on

  Date

• Prepared by

• Client / Site

JOBSITE & TRAILER

• OSHA/EMERGENCY/CODE OF SAFE PRACTICES POSTED?

  Yes

  No

  N/A

• SDS

  Yes

  No

  N/A

• SAFETY MEETINGS

  Yes

  No

  N/A

• FIRST AID KITS/FIRE EXTINGUISHERS?

  Yes

  No

  N/A

PPE

• WEARING REQUIRED PPE FOR TASK?

  Safe

  At Risk

  N/A

TOOLS - HAND & POWER

• TOOLS USED PROPERLY?

  Safe

  At Risk

  N/A

• GUARDS IN PLACE?

  Safe

  At Risk

  N/A

• PAT SIGNAGE/LICENSE/PPE

  Safe

  At Risk

  N/A

EQUIPMENT

• FORKLIFT USE

  Safe

  At Risk

  N/A

• SCISSOR LIFT USE

  Safe

  At Risk

  N/A

• BOOM LIFT USE

  Safe

  At Risk

  N/A

• HEAVY EQUIPMENT USE

  Safe

  At Risk

  N/A

ELECTRICAL

• GFCI

  Safe

  At Risk

  N/A

• CORDS/PLUGS/CAPS

  Safe

  At Risk

  N/A

• GENERATOR

  Safe

  At Risk

  N/A

• LOTO

  Safe

  At Risk

  N/A

TRENCHES/EXCAVATIONS

• ACCESS/EGRESS/CONFINED SPACE

  Safe

  At Risk

  N/A

• CAVE IN PROTECTION

  Safe

  At Risk

  N/A

• FALL PROTECTION

  Safe

  At Risk

  N/A

• BARRICADES

  Safe

  At Risk

  N/A

FALL PROTECTION

• GUARDRAILS/BARRICADES/FLOOR OPENINGS/LEADING EDGE

  Safe

  At Risk

  N/A

• PFAS IN USE?

  Safe

  At Risk

  N/A

WALKING/WORKING SURFACES

• CLEAR PATH OF TRAVEL?

  Safe

  At Risk

  N/A

• RAMPS/STAIRWAY ACCESS

  Safe

  At Risk

  N/A

LADDERS

• USED PROPERLY?

  Safe

  At Risk

  N/A

• LABELS/WARNING

  Safe

  At Risk

  N/A

• CONDITION?

  Safe

  At Risk

  N/A

SCAFFOLDS

• SAFE TO USE?

  Safe

  At Risk

  N/A

HOUSEKEEPING/SANITATION

• SLIP/TRIP/FALL HAZARDS?

  Safe

  At Risk

  N/A

• PROPER DISPOSAL OF WASTE?

  Safe

  At Risk

  N/A

• PORTABLE TOILETS/DRINKING WATER?

  Safe

  At Risk

  N/A

• MATERIALS STORED PROPERLY?

  Safe

  At Risk

  N/A

HOT WORK

• PERMIT COMPLETED?

  Yes

  No

  N/A

• COMPRESSED GAS USED/STORED PROPERLY?

  Safe

  At Risk

  N/A

AUDIT CERTIFICATION

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