FRANSEN PITTMAN CONSTRUCTION, INC.

• Audit No.:

• Audit Date:

  Date

• Date of Last Audit:

  Date

• Project Name:

• Client Name:

• Audit Conducted by:

• Subcontractors on Site:

• Note: Use of this form is not intended to be all encompassing, but is to be used to assist those responsible for implementation of safety procedures, practices , and general compliance with OSHA standards. This form will be used on a weekly basis and all items noted for correction are to be monitored until noted as corrected on this form. A copy of this form is to remain onsite in the field office. Copy to main office and to Subcontractors as deemed necessary or appropriate.

Job Trailer / Bulletin Board (This section is only required during project start-up or job trailer relocation):

• Are all of the below items in proper order?<br> First aid kit, Emergency/FA/CPR #'s, Muster area, Stair Handrails, Defective tags, OSHA access, OSHA 300A, DMP, All-in-ones, FP Work Rules, Haz. Comm, Crane signals.

  Yes

  No

  N/A

Site Documentation:

• Are all of the below items in proper order?<br> Deficiencies corrected, Safety meeting x2, Haz. Comm. Programs, MSDS/SDS, Containers labeled, Health/Safety Programs.

  Yes

  No

  N/A

Housekeeping:

• Are all of the below items in proper order?<br> Dumpsters, Toilets, Aisles/stairs, Work areas, Fall hazards, Drinking water, Trash chutes, PAT, Safety signs, Public protection.

  Yes

  No

  N/A

Fire Prevention and Protection:

• Are all of the below items in proper order?<br> FE's, FE signs, Fuel storage, Fuel containers, Gases, torch carts, exits/stairs.

  Yes

  No

  N/A

Personal Protective Equipment (PPE):

• Are all of the below items in proper order?<br> PPE supplies, Hard hats, Boots, Clothes, Ear plugs, Glasses, Vest, Goggles, Respiratory, Face shield.

  Yes

  No

  N/A

Tools:

• Are all of the below items in proper order?<br> Hand tools, Power tools, PAT, lasers.

  Yes

  No

  N/A

Fall Protection:

• Are all of the below items in proper order?<br> Competent person, Fall protection - adequate, inspected, clean, trained.

  Yes

  No

  N/A

Electrical:

• Are all of the below items in proper order?<br> GFCI, GFCI tests, Temp power panels, Cords, Plugs, Temp lighting.

  Yes

  No

  N/A

Ladders:

• Are all of the below items in proper order?<br> Secured, 3', Used correctly, Condition, 4:1, Firm Surface.

  Yes

  No

  N/A

Scaffold:

• Are all of the below items in proper order?<br> Competent person, Inspected/tagged, Base, Braces, Planks, Guard rails, Fall protection, Falling objects.

  Yes

  No

  N/A

Trenching and Excavations:

• Are all of the below items in proper order?<br> Call before you dig, inspection, Competent person, confined space?, Monitored, Ladder access 4', Shoring/benching 5', Fall protection 6', 2' from edge, protected from equipment.

  Yes

  No

  N/A

Heavy Equipment:

• Are all of the below items in proper order?<br> Certified - forklift, skid steer, arial lifts, Seat belts, Fall protection, Spotters, Flaggers, Rigging/lifting, Generators.

  Yes

  No

  N/A

Safety Audit Completion and Summary:

• Were the workers actively pre-tasking or using the "4 What's"?<br> - What am I doing today?<br> - What materials and tools do I need?<br> - What are the hazards I am going to encounter?<br> - What am I doing to eliminate those hazards?

  Yes

  No

  N/A

• Were there any near misses to report this week?

• Were there any accidents to report this week?

• Was the site free of safety violations? If no, what were the violations?

  Yes

  No

  N/A

• What were the corrective actions taken to eliminate those violations?

• Closing Comments?

Safety Audit Sign-off:

• Signature:

  Sign