Gas Division Safety Audit

• Site conducted

  Select

• Prepared by

• Location
  Address

• Inspection Date and Time

  Date

Personal Protective Equipment

• Hard Hats in use during Job Task

  Safe

  At Risk

  N/A

• Safety Glasses in use during Job Task - Z-87.1 Approved

  Safe

  At Risk

  N/A

• Steel Toe Boots must be F2413 Approved

  Safe

  At Risk

  N/A

Proper Safety Vest in use and in good condition

• Is proper safety vest in use?

  Safe

  At Risk

  N/A

• Full length pants in good repair?

  Safe

  At Risk

  N/A

• FR clothing in use where required?

  Safe

  At Risk

  N/A

• Electrical insulating rubber gloves and leather protectors available and in compliance?

  Safe

  At Risk

  N/A

• Seat Belt in Use All vehicle types

  Safe

  At Risk

  N/A

• Is the proper respiratory protection being used when required?

  Safe

  At Risk

  N/A

• Jewelry Policy Compliance

  Safe

  At Risk

  N/A

Traffic Control/Work Area Protection

• Flagman/Policeman are in Place where needed?

  Safe

  At Risk

  N/A

• Flagman has received training?

  Safe

  At Risk

  N/A

• Proper DOT Signs and/or Cones in Place?

  Safe

  At Risk

  N/A

• Tailboard Completed Accurately?

  Safe

  At Risk

  N/A

• Take Photo of Both sides of Tailboard

  Media

• Is CBYD Ticket for Excavation Zone Active?

  Safe

  At Risk

  N/A

• Stop the Job and notify the division manager

Vehicles and Equipment

• First Aid Kit available and with current expiration date?

  Safe

  At Risk

  N/A

• DVIR Completed?

  Safe

  At Risk

  N/A

• Are First Aide and Fire Extinguisher Decals present and clearly visible?

  Safe

  At Risk

  N/A

• If equipped with backup alarms is it working properly?

  Safe

  At Risk

  N/A

• Are Wheel Chocks in Use when required (All vehicles above F-150 and all disconnected trailers)

  Safe

  At Risk

  N/A

• State Registration and insurance cards in the vehicle and current?

  Safe

  At Risk

  N/A

• Fire Extinguisher within expiration date and checked off monthly?

  Safe

  At Risk

  N/A

• General Housekeeping

  Safe

  At Risk

  N/A

Work Methods and Practices

• Is Communication between operator and spotter set before movement of equipment?

  Safe

  At Risk

  N/A

• Two People with CPR/First Aid training on site?

  Safe

  At Risk

  N/A

• Cell phone use policy violations?

  Safe

  At Risk

  N/A

• Ladders, are decals legible, free of defects?

  Safe

  At Risk

  N/A

• Are flammable/Combustible liquids kept in approved, self-closing metal safety cans?

  Safe

  At Risk

  N/A

• Are electrical extension cords in good condition?(ground prong intact? free of cuts on insultation?

  Safe

  At Risk

  N/A

• Are there any environmental concerns such as fluid leaks on site?

  Safe

  At Risk

  N/A

• Rigging Equipment in good condition, ratings legible?

  Safe

  At Risk

  N/A

• Housekeeping

  Safe

  At Risk

  N/A

Audit Sign Off

• Foreman Signature

  Sign

• Inspectors Signature

  Sign