Gemma Power Systems Audit Moxie Freedom

• Document No.

• Audit Title

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Administrative

• OSHA 300 log posted and up to date?

  Yes

  No

  N/A

• MSDS sheets up to date and available to employees?

  Yes

  No

  N/A

• OSHA and DOL posters up to date and posted?

  Yes

  No

  N/A

• Emergency phone numbers, evacuation plan and muster points posted?

  Yes

  No

  N/A

• SWPPP inspections up to date?

  Yes

  No

  N/A

• Tool box safety talks log up to date?

  Yes

  No

  N/A

• First aid kits available in the office?

  Yes

  No

  N/A

• First responders available?

  Yes

  No

  N/A

• Site safety signage is in place (speed, stop, slow, muster points, visitor sign in, safety rules, etc)?

  Yes

  No

  N/A

STA Completion

• Pre-task planning forms in use and properly filled out (STA, JHA, etc)

  Yes

  No

  N/A

• Hazards properly identified on STA?

  Yes

  No

  N/A

• Tasks being performed are on the STA?

  Yes

  No

  N/A

• Emergency notification section filled out completely on STA?<br> -phone number<br> -nearest plant phone<br> -emergency contact <br> -eye wash station/ first-aid location

  Yes

  No

  N/A

• Supervisor's briefing crews on task for that day?

  Yes

  No

  N/A

• Crew members signing in on STA?

  Yes

  No

  N/A

• Crew members signing out on STA?

  Yes

  No

  N/A

Site Condition

• Ground around work areas?

  Yes

  No

  N/A

• Dry

• Trash containers available, in proper location and not overflowing?

  Yes

  No

  N/A

• Spill containers available and in proper location?

  Yes

  No

  N/A

• Proper amount of sanitary facilities available and well maintained/cleaned?

  Yes

  No

  N/A

• Hand wash stations available and well maintained/cleaned?

  Yes

  No

  N/A

• Drinking water available and properly maintained?

  Yes

  No

  N/A

• Eye wash stations available and ready for use?

  Yes

  No

  N/A

• Eye wash stations unobstructed?

  Yes

  No

  N/A

• Cords, leads, hose, rope etc picked up so they do not pose a tripping hazard?

  Yes

  No

  N/A

• Walkways clear of debris and excess material?

  Yes

  No

  N/A

• Barricades installed and properly maintained?

  Safe

  At Risk

  N/A

• Wooden barricades

  Safe

  At Risk

  N/A

• Orange snow fence

  Safe

  At Risk

  N/A

• Red danger tape

  Safe

  At Risk

  N/A

• Yellow caution tape

  Safe

  At Risk

  N/A

• Wire rope

  Safe

  At Risk

  N/A

• Nails removed or bent over?

  Yes

  No

  N/A

• Rebar caps installed to prevent impalement?

  Yes

  No

  N/A

• Proper storage of flammable material?

  Yes

  No

  N/A

• Fuel and other liquids properly stored in berm, diked, or double wall containers?

  Yes

  No

  N/A

• Fuel storage area properly barricaded?

  Yes

  No

  N/A

• Smoking areas posted and adhered to?

  Yes

  No

  N/A

• Fire extinguishers available, full, inspected and in proper locations?

  Yes

  No

  N/A

• Combustibles removed from hot work areas?

  Yes

  No

  N/A

• Sufficient lighting to perform task?

  Yes

  No

  N/A

• All tools, ladders, cords, leads etc are the proper quarterly color code?

  Yes

  No

  N/A

• Green

• Overall general site condition?

PPE

• Hard hats worn properly and in good repair?

  Yes

  No

  N/A

• Proper safety glass worn for proper lighting?<br> -indoors clear/smoke<br> -outdoors dark/clear/smoke

  Yes

  No

  N/A

• Goggles or face shields used when required?

  Yes

  No

  N/A

• Employees wearing proper attire?

  Yes

  No

  N/A

• Respiratory protection used properly when needed?

  Yes

  No

  N/A

• Hearing protection used where required?

  Yes

  No

  N/A

• High visibility vest worn when required?

  Yes

  No

  N/A

• Fire retardant clothing worn where required?

  Yes

  No

  N/A

• Steel toed boots or foot protection used?

  Yes

  No

  N/A

• Gloves being worn when handling material or tools?

  Yes

  No

  N/A

Fall Protection

• Fall arrest equipment inspected prior to each use?

  Yes

  No

  N/A

• Harness

  Safe

  At Risk

  N/A

• Lanyards

  Safe

  At Risk

  N/A

• SRL

  Safe

  At Risk

  N/A

• Fall arrest equipment used properly?

  Yes

  No

  N/A

• Maintaining 100% tie off?

  Yes

  No

  N/A

• Tools secured from falling?

  Yes

  No

  N/A

• Unused fall protection properly stored when not in use?

  Yes

  No

  N/A

• Employees below protected from falling objects?

  Yes

  No

  N/A

• Holes are covered and labeled?

  Yes

  No

  N/A

• Excess material, trip hazards, removed from work area?

  Yes

  No

  N/A

• Step ladders opened and not used as straight ladders?

  Yes

  No

  N/A

• Extension ladders extend 3 ft beyond landing?

  Yes

  No

  N/A

• Extension ladders secured from displacement? Tied off?

  Yes

  No

  N/A

• Ladders used properly?

  Yes

  No

  N/A

• Ladders and fall protection quarterly inspections current?

  Yes

  No

  N/A

• Green

Equipment Usage

• Employees operating equipment have proper training for specific equipment?

  Yes

  No

  N/A

• Pre-use inspection forms being used on all equipment?

  Yes

  No

  N/A

• Aerial lifts used properly, employees are tied off with both feet in basket?

  Yes

  No

  N/A

• Scissor lifts used properly, employees are tied off with both feet in basket?

  Yes

  No

  N/A

• Warning devices in place on vehicles (back up alarms, strobes, signage etc)?

  Yes

  No

  N/A

• Seat belts worn at all times?

  Yes

  No

  N/A

• Operators checking surroundings at all times?

  Yes

  No

  N/A

• Operators using spotters when backing or in tight spots?

  Yes

  No

  N/A

Tools

• Proper tools used for the job?

  Yes

  No

  N/A

• Proper use of tools by employees ?

  Yes

  No

  N/A

• Tools in good repair?

  Yes

  No

  N/A

• GFCI's used on all 110V power tools?

  Yes

  No

  N/A

• Guards properly used and functional?

  Yes

  No

  N/A

• Handles and guards are installed on all tools?

  Yes

  No

  N/A

• Cords in acceptable condition for use and have ground?

  Yes

  No

  N/A

• Unused tools returned to gang box?

  Yes

  No

  N/A

Welding

• Hot work permits filled out properly and used?

  Yes

  No

  N/A

• Fire watch utilized?

  Yes

  No

  N/A

• Fire extinguisher within 25' of any hot work and accessible?

  Yes

  No

  N/A

• Compressed gasses properly secured and separated when stored?

  Yes

  No

  N/A

• Proper separating distances between fuels and oxygen?

  Yes

  No

  N/A

• Welding shields and fire blankets used?

  Yes

  No

  N/A

• Ventilation adequate during welding?

  Yes

  No

  N/A

• Sparks, slag and flames controlled?

  Yes

  No

  N/A

• Leads and hoses protected and not causing a hazard?

  Yes

  No

  N/A

Cranes and Rigging

• Crane annual inspection up to date?

  Yes

  No

  N/A

• Certified crane operators operating cranes?

  Yes

  No

  N/A

• Daily crane inspection and pre-operational checks complete?

  Yes

  No

  N/A

• Lift plan in place and approved for all lifts?

  Yes

  No

  N/A

• Rigging inspected prior to each use?

  Yes

  No

  N/A

• Rigging in good repair?

  Yes

  No

  N/A

• Safety latches in place?

  Yes

  No

  N/A

• Softeners being used?

  Yes

  No

  N/A

• Rigging has proper quarterly inspections complete and proper color code?

  Yes

  No

  N/A

• Green

• Lift area barricaded or spotter in place during all lifts?

  Yes

  No

  N/A

• One person directing operator at all times?

  Yes

  No

  N/A

• Riggers keeping employees clear of overhead loads?

  Yes

  No

  N/A

• Operators and riggers using horns/whistles during lifts?

  Yes

  No

  N/A

• Tag lines being used on all loads?

  Yes

  No

  N/A

• Riggers maintaining eye contact with crane operator?

  Yes

  No

  N/A

Energy Control (LOTO)

• Personnel working on equipment requiring LOTO are properly trained?

  Yes

  No

  N/A

• LOTO form completed?

  Yes

  No

  N/A

• LOTO equipment in good repair, organized and available?

  Yes

  No

  N/A

• Locks installed properly and all locks tagged?

  Yes

  No

  N/A

• Energy within system properly controlled?

  Yes

  No

  N/A

• Employees removed locks upon end of shift?

  Yes

  No

  N/A

• LOTO logging system and records in place and organized?

  Yes

  No

  N/A

Excavations

• Dig permits used properly prior to excavations?

  Yes

  No

  N/A

• DigSafe or OneCall complete prior to excavations? Note: not all utilities can be located<br>In this manner. Private utilities located using drawings or proper locating service.

  Yes

  No

  N/A

• Holes deeper then 4' are benched or sloped in accordance with dig permit?

  Yes

  No

  N/A

• All holes, trenches and pits properly barricaded?

  Yes

  No

  N/A

• Access/Egress within 25' of each employee. Minimum 2 exits from excavation.

  Yes

  No

  N/A

• Spoil piles more then a minimum of 2' from excavation?

  Yes

  No

  N/A

• Employees working in trench can see operator at all times?

  Yes

  No

  N/A

• Safety Manager

  Sign

• Superintendent

  Sign

• Project Manager

  Sign