Title Page
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Document No.
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Audit Title
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Job Number
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Conducted on
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Prepared by
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Personnel
1. General Information
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Basic Job Description:
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1.1 Did a company representative accompany the inspector?
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1.2 Are all Safety/HazCom/Emergency Programs on site?
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1.3 Are OSHA posters/Emergency numbers posted?
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1.4 Are Confined Space Hazards identified and addressed?
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1.5 Are Hot work Permits being used accordingly?
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1.6 Are Gas Cylinders stored and used properly?
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1.7 Are first aid kits available and properly stocked?
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1.8 Are fire extinguishers available/charged/inspected?
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1.9 Is Material storage proper?
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1.10 Is housekeeping and sanitation proper?
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1.11 Are flammable materials in approved containers and properly labeled?
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1.12 Are all hand tools properly labeled/used/stored?
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1.13 Are barricades around work and traffic proper?
2. Personal Protective Equipment (PPE)
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2.1 Is all PPE provided by employer and readily available on site?
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2.2 Is respiratory protection proper/silica standard enforced?
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2.3 Is respiratory protection proper?
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2.4 Is proper foot protection worn?
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2.5 Is proper head protection worn?
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2.6 Is proper eye protection worn?
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2.7 Is hand protection/gloves proper?
3. Fall Protection
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3.1 Are fall protection plans required and in place?
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3.2 Is fall protection provided at heights over 6 feet or site specific height?
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3.3 Is fall protection equipment inspected and maintained?
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3.4 Are stairways protected and properly used?
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3.5 Are ladders properly used and maintained?
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3.6 Are all floor holes properly covered or protected?
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3.7 Is a roof warning line system or flag system being used properly?
4. Electrical
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4.1 Are GFCI's in use?
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4.2 Is temporary lighting used and proper?
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4.3 Are lockout/tagout procedures in place and being used properly?
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4.4 Are extension cords maintained/taped/hung and being used properly?
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4.5 Do all electrical panels have covers and circuits labeled?
5. Scaffolding
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5.1 Is a scaffold competent person on site?
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5.4 Is fall protection provided for anyone working on scaffolding if required?
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5.5 Are baseplates or mud sills stable and proper?
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5.6 Are all scaffold frames pinned together?
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5.7 Is scaffolding tied to structure using wire?
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5.9 Are all work planks properly installed and free of damage?
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5.10 Are all guardrails properly installed?
6. Heavy Equipment
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6.1 Are all parts/equipment free of damage?
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6.2 Are all guards in place and working properly?
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6.3 Is all equipment maintained and inspected/documented?
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6.4 Do backup alarms work on all equipment?
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6.5 Are all equipment operators trained/licensed?
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6.6 Are seatbelts operative and in use?
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6.7 Are aerial/scissor lifts properly used/documented/inspected?
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6.8 Are forks on the ground when forklift is parked?
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6.9 Is all equipment kept more than 10 feet away from overhead power lines?
7.0 Excavation/Trenching
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7.1 Is the trench competent person on site?
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7.2 Is the trench/excavation inspected daily?
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7.3 Has proper soil analysis been completed?
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7.4 Is employee protection proper for the type of soil/depth? (Trench Shoes,Shoring,Benching)
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7.5 Is safe access/egress provided?
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7.6 Are water removal procedures proper?
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7.7 Has the trench been evaluated as a confined space?
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Overall Audit Notes:
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8. Overall Rating for the Audit?
- Outstanding-No deficiencies
- Satisfactory-Minor issues
- Unsatisfactory-Major issues
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Signature