Title Page

  • Document No.

  • Audit Title

  • Job Number

  • Conducted on

  • Prepared by

  • Personnel

1. General Information

  • Basic Job Description:

  • 1.1 Did a company representative accompany the inspector?

  • 1.2 Are all Safety/HazCom/Emergency Programs on site?

  • 1.3 Are OSHA posters/Emergency numbers posted?

  • 1.4 Are Confined Space Hazards identified and addressed?

  • 1.5 Are Hot work Permits being used accordingly?

  • 1.6 Are Gas Cylinders stored and used properly?

  • 1.7 Are first aid kits available and properly stocked?

  • 1.8 Are fire extinguishers available/charged/inspected?

  • 1.9 Is Material storage proper?

  • 1.10 Is housekeeping and sanitation proper?

  • 1.11 Are flammable materials in approved containers and properly labeled?

  • 1.12 Are all hand tools properly labeled/used/stored?

  • 1.13 Are barricades around work and traffic proper?

2. Personal Protective Equipment (PPE)

  • 2.1 Is all PPE provided by employer and readily available on site?

  • 2.2 Is respiratory protection proper/silica standard enforced?

  • 2.3 Is respiratory protection proper?

  • 2.4 Is proper foot protection worn?

  • 2.5 Is proper head protection worn?

  • 2.6 Is proper eye protection worn?

  • 2.7 Is hand protection/gloves proper?

3. Fall Protection

  • 3.1 Are fall protection plans required and in place?

  • 3.2 Is fall protection provided at heights over 6 feet or site specific height?

  • 3.3 Is fall protection equipment inspected and maintained?

  • 3.4 Are stairways protected and properly used?

  • 3.5 Are ladders properly used and maintained?

  • 3.6 Are all floor holes properly covered or protected?

  • 3.7 Is a roof warning line system or flag system being used properly?

4. Electrical

  • 4.1 Are GFCI's in use?

  • 4.2 Is temporary lighting used and proper?

  • 4.3 Are lockout/tagout procedures in place and being used properly?

  • 4.4 Are extension cords maintained/taped/hung and being used properly?

  • 4.5 Do all electrical panels have covers and circuits labeled?

5. Scaffolding

  • 5.1 Is a scaffold competent person on site?

  • 5.4 Is fall protection provided for anyone working on scaffolding if required?

  • 5.5 Are baseplates or mud sills stable and proper?

  • 5.6 Are all scaffold frames pinned together?

  • 5.7 Is scaffolding tied to structure using wire?

  • 5.9 Are all work planks properly installed and free of damage?

  • 5.10 Are all guardrails properly installed?

6. Heavy Equipment

  • 6.1 Are all parts/equipment free of damage?

  • 6.2 Are all guards in place and working properly?

  • 6.3 Is all equipment maintained and inspected/documented?

  • 6.4 Do backup alarms work on all equipment?

  • 6.5 Are all equipment operators trained/licensed?

  • 6.6 Are seatbelts operative and in use?

  • 6.7 Are aerial/scissor lifts properly used/documented/inspected?

  • 6.8 Are forks on the ground when forklift is parked?

  • 6.9 Is all equipment kept more than 10 feet away from overhead power lines?

7.0 Excavation/Trenching

  • 7.1 Is the trench competent person on site?

  • 7.2 Is the trench/excavation inspected daily?

  • 7.3 Has proper soil analysis been completed?

  • 7.4 Is employee protection proper for the type of soil/depth? (Trench Shoes,Shoring,Benching)

  • 7.5 Is safe access/egress provided?

  • 7.6 Are water removal procedures proper?

  • 7.7 Has the trench been evaluated as a confined space?

  • Overall Audit Notes:

  • 8. Overall Rating for the Audit?

  • Signature

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