Giampolini Safety Audit (PM)

• Project Number - Name

• General Contractor

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

1. Personal Protective Equipment

• 1.1 Hard Hats/Gloves/Footwear/Glasses/Clothes?

  Yes

  No

  N/A

• 1.2 Ear Protection/Respirators/Face Shield?

  Yes

  No

  N/A

• 1.3 Fall protection (Harness, Lanyard, Yo-Yo, Anchor point) inspected, worn/fit properly, in good condition w/o damage?

  Yes

  No

  N/A

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2. Jobsite Conditions - Giampolini

• 2.1 Adequate Task Lighting?

  Yes

  No

  N/A

• 2.2 Piling & Stacking of Materials?

  Yes

  No

  N/A

• 2.3 Debris Removal?

  Yes

  No

  N/A

• 2.4 Drinking water available and in close proximity to workers (2 gal. per employee, per 8-hour shift)?

  Yes

  No

  N/A

• 2.5 Signage (Laser/Powder Actuated Tool/Work Overhead/etc.) posted <>50' from operation?

  Yes

  No

  N/A

• 2.6 Danger/Caution Area Properly Marked-secured w/identification signage attached?

  Yes

  No

  N/A

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3. Jobsite Conditions - General Contractor

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• 3.1 Perimeter Rails/Cables (in place at 42" & 21" with a deflection < 3")?

  Yes

  No

  N/A

• 3.2 Floor Opening/Covered/Secured in place/Marked?

  Yes

  No

  N/A

• 3.3 Stairs/Ramps/Exits/Walkways clear?

  Yes

  No

  N/A

• 3.4 Trip Hazards?

  Safe

  At Risk

  N/A

• 3.5 Piling/Stacking/Debris Removal?

  Yes

  No

  N/A

• 3.6 General Lighting (minimum of 5-foot candles)?

  Yes

  No

  N/A

• 3.7 Sanitation (CA 1:20)?

  Yes

  No

  N/A

• 3.8 Barricades/Fencing?

  Yes

  No

  N/A

• 3.9 Rebar Caps?

  Yes

  No

  N/A

• 3.10 Danger/Caution Area Properly Marked Off & Identified?

  Yes

  No

  N/A

4. Programs & Information

• 4.1 Daily Inspections Conducted (Jobsite Safety/Scaffold/Etc.)?

  Yes

  No

  N/A

• 4.2 New Employee Training?

  Yes

  No

  N/A

• 4.3 Tailgate Meetings?

  Yes

  No

  N/A

• 4.4 Posters/Signs posted/IIPP-WWSP/MSDS/SWPPP present?

  Yes

  No

  N/A

• 4.5 Equipment certifications (including scaffold permit - if applicable) in safety binder?

  Yes

  No

  N/A

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5. First Aid

• 5.1 Trained personnel documented w/copies on file?

  Yes

  No

  N/A

• 5.2 First aid kits/supplies adequately available w/identification & proper signage ("First Aid Kit Inside")?

  Yes

  No

  N/A

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6. Scaffold/Equipment

• 6.1 Railings (@42" & 21")/Toe boards (>4")?

  Yes

  No

  N/A

• 6.2 Tied back to structure (or out-rigged CA @ 3:1)?

  Yes

  No

  N/A

• 6.3 Planks/Platforms (in good proper condition/no more than 1" gap between planks)?

  Yes

  No

  N/A

• 6.4 Access (Green Tagged & Inspected)?

  Yes

  No

  N/A

• 6.5 Scaffold Stairs (Green Tagged & Inspected)?

  Yes

  No

  N/A

• 6.6 Safety Devices/back-up alarms functioning properly?

  Yes

  No

  N/A

• 6.7 Equipment inspections completed and documented?

  Yes

  No

  N/A

• 6.8 All wheels on rolling scaffolds locked while in use?

  Yes

  No

  N/A

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7. Fire Protection

• 7.1 Extinguishers in proper working condition (indicator needle in green; inspection < 1 year; pull-pin secured with breakaway zip-tie; inspection sticker and tag) & inspected?

  Yes

  No

  N/A

• 7.2 Flammable Material Storage ( Yellow Cabinet, containment pallet, etc.) Available and identified?

  Yes

  No

  N/A

• 7.3 Welding/Equipment Tanks Stored and in proper condition?

  Yes

  No

  N/A

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8. Ladders

• 8.1 Ladder condition/all regulatory stickers?

  Yes

  No

  N/A

• 8.2 Ladder Tied Off (top and bottom)?

  Yes

  No

  N/A

• 8.3 Ladder 3' above landing?

  Yes

  No

  N/A

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9. Tools

• 9.1 Proper working condition (broken bits/grinding wheels/etc.)?

  Yes

  No

  N/A

• 9.2 Guards/Safety devices in place?

  Yes

  No

  N/A

• 9.3 Cords/Plugs in good condition (no tears in cord/exposed wiring/pulled out of plug) /GFCI?

  Yes

  No

  N/A

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10. Pumps & Mixing Equipment

• 10.1 Pressure Ball/relief valve/safety devices operable and in place?

  Yes

  No

  N/A

• 10.2 Hose whip checks in place and secured (zip-ties/duct tape)?

  Yes

  No

  N/A

• 10.3 Good working condition?

  Yes

  No

  N/A

• 10.4 All Guards in place?

  Yes

  No

  N/A

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11. Comments/Corrections:

• Jobsite photos

  Media

• Comments:

• Corrections:

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• Foreman Signature

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• (PM) Inspector Signature

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