Information
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Document No.
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Audit Title
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Client / Site
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Conducted on
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Prepared by
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Location
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Personnel
Housekeeping and Physical surroundings
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1. Does the customer provide Kelly employees with site-specific emergency response training (e.g., fire evacuation, severe weather shelter-in-place, fire extinguisher)? <br> <br>
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2. Do floors appear to be clear of slip, trip and fall hazards?<br> <br>
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3. Do stairways, aisles and emergency exits appear to be clear, open, and accessible (i.e., unblocked, free of objects)?<br> <br>
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Are all employees and subcontractors employees wearing safety glasses?
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5. Does the air quality, lighting, and general work environment appear acceptable?<br> <br>
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6. Do fire alarms and portable extinguishers appear to be unblocked and accessible?<br> <br>
Powered Industrial Truck
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1. Does customer agree to train and certify Kelly employees on the use of powered industrial vehicles?<br>
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2. Do powered industrial vehicles appear to be well maintained and in good working order (e.g., good tires, seat belts in good condition, fire extinguishers)?<br>
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3. Do powered industrial vehicle operators wear seatbelts and drive in a safe and controlled manner?<br>
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4. Are dock boards (i.e., dock plates, bridge plates) used when loading or unloading tractor/semi-truck trailers or other containers?<br>
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5. Are wheel chocks and/or a mechanical dock locking system used when loading or unloading tractor/semi-truck trailers or other containers?<br>
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6. If only wheel chocks are used, are procedures in place to verify that the wheel chocks are in place prior to loading or unloading tractor/semi-truck trailers or other containers?<br>
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Are all work areas, tool storage, equipment, and lay-down areas properly marked and barricaded or protected?
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Do all fenced areas have "no trespassing" signs posted on perimeter fencing?
Powered Lifts
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Do all operators of powered lifts have appropriate and current (w/in 3 years) licensing through Woods to operate that equipment?
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Are all scissor lift chains in place?
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Are all feet planted on the platforms of the lifts (I.e. not on railings)?
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Lull and Forklift: are seat belts being used?
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Articulating boom and mobile platforms attached to lifts: are harnesses being used, properly worn and properly tethered?
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Are operators of lifts outside the building wearing DOT / Hi-Viz vest?
General Safety - Observations
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Are all barricade doors closed and locked?
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Are all barricade edges lined up so there are no trip hazards?
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Do all emergency exit routes and doors have free and easy access and a clear path of travel both to the door and from the door away from the building?
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Are all ladders in use being used safely? Set up correctly / No standing on top 2 steps / etc...?
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Are all fire extinguishers, electrical panels, fire risers/shutoffs, and other emergency equipment free from obstruction and clearly accessible?
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Are all workers operating internal combustion equipment inside the building or other enclosed space(s) using a Carbon Monoxide monitor?
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Are all propane containers NOT IN USE stored outside the building?
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Are workers involved in spraying operations wearing approved respirators?
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Are workers within 10 feet of leading edge (>6' fall to next level) wearing harness and tether to approved attachment point (5400 lbs cap.)?
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Do all containers containing chemicals have a label showing container contents?
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Are there any other trip/fall hazards observed inside or out as you walk the site (flooring transitions, temporary flooring changes, sidewalks, parking lots, etc...)?
Superintendent / Foreman Comments & Signature
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COMMENTS:
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Foreman Signature