Hilscher-Clarke Electric

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date
• Location
  Address

• Site Foreman

House Keeping

• How is cord management?

  Safe

  At Risk

  N/A

• Are Stairways and walkways clear?

  Safe

  At Risk

  N/A

• Is scrap wire and conduit drops picked up to eliminate tripping hazards?

  Safe

  At Risk

  N/A

• Is material storage neat?

  Safe

  At Risk

  N/A

• Are there any slipping hazards I.e oil, grease, mud?

  Safe

  At Risk

  N/A

Access and Egress into the building / job site

• Are these areas clearly marked?

  Safe

  At Risk

  N/A

• Are they obstructed or blocked?

  Safe

  At Risk

  N/A

• Do these areas require steps or ramps?

  Safe

  At Risk

  N/A

Pre-Task Plans

• Is TSA filled out in detail?

  Safe

  At Risk

  N/A

• Has the foreman or lead person signed off on the Pre-task plan?

  Safe

  At Risk

  N/A

Hand and Power Tools

• Have they been inspected? (assured grounding)

  Safe

  At Risk

  N/A

• Is the right tool for the right job being used?

  Safe

  At Risk

  N/A

• Is the tool being used properly?

  Safe

  At Risk

  N/A

• Are the guards in place?

  Safe

  At Risk

  N/A

• If a Port-a-band is being used is mounted or handheld?

  Safe

  At Risk

  N/A

Flammables / Combustibles

• Are they being stored properly?

  Safe

  At Risk

  N/A

• Are they clearly labeled?

  Safe

  At Risk

  N/A

• Is there a fire extinguisher within 25'?

  Safe

  At Risk

  N/A

First Aid Kits / Postings

• Is there a first aid kit on site?

  Safe

  At Risk

  N/A

• Are there any expired items in the kit?

  Safe

  At Risk

  N/A

• Are the OSHA posters posted so that employees can see them?

  Safe

  At Risk

  N/A

Fork Lift

• Is the operator trained and have a training card on their person?

  Safe

  At Risk

  N/A

• Is the operator using the seatbelt?

  Safe

  At Risk

  N/A

• Are there any distractions such as talking on the phone or a radio on board?

  Safe

  At Risk

  N/A

• Is the operator using a safe travel path and obeying speed limits?

  Safe

  At Risk

  N/A

Excavations and Trenching

• Has the person been trained to be working in an excavation?

  Safe

  At Risk

  N/A

• Has the area been surveyed by OUPS or a private locator?

  Safe

  At Risk

  N/A

• Does the excavation need any safety shoring, benching or sloping?

  Safe

  At Risk

  N/A

• Is there egress within 25' of employees?

  Yes

  No

  N/A

• Is the trench or excavation red barricaded off and maintained?

  Safe

  At Risk

  N/A

Ladders

• Have the ladders been inspected and maintained?

  Safe

  At Risk

  N/A

• Are the ladders being used properly?

  Safe

  At Risk

  N/A

• Is the extension ladder secure 3' above the working surface?

  Safe

  At Risk

  N/A

• Are the stickers legible? (duty rating and safety)

  Yes

  No

  N/A

• Are tools being stored on top of the ladder?

  Safe

  At Risk

  N/A

• Is the set up of the ladder on a stable surface and clear of debris underneath?

  Safe

  At Risk

  N/A

Fall Protection

• Is fall protection being used at heights of 6' and greater?

  Safe

  At Risk

  N/A

• Are fall protection harnesses being properly worn?

  Safe

  At Risk

  N/A

• Are the proper lanyards being used, I.e retractable or 6 foot lanyard?

  Yes

  No

  N/A

• Has the fall protection been inspected?

  Safe

  At Risk

  N/A

• Are floor holes covered and clearly marked?

  Safe

  At Risk

  N/A

• Has the employee had fall protection training?

  Safe

  At Risk

  N/A

• Fall Protection properly stored when not in use?

  Safe

  At Risk

  N/A

Lock Out Tag Out

• Has the employee been trained to perform LOTO?

  Safe

  At Risk

  N/A

• Are employees aware of energy sources involved?

  Safe

  At Risk

  N/A

• Has the proper keys been placed in the master lockbox??

  Safe

  At Risk

  N/A

• Are all affected employee's personal locks on lock box?

  Safe

  At Risk

  N/A

Personnel Lifts (Scissors and Boom)

• Has the employee been trained to operate a lift and have a training card on their person?

  Safe

  At Risk

  N/A

• Has a daily lift inspection checklist been filled out?

  Safe

  At Risk

  N/A

• Is the area safe to be operating a lift? (uneven surfaces, leading edges, debris)

  Safe

  At Risk

  N/A

Fire Protection

• Is there a fire extinguisher present in the job site office trailer and material trailer?

  Safe

  At Risk

  N/A

• Has the monthly inspection been conducted and documented?

  Safe

  At Risk

  N/A

• Has the annual inspection and or service been performed and documented?

  Safe

  At Risk

  N/A

Temp power Boxes

• Has an inspection been done on condition of power boxes?

  Safe

  At Risk

  N/A

• Is there any cord damage? ( If so have the cord taken out of service)

  Safe

  At Risk

  N/A

• Are all open breakers covered with blanks?

  Safe

  At Risk

  N/A

• Are temp power boxes labeled ?

  Safe

  At Risk

  N/A

Assured Grounding

• Are all company power tools clearly marked with the proper color code (1st quarter White, 2nd quarter Green, 3rd quarter Red, 4th quarter Orange)

  Safe

  At Risk

  N/A

PPE

• Are the employees wearing Z87 safety glasses?

  Safe

  At Risk

  N/A

• Are the employees wearing a hard hat?

  Safe

  At Risk

  N/A

• Are the employees wear the right glove for the job?

  Safe

  At Risk

  N/A

• Are the employees wearing a Hi-Vis vest?

  Safe

  At Risk

  N/A

Comments:

• Supervisor's Signature Acknowledgment of Audit Findings

  Sign