HS-154

• Audit Title

• Document No.

• Client / Site

• Conducted on

  Date

• Prepared by

• Location
  Address

• Personnel

Administration

• Is the Safety/Environmental Worksheet on site and accessible to all associates?

  Yes

  No

  N/A

• Does the Safety/Environmental Worksheet accurately reflect site conditions and tasks?

  Yes

  No

  N/A

• Have all the associates, temporary workers, subcontractors signed the S/E Worksheet?

  Yes

  No

  N/A

• Are the Following documents posted in a prominent and accessible area?<br> "Commitment to Health and Safety"<br> Jobsite Safety Rules (GSP's)<br> Labor Law Posters (Federal and State)

  Yes

  No

  N/A

• Is documentation of maintenance and calibration of air monitoring equipment available?<br> Bump Tests and Monthly Calibrations

  Yes

  No

  N/A

• Have all the associates met applicable medical surveillance requirements?<br> Hearing Conservation, Hazwoper, asbestos, heavy metals, radiation

  Yes

  No

  N/A

• Have all jobsite personnel fulfilled "Respirator Readiness" requirements?<br> Fit Testing, Training, medical clearence

  Yes

  No

  N/A

• Have jobsite personnel received all required training?<br> New Hire, Recertification, Customer-Specific, Water Blasting, Wet/Dry Vacuuming

  Yes

  No

  N/A

• Are JSA's for each current activity available?

  Yes

  No

  N/A

• Have the crew members signed the JSA?

  Yes

  No

  N/A

• Are Daily Toolbox Safety Meetings begin held and documented?

  Yes

  No

  N/A

Environmental Factors

• Are all work areas adequately illuminated?

  Yes

  No

  N/A

• Are adequate replenishment fluids available to prevent heat stress?

  Yes

  No

  N/A

• Are workers provided adequate breaks to prevent heat stress?

  Yes

  No

  N/A

• Are workers provided breaks in a warm environment to prevent cold stress?

  Yes

  No

  N/A

• Is hearing protection provided when noise levels exceed 90 decibels?

  Yes

  No

  N/A

Hazard Communication

• Have potential hazards been described to the associates on site?

  Yes

  No

  N/A

• Are MSDS's for each hazardous chemical on site and available for review

  Yes

  No

  N/A

• Do associates understand the effects of exposure from chemicals on site?

  Yes

  No

  N/A

• Are all containers properly labeled as to the content, hazard and route of entry?<br> NFPA Labeling, HMIS Labeling

  Yes

  No

  N/A

Power Source & Electrical Equipment

• Is electrical equipment and wiring properly guarded and maintained in good condition?

  Yes

  No

  N/A

• Are extension cords kept out of wet areas?

  Yes

  No

  N/A

• Are GFCI's being used for all 110Volt outlets?

  Yes

  No

  N/A

• Are extension cords inspected daily for abrasions, burns, exposed wires and stress relief?<br> Quarterly Color Code Inspection

  Yes

  No

  N/A

• Are extension cords kept out of walkways (elevated over 7ft or buried)

  Yes

  No

  N/A

Hand & Power Tools

• Are defective hand and power tools tagged and taken out of service?

  Yes

  No

  N/A

• Is eye protection available and used when operating power tools?<br> Face Shield for Bench Grinders

  Yes

  No

  N/A

• Are guards and safety devices in place and on power tools?<br> Tool Rests on Bench Grinders

  Yes

  No

  N/A

• Are power tools inspected before each use?

  Yes

  No

  N/A

• Are non-sparking tools available when required?<br> Concealed drop lead lights when in some Permit Required Confined Spaces

  Yes

  No

  N/A

Personal/Respiratory Protective Equipment

• Has the task-specific PPE/RPE been selected and being worn?

  Yes

  No

  N/A

• Have PPE selection decision been communicated to the associates?<br> WTSR, JSA's, SOP's, Daily Toolbox Safety Meetings

  Yes

  No

  N/A

• Does the PPE selected fit the associate properly?

  Yes

  No

  N/A

• Does the minimum protection in the work area include leather steel-toed boots, safety glasses, hard hats, bump caps, work uniform?

  Yes

  No

  N/A

• Are adequate supplies of PPE readily available?

  Yes

  No

  N/A

• Is PPE/RPE inspected prior to use?

  Yes

  No

  N/A

• Are respirators being cleaned and maintained properly?

  Yes

  No

  N/A

• Are respirators being used properly?

  Yes

  No

  N/A

• Are respirators being stored properly?

  Yes

  No

  N/A

• Does the breathing air meet the CGA Grade "D" minimum?

  Yes

  No

  N/A

First Aid and Hygiene

• Are first aid supplies available and in adequate quantities?

  Yes

  No

  N/A

• Is an emergency eye wash available and accessible when exposure to splashed liquids or airborne particles are possible?

  Yes

  No

  N/A

• Is an emergency shower available and accessible when corrosive materials are handled?

  Yes

  No

  N/A

• Is smoking, eating, drinking and chewing prohibited in the work area?

  Yes

  No

  N/A

• Is adequate hand washing facilities vailable?

  Yes

  No

  N/A

• Are adequate toilet facilities available?

  Yes

  No

  N/A

Fire Protection and Emergency Response

• Is the Emergency Action Plan (EAP) current and posted?<br> Have local authorities been indentified?<br> Have emergency escape routes been identified?<br> Have emergency evacuation drills been held/conducted?<br> Are associates familiar with the warning signals?

  Yes

  No

  N/A

• Are Fire Extinguishers available and adequate?

  Yes

  No

  N/A

• Are Fire Extinguishers Posted? Is there a sign visible from all areas of the trailer?

  Yes

  No

  N/A

• Is access to the fire extinguishers unobstructed?

  Yes

  No

  N/A

• Are job-site associates currently trained in the use of fire extinguishers?

  Yes

  No

  N/A

• Have Fire Extinguishers been inspected by a qualified person annually?

  Yes

  No

  N/A

• Have Fire Extinguishers been inspected by a competent person monthly?

  Yes

  No

  N/A

• Are flammable liquids stored in metal containers equipped with flame arrestors and spring-loaded caps?

  Yes

  No

  N/A

• Are all flammable liquids kept inside buildings stored in proper containers and cabinets?

  Yes

  No

  N/A

• Is smoking prohibited in flammable storage areas? Is there a "No Smoking" sign posted?

  Yes

  No

  N/A

Walking Working Surfaces

• Are work areas neat and orderly?

  Yes

  No

  N/A

• Are stairs, ramps and ladders clear of ice, mud, grease or debris?

  Yes

  No

  N/A

• Are Floor holes (1"-12") covered/guarded?<br> Are the covers secured in-place?<br> Are they labeled "Hole Cover"?

  Yes

  No

  N/A

• Are Type I (Industrial Duty Grade) ladders utilized?

  Yes

  No

  N/A

• Are Ladders properly used?<br> Are they Inspected prior to use?<br> Are the cross braces secured and locked?<br> Are they setup properly (4:1)(Up:Out), tied-off and extended 3ft above the landing?<br> Are the safety feet in place?<br> No metal ladders?

  Yes

  No

  N/A

• Are we using Scaffolding that has been inspected and tagged accordingly?

  Yes

  No

  N/A

• Are Aerial Work Platforms (AWP's), JLG's and/or scissor lifts inspected pre-shift?<br> Are the operators properly trained?

  Yes

  No

  N/A

Decontamination

• Is contaminated clothing/PPE removed properly?<br> Donning and Doffing?

  Yes

  No

  N/A

• Is reusable PPE cleaned and stored properly?

  Yes

  No

  N/A

• Are vehicle/equipment decontaminated prior to leaving the job-site?

  Yes

  No

  N/A

Material Handling

• Are Power Industrial Trucks (PIT's) operator properly trained?<br> An Authorized Operator?

  Yes

  No

  N/A

• Is 60lbs or equal the maximum weight to be lifted by any one associate?

  Yes

  No

  N/A

• Are associates following proper lift technics?

  Yes

  No

  N/A

• Are door and body props or bracing used when performing maintenance on equipment?

  Yes

  No

  N/A

• Are all slings (chains, cables, synthetic, come-a-longs) inspected and free of defects?<br> Are they rated for the intended use?<br> Are the tags lediglbe?

  Yes

  No

  N/A

• Are all cranes and hoisting devices inspected daily and certified anually?

  Yes

  No

  N/A

Vehicles & Equipment

• Are all vehicles inspected daily?<br> Pre-Trip?<br> Post-Trip?

  Yes

  No

  N/A

• Are all personnel licensed for the equipment they are operating?<br> Authorized Operator?<br> Certified Operator?

  Yes

  No

  N/A

• Are spotters being utilized for backing up operations?

  Yes

  No

  N/A

• Are backup alarms installed on equipment?

  Yes

  No

  N/A

• Are loads properly secured?

  Yes

  No

  N/A

• Are operators utilizing the seatbelt?

  Yes

  No

  N/A

• Is safety equipment in the vehicles?<br> Fire Extinguisher?<br> Wheel Chocks?<br> Roadside Triangles/flares?<br> First Aid Box?

  Yes

  No

  N/A

Warning/Signaling Devices

• Are vehicles equipped with back up alarms?

  Yes

  No

  N/A

• Is work area barricaded to restrict access by non-essential associates?

  Yes

  No

  N/A

• Are appropriate hazard warning signs posted?<br> "Danger Water Blasting"<br> "Caution Load Noise"

  Yes

  No

  N/A

Containers

• Are all compressed gas cylinders stored and secured upright?

  Yes

  No

  N/A

• Are cylinder caps in place prior to being moved?

  Yes

  No

  N/A

• Is fuel gas and oxygen compressed gas cylinders stored a minimum of 20ft apart?

  Yes

  No

  N/A

• Are proper procedures followed when stacking or storing 55/45/35 gallon drums?

  Yes

  No

  N/A

• Is a Spill Kit readily available and identified?

  Yes

  No

  N/A

Hazardous Work

• Are MPW Confined Space Permits completed and retained on file for the current and past year?

  Yes

  No

  N/A

• Has the Environmental/Safety Checklist been completed for the confined space?

  Yes

  No

  N/A

• Has a pre-entry confined space entry briefing been held and signed by the associates?

  Yes

  No

  N/A

• Has the confined space permit been completed correctly?

  Yes

  No

  N/A

• Has a rescue plan been established and confirmed on the permit?

  Yes

  No

  N/A

• Have all energy sources been LO/TO properly?

  Yes

  No

  N/A

• Have all the energy sources been verified as de-engergized and de-pressurized?

  Yes

  No

  N/A

• Are the GSP's being followed?

  Yes

  No

  N/A

• Is a "Safety Tee" in place on all vacuum operations?

  Yes

  No

  N/A

• Is the Vacuuming truck grounded?

  Yes

  No

  N/A

• Are devices to allow the remote handling of the vacuum hoses being used?

  Yes

  No

  N/A

• Has the water blast hose been inspected prior to use and marked accordingly to the quarterly color code?

  Yes

  No

  N/A

• Are water jet lances marked at least 24in from the end of the nozzle?

  Yes

  No

  N/A

• Are water blast guns correctly piped and are the connections tight?

  Yes

  No

  N/A

• Are water blast guns at least 42in long?

  Yes

  No

  N/A

• Is a starter rod used to prevent line-mole reversal?

  Yes

  No

  N/A

Professional Appearence

• Are all associates in accordance to the No Facial Hair expectation?

  Yes

  No

  N/A

• Are all associates in accordance to the No Jewlery expectation?

  Yes

  No

  N/A

• Are all associates in accordance to the No Rolled Up Sleeves expectation?

  Yes

  No

  N/A

• Are all associates in accordance to Leather Style Steel Toe work boots expectation?

  Yes

  No

  N/A

• Are work stations in accordance to Neat and Tidy expectations?

  Yes

  No

  N/A

• Comments

• Auditor signature

  Sign