INGLETT & STUBBS SAFETY AUDIT

• Audit Title

• Jobsite

• Conducted on

  Date

• Prepared by

GENERAL INSPECTION

• Is there a current copy of the Inglett & Stubbs Safety Program on site?

  Yes

  No

  N/A

• Is there a current copy of the Inglett & Stubbs SDS book on site?

  Yes

  No

  N/A

• Is the SDS book being updated properly with new safety data sheets when adding new products to the jobsite?

  Yes

  No

  N/A

• Is there a Hazard Communication Program on site?

  Yes

  No

  N/A

• Is Physician's Panel posted?

  Yes

  No

  N/A

• Is the back signed and dated by all employees on site?

  Yes

  No

  N/A

• Are Emergency phone numbers posted along with the evacuation route?

  Yes

  No

  N/A

• Is there an Emergency Contact Form for every employee on site?

  Yes

  No

  N/A

• Has every employee signed the site specific job rules?

  Yes

  No

  N/A

• Are new hire re-orientations being done and documented?

  Yes

  No

  N/A

• Are I&S Weekly Jobsite Inspections being done?

  Yes

  No

  N/A

• Where any deficiencies found?

  Subject

• Who completed the last inspection?

  Name

• When was the last inspection done?

  Date

• Tool Box Meetings being done?

  Yes

  No

  N/A

• What safety subject did the meeting cover?

  Subject

• When was last meeting done?

  Date

• Is there a fire extinguisher on site?

  Yes

  No

  N/A

• Are fire extinguishers in proper working order?

  Yes

  No

  N/A

• Are Ground-Fault Circuit Interrupters (GFCI) Inspections being done?

  Yes

  No

  N/A

• Is there a completed log present?

  Yes

  No

  N/A

• When was last inspection done?

  Date

• Are fall protection equipment logs being kept on site for inspections?

  Yes

  No

  N/A

• What equipment is being inspected?

  Name

• Who inspected the equipment?

  Name

• When was the last inspection completed?

  Date

• Are inspections of PPE being done and logged?

  Yes

  No

  N/A

• Does someone on site have a current CPR / First Aid Training?

  Yes

  No

  N/A

• Who?

  Name

• First Aid Kit on site?

  Yes

  No

  N/A

LOCKOUT / TAGOUT

• Lockout/Tagout forms being kept?

  Yes

  No

  N/A

• Are all keys secured at all times?

  Yes

  No

  N/A

• Are I&S policies being followed?

  Yes

  No

  N/A

• What date was the last form written?

  Date

• Is program being worked properly? (If active lockout/tagout being done......trace on form to where it's locked out)

  Yes

  No

  N/A

HOUSEKEEPING

• Is drinking water available?

  Safe

  At Risk

  N/A

• If coolers are used, is it sealed, labeled I&S and dated?

  Safe

  At Risk

  N/A

• Is there a trash can available near cooler?

  Safe

  At Risk

  N/A

• Add media

  Media

• Is there a toilet facility available?

  Safe

  At Risk

  N/A

• Add media

  Media

• Is there a wash station available?

  Safe

  At Risk

  N/A

• Add media

  Media

• Is the jobsite free of trash and debris?

  Safe

  At Risk

  N/A

• Add media

  Media

• Are walkways and passageways clear?

  Safe

  At Risk

  N/A

• Add media

  Media

SITE SECURITY

• Work areas properly signed and barricaded?

  Safe

  At Risk

  N/A

• Add media

  Media

• Site fencing up and in good shape?

  Safe

  At Risk

  N/A

• Add media

  Media

• Are any openings unprotected?

  Safe

  At Risk

  N/A

• Add media

  Media

• Are any drop offs unprotected? Perimeter protection in place?

  Safe

  At Risk

  N/A

• Add media

  Media

• Rebar or any other impalement hazard protected?

  Safe

  At Risk

  N/A

• Add media

  Media

• Any struck by exposed?

  Safe

  At Risk

  N/A

• Add media

  Media

• Projected nails bent over or removed?

  Safe

  At Risk

  N/A

• Add media

  Media

• Is there adequate lighting and the proper amount of temporary lighting fixtures being used?

  Safe

  At Risk

  N/A

• Add media

  Media

PERSONAL PROTECTIVE EQUIPMENT (PPE)

• Hard hats being worn?

  Safe

  At Risk

  N/A

• Safety glasses being worn?

  Safe

  At Risk

  N/A

• Clear safety glasses being used inside?

  Safe

  At Risk

  N/A

• Safety gloves being worn at all times?

  Safe

  At Risk

  N/A

• Is hearing protection being utilized when needed?

  Safe

  At Risk

  N/A

• Are respirators (including N95) needed?

  Safe

  At Risk

  N/A

• What hazard is present?

  Name

• Has the employee been trained on the hazard?

  Yes

  No

  N/A

• Is there a hazard abatement program on site noting the hazard?

  Yes

  No

  N/A

• If needed, is the proper respirator being used?

  Safe

  At Risk

  N/A

• If needed, have all employees been fit tested? Ensure medical questionnaire has been filled out and retained in employee's file.

  Safe

  At Risk

  N/A

• Is the current level of PPE on site appropriate for work being done?

  Safe

  At Risk

  N/A

• Are employees properly trained on PPE that is currently on site? (I.e. harness, lanyard, respirator, etc)

  Safe

  At Risk

  N/A

• Add media

  Media

FALL PROTECTION

• Is there adequate fall protection and tied off (above 6 feet)?

  Yes

  No

  N/A

• Add media

  Media

• Any employee operating a lift has certification on their person at all times and has been properly trained?

  Safe

  At Risk

  N/A

• Add media

  Media

• Safety rails and cables are secured properly?

  Safe

  At Risk

  N/A

• Add media

  Media

• Employees below protected from falling objects?

  Safe

  At Risk

  N/A

• In a high traffic area, are barricades and/or spotters being utilized?

  Safe

  At Risk

  N/A

• Add media

  Media

• Are flights of stairs with 4 or more risers equipped with standard stair railings or handrails?

  Safe

  At Risk

  N/A

• Add media

  Media

• Is there a fall protection rescue plan in place

  Safe

  At Risk

  N/A

• Details of fall protection rescue plan:

• Add media

  Media

ELECTRICAL SAFETY

• No exposed electrical wires?

  Safe

  At Risk

  N/A

• Add media

  Media

• No cracked or broken receptacle covers?

  Safe

  At Risk

  N/A

• Add media

  Media

• Are ground-fault circuits interrupters installed on each temporary 15 or 20 ampere, 120 volt AC circuit?

  Safe

  At Risk

  N/A

• Add media

  Media

• No broken or bent ground prongs on plugs?

  Safe

  At Risk

  N/A

• Add media

  Media

• No broken insulation on cords?

  Safe

  At Risk

  N/A

• Add media

  Media

• Outlet covers and switch covers in place?

  Safe

  At Risk

  N/A

• Add media

  Media

• Power tools do not have broken or cracked casings?

  Safe

  At Risk

  N/A

• Add media

  Media

• Breaker panels have covers and breakers are labeled?

  Safe

  At Risk

  N/A

• Add media

  Media

• All temporary fixtures with proper guarding in place?

  Safe

  At Risk

  N/A

• Add media

  Media

• Are all cords heavy duty / construction grade?

  Safe

  At Risk

  N/A

• Add media

  Media

• Are all cord-connected, electrically operated tools and equipment effectively grounded or of the approved double insulated type?

  Safe

  At Risk

  N/A

• Add media

  Media

ELECTRICAL ROOMS & PANELS

• Electrical rooms locked?

  Safe

  At Risk

  N/A

• Add media

  Media

• Electrical panels locked and secured?

  Safe

  At Risk

  N/A

• Add media

  Media

• Any exposure within the panel?

  Safe

  At Risk

  N/A

• Add media

  Media

• Are all cabinets, panels and switches located in wet locations enclosed in weather proof enclosures?

  Safe

  At Risk

  N/A

• Add media

  Media

• Is there adequate lighting?

  Safe

  At Risk

  N/A

• Add media

  Media

LADDERS

• Are the proper stickers / labels on the ladder?

  Safe

  At Risk

  N/A

• Add media

  Media

• Are ladders extended 36" above top of landing?

  Safe

  At Risk

  N/A

• Add media

  Media

• Ladders secured to prevent slipping, sliding, or falling?

  Safe

  At Risk

  N/A

• Add media

  Media

• Ladders inspected and in good condition?

  Yes

  No

  N/A

• Add media

  Media

• No painted ladders?

  Safe

  At Risk

  N/A

• Add media

  Media

• Employees not standing on top two steps of the stepladder?

  Safe

  At Risk

  N/A

• Add media

  Media

• Stepladders are only used in the open position?

  Safe

  At Risk

  N/A

• Add media

  Media

MATERIAL HANDLING

• Materials are properly stored or stacked? Shrink wrapped or taped if needed

  Safe

  At Risk

  N/A

• Add media

  Media

• Materials are stored away from floor openings or the sides of the building?

  Safe

  At Risk

  N/A

• Add media

  Media

• Employees are using the proper lifting methods?

  Safe

  At Risk

  N/A

• Add media

  Media

• Tag lines are used to guide loads?

  Safe

  At Risk

  N/A

• Add media

  Media

TRENCHING AND EXCAVATION

• Proper supervision, including competent person on site? Current certification available for competent person?

  Safe

  At Risk

  N/A

• Is the I&S Excavation Daily Checklist being done?

  Safe

  At Risk

  N/A

• Add media

  Media

• Excavations over 4' in depth are shored or sloped back depending on soil class?

  Safe

  At Risk

  N/A

• Add media

  Media

• All soil considered as type "C" soil?

  Safe

  At Risk

  N/A

• Spill pile stored away from edge a minimum of 2 feet?

  Safe

  At Risk

  N/A

• Add media

  Media

• Equipment kept away from the edge?

  Safe

  At Risk

  N/A

• Add media

  Media

• Ladder or ramp available every 25 ft if trench is 4 feet or more deep?

  Safe

  At Risk

  N/A

• Add media

  Media

• For excavations deeper than 4 feet does ladder extend over the side 4 feet?

  Safe

  At Risk

  N/A

• Add media

  Media

• Is the excavation 20 feet or more?

  Safe

  At Risk

  N/A

• Add media

  Media

• Are employees exposed to vehicle traffic wearing high visibility vests?

  Safe

  At Risk

  N/A

• Add media

  Media

CRANES & RIGGING

• Compliant to I&S policy and to new crane standard?

  Safe

  At Risk

  N/A

• Rigger/Flagger properly trained with current certification?

  Safe

  At Risk

  N/A

• Proper PPE worn?

  Safe

  At Risk

  N/A

• Add media

  Media

• Equipment firmly supported?

  Safe

  At Risk

  N/A

• Add media

  Media

• Outriggers are extended and swing radius?

  Safe

  At Risk

  N/A

• Add media

  Media

• Inspection and maintenance log for crane maintained?

  Safe

  At Risk

  N/A

• Add media

  Media

• Chokers, chains, slings, and shackles inspected?

  Safe

  At Risk

  N/A

• Add media

  Media

EQUIPMENT

• Operator qualified and tested?

  Safe

  At Risk

  N/A

• Daily inspection made and logged?

  Yes

  No

  N/A

• Certification current and on person?

  Safe

  At Risk

  N/A

• Seat belt worn?

  Safe

  At Risk

  N/A

• Backup alarm working?

  Safe

  At Risk

  N/A

• Fire extinguisher present with gas fueled?

  Safe

  At Risk

  N/A

• Add media

  Media

OTHER OBSERVATIONS NOT NOTED ABOVE

• Add media

  Media

CORRECTIVE ACTIONS

• Add media

  Media

JOBSITE FOREMAN SIGNATURE

• Add signature

  Sign

SAFETY INSPECTION DONE BY

• Add signature

  Sign

DATE

• Select date

  Date