IX Audit 1.0.2

• Job Name

• Client / Site

• Prepared by

• Personnel

• Conducted on

  Date
• Location
  Address

Fall Protection

• Fall Protection

• Details:

• Picture(s):

  Media

• Fall protection present at 6' or above?

  YES

  NO

  N/A

• Rescue plan present and reviewed?

  YES

  NO

  N/A

• Yes

  No

  N/A

• Guardrails at 42"/21" +/- 3"?

  YES

  NO

  N/A

• Have users been trained and documented in fall protection?

  YES

  NO

  N/A

• Has fall protection equipment been inspected prior to use? (Safety Harness, SRL, Anchor Points)

  YES

  NO

  N/A

• Are floor and wall openings protected, covered, and marked? Are covers adequate, secured, and labelled?

  YES

  NO

  N/A

• Is protection present for changes in elevation?

  YES

  NO

  N/A

Ladders/Stairs

• Ladders/Stairs

• Details:

• Picture(s):

  Media

• Is ladder free of defects?

  YES

  NO

  N/A

• Is ladder being used properly?

  YES

  NO

  N/A

• Is ladder secured?

  YES

  NO

  N/A

• Is extension ladder used on a 4:1 pitch?

  YES

  NO

  N/A

• Does ladder extend 3' or more above landing?

  YES

  NO

  N/A

• Is ladder a safe work distance from hazard?

  YES

  NO

  N/A

• Have slip/trip exposures on ladder been eliminated?

  YES

  NO

  N/A

• Are access/egress areas free of debris/materials?

  YES

  NO

  N/A

Excavations

• Excavations

• Add media

  Media

• One-Call System used?

  YES

  NO

  N/A

• Surface traffic exposure?

  YES

  NO

  N/A

• Are daily inspections documented?

  YES

  NO

  N/A

• Are excavations > 20' engineered?

  YES

  NO

  N/A

• If water entering excavation, is it adequately controlled?

  YES

  NO

  N/A

• Is excavation >5' deep properly sloped, benched or shored?

  YES

  NO

  N/A

• Is a ladder present in excavation over 4' deep and withing 25' of workers?

  YES

  NO

  N/A

• Spoils >2' from edge?

  YES

  NO

  N/A

• Surface encumbrances present within 2' off edge?

  YES

  NO

  N/A

• Perimeter properly protected?

  YES

  NO

  N/A

Confined Space

• Confined Space

• Add media

  Media

• Are atmospheric conditions being monitored?

  YES

  NO

  N/A

• Is Permit required?

  Yes

  No

• Are secured/sinage posted?

  YES

  NO

  N/A

• Are rescue plans, emergency numbers, map readily available?

  YES

  NO

  N/A

• Is training documentation readily available?

  YES

  NO

  N/A

• Are regular periodic inspections, including monitoring, taking place?

  Yes

  No

  N/A

• Is ventilation adequate?

  Yes

  No

  N/A

• Is harness and extraction equipment inspected and in proper working condition?

  YES

  NO

  N/A

• Are electrical and/or fire hazards present?

  Yes

  No

• Is respiratory equipment in proper working condition?

  YES

  NO

  N/A

• Is entry supervisor/monitor present and properly trained?

  YES

  NO

  N/A

Motorized Equipment

• Motorized Equipment

• Add media

  Media

• Is operator working safely?

  YES

  NO

  N/A

• Is machine operating at least 10' away from overhead power lines?

  Yes

  No

  N/A

• Is proper operator protection in place (ROPS, Cage, Screen, etc.)?

  YES

  NO

  N/A

• Are seat belts being used?

  YES

  NO

  N/A

• Does backup alarm function properly?

  Yes

  No

  N/A

• Is fire extinguisher present with current inspection?

  YES

  NO

  N/A

• Is flag man required/present?

  YES

  NO

  N/A

• Is glass free of obstructions?

  YES

  NO

  N/A

• Does horn function properly?

  YES

  NO

  N/A

• Is weekly equipment inspection form completed?

  YES

  NO

  N/A

Electrical

• Electrical

• Add media

  Media

• Is electrical equipment properly grounded?

  YES

  NO

  N/A

• Are GFCI's being utilized?

  YES

  NO

  N/A

• Are appropriate cords being used and in good condition? (3-wire/12 gauge type cords-no exposed wires, cuts in rubber-ground pin)

  YES

  NO

  N/A

• Are cords protected from traffic?

  YES

  NO

  N/A

• Are energized parts and equipment protected?

  YES

  NO

  N/A

• Are LOTO procedures in use?

  YES

  NO

  N/A

• Is signage present warning of electrocution hazards? (Where applicable)

  YES

  NO

  N/A

Hand & Power Tools

• Hand & Power Tools

• Add media

  Media

• Proper tool for the job?

  YES

  NO

  N/A

• Tool in good condition? Ground prong in place? GFCI's in use?

  YES

  NO

  N/A

• Anti-whip attached to pressurized lines?

  YES

  NO

  N/A

• Auto shut-off/ safety switches operational?

  YES

  NO

  N/A

• Strain relief functioning properly?

  YES

  NO

  N/A

• Proper PPE? (Face shield, chaps, gloves, etc.)

  YES

  NO

  N/A

Manual Material Handling

• Manual Material Handling

• Add media

  Media

• Proper lifting technique? (Lifting in "power zone", no twisting, no over reaching)

  YES

  NO

  N/A

• No manual lift over 50 lbs

  YES

  NO

  N/A

• Lifts over 50 lbs get aid or assistance

  Yes

  No

  N/A

• Use of mechanical aid? (if applicable)

  Yes

  No

  N/A

• Clear and planned path?

  YES

  NO

  N/A

PPE

• Add media

  Media

• Hard hats

  YES

  NO

  N/A

• Safety glasses (goggles where applicable)

  YES

  NO

  N/A

• Face shields

  YES

  NO

  N/A

• Hearing protection

  YES

  NO

  N/A

• Respiratory Protection

  YES

  NO

  N/A

• Appropriate clothing for the task (hi-vis, chaps, fire retardant, etc.)

  YES

  NO

  N/A

• Gloves

  Yes

  No

  N/A

• Work boots

  YES

  NO

  N/A

• Visitor PPE available?

  YES

  NO

  N/A

Fire Protection

• Fire Protection

• Add media

  Media

• Extinguishers charged and inspections current?

  YES

  NO

  N/A

• Extinguishers at least 25' from fuel station, not more than 75'?

  YES

  NO

  N/A

• Temporary fuel station properly protected (sings, barricades, ground pin, locks, etc)?

  YES

  NO

  N/A

• Flammables stored properly (vented, labelled, containers 20' away from other unlike flammables)?

  YES

  NO

  N/A

• Flammables stored away from structures?

  YES

  NO

  N/A

• Clear access for emergency vehicles, hydrants?

  YES

  NO

  N/A

Housekeeping

• Housekeeping

• Add media

  Media

• Is trailer access/egress hazard free?

  YES

  NO

  N/A

• Are sanitary facilities available, adequate, and clean?

  YES

  NO

  N/A

• Is an adequate supply of drinking water available?

  YES

  NO

  N/A

• Are slip, trip, and fall hazards present in or around work areas?

  YES

  NO

  N/A

• Is material storage adequate and utilized properly?

  YES

  NO

  N/A

• Is trash collected in protected containers?

  YES

  NO

  N/A

Medical/Emergency

• Medical/Emergency

• Add media

  Media

• Is there an individual certified in first aid/CPR onsite?

  YES

  NO

  N/A

• Is there a first aid kit available onsite?

  YES

  NO

  N/A

• Is eyewash available?

  YES

  NO

  N/A

• Are emergency/safety team/hotline numbers posted?

  YES

  NO

  N/A

• Is a map to medical facility available/posted?

  YES

  NO

  N/A

• Is a map to medical facility available/posted?

  YES

  NO

  N/A

HAZCOM

• HAZCOM

• Add media

  Media

• Are employees trained?

  YES

  NO

  N/A

• Site Specific SDS available?

  YES

  NO

  N/A

• Copy of program readily available?

  YES

  NO

  N/A

• Containers properly labelled and inventory listed?

  YES

  NO

  N/A

Environmental

• Environmental

• Add media

  Media

• Are airborne contaminants properly controlled/eliminated?

  YES

  NO

  N/A

• Is HazMat storage, use, and disposal adequate/appropriate?

  YES

  NO

  N/A

• Is spill containment adequate/appropriate?

  YES

  NO

  N/A

• Is concrete cut wet and/or vacuumed?

  YES

  NO

  N/A

• Is nuisance dust controlled/eliminated?

  YES

  NO

  N/A

Site/Public Protection

• Site/Public Protection

• Add media

  Media

• Are excavations properly protected?

  YES

  NO

  N/A

• Is falling object/overhead protection in place?

  YES

  NO

  N/A

• Are perimeter fences installed?

  YES

  NO

  N/A

• Is impalement protection in place? (Re-bar caps)

  YES

  NO

  N/A

• Are barricades installed properly?

  YES

  NO

  N/A

• Is adequate lighting available?

  YES

  NO

  N/A

• Is public protection signage necessary/present?

  YES

  NO

  N/A

• Is traffic control plan in place?

  YES

  NO

  N/A

• Is street closure properly identified?

  YES

  NO

  N/A

Administration

• Administration

• Add media

  Media

• Is a properly trained supervisor on site?

  YES

  NO

  N/A

• OSHA posters posted?

  YES

  NO

  N/A

• State/Fed. posters posted in English/Spanish?

  YES

  NO

  N/A

• Is an IX safety manual readily available?

  YES

  NO

  N/A

• Is trench box tabulated data readily available?

  YES

  NO

  N/A

• Have IX orientations been conducted/completed?

  YES

  NO

  N/A

• Has a JSA been submitted for each trade/task?

  YES

  NO

  N/A

• Are changing conditions being noted on JSA and communicated as needed?

  YES

  NO

  N/A

• Are Pre-con meetings documented?

  YES

  NO

  N/A

• Is there documentation of corrective actions taken since last audit?

  YES

  NO

  N/A

• Are toolbox talks being conducted and recorded weekly?

  YES

  NO

  N/A

• Silica Plan displayed in trailer?

  YES

  NO

  N/A

Welding/Cutting

• Welding/Cutting

• Add media

  Media

• Fire extinguisher present; properly charged, inspected?

  YES

  NO

  N/A

• Is welding flash protection available?

  YES

  NO

  N/A

• Are flash arresters present?

  YES

  NO

  N/A

• Are cylinders 20' apart or separated by burn barrier?

  Yes

  No

  N/A

• Are gauges working and adjusted properly?

  YES

  NO

  N/A

• Is burn permit in use and properly filled out?

  YES

  NO

  N/A

• Are cylinders upright, capped, and properly secured?

  YES

  NO

  N/A

• Are torch hoses in good condition?

  YES

  NO

  N/A

• Is proper PPE in use (FR clothing, gloves, burning shield, safety glasses)?

  YES

  NO

  N/A

• Is welding machine properly ventilated?

  Yes

  No

  N/A

• Are welding leads in good condition?

  YES

  NO

  N/A

Aerial Lifts

• Aerial Lifts?

• Add media

  Media

• Annual inspection current?

  YES

  NO

  N/A

• Are operator training records readily available including fall protection training?

  YES

  NO

  N/A

• Are PFAS (Personal Fall Arrest Systems) in use during operation?

  Yes

  No

  N/A

• Is gate or chain secured?

  YES

  NO

  N/A

• Is lift operating on stable surface?

  YES

  NO

  N/A

• Is operating surface free of holes, sudden changes in elevation?

  YES

  NO

  N/A

• Are safe work distances addressed and maintained?

  YES

  NO

  N/A

• Is equipment loaded properly (not to exceed manufacturers weight limit including operator, tools, and equipment)?

  YES

  NO

  N/A

Cranes & Hoisting Equipment

• Cranes & Hoisting Equipment?

• Add media

  Media

• Annual inspection current?

  YES

  NO

  N/A

• Are daily inspections performed and current?

  YES

  NO

  N/A

• Are operator, signaler/rigger training records readily accessible?

  YES

  NO

  N/A

• Is crane properly supported and level?

  YES

  NO

  N/A

• Are safe work distances from power lines being adhered to?

  YES

  NO

  N/A

• Fire extinguisher present; properly charged, inspected?

  YES

  NO

  N/A

• Is a lift plan, operator certs, and evaluation readily available?

  YES

  NO

  N/A

• Is the proper load chart posted?

  YES

  NO

  N/A

• Are outriggers properly extended, supported, cribbed?

  YES

  NO

  N/A

• Are loads properly rigged by a trained, qualified rigger?

  YES

  NO

  N/A

• Has the weight of the load been verified?

  YES

  NO

  N/A

• Has rigging been properly rated and inspected?

  YES

  NO

  N/A

• Are safety latches present and being used?

  YES

  NO

  N/A

• Has swing radius been properly barricaded?

  YES

  NO

  N/A

• Are tag lines being used properly?

  YES

  NO

  N/A

• Are effective means of communication in use?

  YES

  NO

  N/A

• Is boom angle indicator in place and working properly?

  YES

  NO

  N/A

• Is operator's manual present in crane?

  YES

  NO

  N/A

• Rigging?

• Add media

  Media

• Are loads properly rigged by a trained, qualified rigger?

  YES

  NO

  N/A

• Has rigging been properly rated and inspected?

  YES

  NO

  N/A

• Are safety latches present and being used?

  YES

  NO

  N/A

• Are tag lines being used properly?

  YES

  NO

  N/A

Scaffolds

• Scaffolds?

• Add media

  Media

• Are scaffolds inspected daily and documented?

  YES

  NO

  N/A

• Are scaffold user training records readily available?

  YES

  NO

  N/A

• Are all appropriate guard rails in place?

  YES

  NO

  N/A

• Are all wheels locked?

  YES

  NO

  N/A

• Are compatible components used?

  YES

  NO

  N/A

• Are outriggers necessary and installed properly?

  YES

  NO

  N/A

• Are bracing and pins placed properly?

  YES

  NO

  N/A

• Is scaffold properly secured to structure?

  YES

  NO

  N/A

• Is proper access to platforms present?

  YES

  NO

  N/A

• Is scaffold properly guyed at 4:1 height to base ratio?

  YES

  NO

  N/A

• Are materials being loaded properly?

  YES

  NO

  N/A

• Have safe work distances been addressed and maintained?

  YES

  NO

  N/A

• Are sills, plates, and jacks properly installed?

  YES

  NO

  N/A

• Is work surface in safe condition?

  YES

  NO

  N/A

Safety Equipment/Supplies

• Tripod

• Winch

• 4 Gas Meter

• SRL(s)

• Beam Clamp(s)

• Life Lines

• Misc.

Conclusion

• I agree to address and abate the above issues prior to

  Date

• Name

• Signature

  Sign